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pantoprazole

(pan toe' pray zol)


Pantoloc (CAN), Protonix, Protonix IV

Pregnancy Category B

Drug classes
Antisecretory agent
Proton pump inhibitor

Therapeutic actions
Gastric acid-pump inhibitor: Suppresses gastric acid secretion by specific inhibition of
the hydrogen-potassium ATPase enzyme system at the secretory surface of the gastric
parietal cells; blocks the final step of acid production.

Indications
• Oral: Short-term (< 8 wk) and long-term treatment of GERD (gastric esophageal
reflux disease)
• IV: Short-term (7–10 days) treatment of GERD in patients unable to continue oral
therapy
• Treatment of pathological hypersecretory conditions associated with Zollinger-
Ellison syndrome and other neoplastic conditions
• Unlabeled uses: Treatment of peptic ulcer

Contraindications and cautions


• Contraindicated with hypersensitivity to any proton pump inhibitor or any drug
components.
• Use cautiously with pregnancy, lactation.

Available forms
DR tablet—20, 40 mg; powder for injection—40 mg/vial

Dosages
ADULTS
40 mg PO daily to bid for < 8 wk for erosive esophagitis. 8-wk course may be repeated if
healing has not occurred; 40 mg/day IV for 7–10 days. Up to 240 mg/day PO or IV has
been used for hypersecretory syndromes.
PEDIATRIC PATIENTS < 18 YR
Safety and efficacy not established.
PATIENTS WITH HEPATIC IMPAIRMENT
Use caution and monitor patient closely.

Pharmacokinetics
Route Onset Peak
Oral 1 hr 3–5 hr
IV Rapid 3–5 hr
Metabolism: Hepatic; T1/2: 1.5 hr
Distribution: Crosses placenta; may enter breast milk
Excretion: Urine and bile

IV facts
Preparation: Reconstitute with 10 mL 0.9% sodium chloride; may then be further
diluted with 100 mL 5% dextrose injection, 0.9% sodium chloride injection or lactated
Ringer's, final concentration 0.4 mg/mL; reconstituted solution can be stored 2 hr,
dilution up to 12 hr at room temperature.
Infusion: Infuse over at least 15 min using in-line filter.
Incompatibilities: Do not mix with or administer through the same line as other IV
solutions.

Adverse effects
• CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety,
paresthesias, dream abnormalities
• Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin
• GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue
atrophy
• Respiratory: URI symptoms, cough, epistaxis
• Other: Cancer in preclinical studies, back pain, fever

Interactions
Drug-drug
• Fewer drug interactions reported than with other proton pump inhibitors

Nursing considerations
Assessment
• History: Hypersensitivity to any proton pump inhibitor or any drug components;
pregnancy; lactation
• Physical: Skin lesions; T; reflexes, affect; urinary output, abdominal exam;
respiratory auscultation

Interventions
• Administer once or twice a day. Caution patient to swallow tablets whole; not to
cut, chew, or crush them.
• Arrange for further evaluation of patient after 4 wk of therapy for gastroreflux
disorders. Symptomatic improvement does not rule out gastric cancer; gastric
cancer did occur in preclinical studies.
• Maintain supportive treatment as appropriate for underlying problem.
• Switch patients on IV therapy to oral dosage as soon as possible.
• Provide additional comfort measures to alleviate discomfort from GI effects and
headache.

Teaching points
• Take the drug once or twice a day. Swallow the tablets whole—do not chew, cut,
or crush them.
• Arrange to have regular medical follow-up while you are using this drug.
• Maintain all of the usual activities and restrictions that apply to your condition. If
this becomes difficult, consult with your nurse or physician.
• These side effects may occur: Dizziness (avoid driving a car or performing
hazardous tasks); headache (consult with your nurse if these become bothersome,
medications may be available to help); nausea, vomiting, diarrhea (proper
nutrition is important, consult with your dietitian to maintain nutrition; ensure
ready access to bathroom facilities); symptoms of URI, cough (it may help to
know that this is a drug effect, do not self-medicate, consult with your nurse or
physician if this becomes uncomfortable).
• Report severe headache, worsening of symptoms, fever, chills, blurred vision,
periorbital pain.

Adverse effects in Italic are most common; those in Bold are life-threatening.