Protonix
pantoprazole sodium
Pharmacologic class: Proton pump inhibitor
Therapeutic class: GI agent
Pregnancy risk category B
Action
Reduces gastric acid secretion and increases gastric mucus and bicarbonate production, creating protective coating on gastric mucosa
Availability
Granules (delayed-release oral suspension): 40 mg
Powder for injection (freeze-dried): 40 mg/vial
Tablets (delayed-release): 20 mg, 40 mg
Indications and dosages
➣ Erosive esophagitis caused by gastroesophageal reflux disease (GERD)
Adults: 40 mg I.V. daily for 7 to 10 days or 40 mg P.O. daily for 8 weeks. May repeat P.O. course for 8 additional weeks.
Children ages 5 and older weighing 40 kg (88 lb) or more: 40 mg P.O. daily for up to 8 weeks
Children ages 5 and older weighing 15 kg (33 lb) to less than 40 kg (88 lb): 20 mg P.O. daily for up to 8 weeks
➣ Erosive esophagitis
Adults: 40 mg P.O. daily
➣ Pathologic hypersecretory conditions
Adults: Initially, 40 mg P.O. b.i.d., increased as needed to maximum of 240 mg P.O. daily; some patients may need up to 2 years of therapy. Alternatively, 80 mg I.V. q 12 hours, to a maximum of 240 mg/day (80 mg q 8 hours).
Contraindications
• Hypersensitivity to drug or any substituted benzimidazole
Precautions
Use cautiously in:
• severe hepatic disease
• atrophic gastritis with long-term use
• increased risk of osteoporosis-related hip, wrist, or spine fractures with long-term use or multiple daily doses
• concurrent use of atazanavir, nelfi-navir, or methotrexate
• pregnant or breastfeeding patients
• children.
Administration
• Be aware that oral granules may be mixed with applesauce or apple juice and given 30 minutes before a meal. Once mixed, give drug within 10 minutes.
• Know that oral granules may be mixed with 10 ml apple juice and administered into nasogastric tube using 60-ml catheter-tip syringe. Rinse syringe with additional apple juice so that no granules remain in syringe.
• For I.V. administration, use in-line filter provided. If Y-site is used, place filter below Y-site closest to patient.
• Dilute I.V. form with 10 ml of normal saline solution; further dilute in dextrose 5% in water, normal saline solution, or lactated Ringer's solution, as directed. Give over 15 minutes at a rate no faster than 3 mg/minute.
• Don't give I.V. form with other I.V. solutions.
• Know that I.V. form is indicated for short-term treatment of GERD in patients with history of erosive esophagitis as alternative to P.O. therapy.
• Be aware that symptomatic response doesn't rule out gastric cancer.
Adverse reactions
CNS: dizziness, headache
CV: chest pain
EENT: rhinitis
GI: vomiting, diarrhea, abdominal pain, dyspepsia
Metabolic: hyperglycemia
Musculoskeletal: hip, wrist, spine fractures (with long-term daily use)
Skin: rash, pruritus
Other: injection site reaction
Interactions
Drug-drug. Ampicillin, cyanocobalamin, digoxin, iron salts, ketoconazole: delayed absorption of these drugs Atazanavir, nelfinavir: substantially decreased atazanavir or nelfinavir plasma concentration with loss of therapeutic effect and development of drug resistance
Clarithromycin, diazepam, flurazepam, phenytoin, triazolam: increased panto-prazole blood level
Sucralfate: delayed pantoprazole absorption
Warfarin: increased bleeding
Drug-diagnostic tests. Aspartate aminotransferase, glucose: increased levels
Tetrahydrocannabinol test: false-positive result
Patient monitoring
• Assess for symptomatic improvement.
• Monitor blood glucose level in diabetic patient.
Patient teaching
• Tell patient to swallow delayed-release tablets whole without crushing, chewing, or splitting.
• Tell patient he may take tablets with or without food.
• Explain that antacids don't affect drug absorption.
• Instruct diabetic patients to monitor blood glucose level carefully and stay alert for signs and symptoms of hyperglycemia.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
pantoprazole
(pan-toe-pra-zole) pantoprazole,Panto IV
(trade name),Pantoloc
(trade name),Protonix
(trade name),Protonix IV
(trade name),Tecta
(trade name)Classification
Therapeutic: antiulcer agentsPharmacologic: proton pump inhibitors
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (effect on acid secretion)
| ROUTE | ONSET† | PEAK | DURATION† |
|---|---|---|---|
| PO | 2.5 hr | unknown | 1 wk |
| IV | 15–30 min | 2 hr | unknown |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- headache
Gastrointestinal
- pseudomembranous colitis (life-threatening)
- abdominal pain
- diarrhea
- eructation
- flatulence
Endocrinologic
- hyperglycemia
Fluid and Electrolyte
- hypomagnesemia (especially if treatment duration ≥3 mo)
Musculoskeletal
- bone fracture
Interactions
Drug-Drug interaction
May ↓ absorption of drugs requiring acid pH, including ketoconazole, itraconazole, atazanavir, ampicillin esters, and iron salts.May ↑ risk of bleeding with warfarin (monitor INR/PT).Hypomagnesemia ↑ risk of digoxin toxicity.May ↑ methotrexate levelsRoute/Dosage
GERD
Gastric Hypersecretory Conditions
Availability (generic available)
Nursing implications
Nursing assessment
- Assess patient routinely for epigastric or abdominal pain and for frank or occult blood in stool, emesis, or gastric aspirate.
- Lab Test Considerations: May cause abnormal liver function tests, including ↑ AST, ALT, alkaline phosphatase, and bilirubin.
- May cause hypomagnesemia. Monitor serum magnesium prior to and periodically during therapy.
Potential Nursing Diagnoses
Acute pain (Indications)Implementation
- Do not confuse Protonix (pantoprazole) with Lotronex (alosetron) or protamine.
- Patients receiving pantoprazole IV should be converted to PO dosing as soon as possible.
- Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
- Oral: May be administered with or without food. Do not break, crush, or chew tablets.
- Antacids may be used concurrently.
Intravenous Administration
- Intravenous: Reconstitute each vial with 10 mL of 0.9% NaCl. Reconstituted solution is stable for 6 hr at room temperature.
- Diluent: Administer undiluted.Concentration: 4 mg/mL.
- Rate: Administer over at least 2 min.
- Intermittent Infusion: Diluent: Dilute further with D5W, 0.9% NaCl, or LR.Concentration: 0.4–0.8 mg/mL. Diluted solution is stable for 24 hr at room temperature.
- Rate: Administer over 15 min at a rate of <3 mg/min.
- Y-Site Compatibility: allopurinol, alprostadil, amifostine, aminocaproic acid, amikacin, aminophylline, amphotericin B lipid complex, amphotericin B liposome, ampicillin, amipcillin/sulbactam, anidulafungin, argatroban, azithromycin, bleomycin, bumetanide, carboplatin, carmustine, ceftaroline, ceftriaxone, cyclophosphamide, cytarabine, docetaxel, doripenem, doxorubicin liposome, doxycycline, ertapenem, fluorouracil, foscarnet, fosphenytoin, ganciclovir, granisetron, imipenem/cilastatin, irinotecan., mesna, methyldopate, paclitaxel, penicillin G sodium, pentazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, potassium chloride, procainamide, rifampin, succinylcholine, sufentanyl, telavancin, teniposide, theophylline, ticarcillin/clavulanate, tigecycline, tirofiban, vasopressin, zidovudine, zoledronic acid
- Y-Site Incompatibility: alemtuzumab, alfentanil, amphotericin B colloidal, atropine, aztreonam, buprenorphine, butorphanol, calcium acetate, calcium chloride, cefepime, cefoperazone, cefotaxime, cefotetan, chloramphenicol, chlorpromazine, ciprofloxacin, cisatracurium, cisplatin, dacarbazine, dactinomycin, dantrolene, daptomycin, daunorubicin hydrochloride, dexamethasone, dexmedetomidine, dexrazoxane, diazepam, diltiazem, diphenhydramine, dobutamine, dolasetron, doxorubicin hydrochloride, droperidol, ephedrine, epirubicin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, furosemide, gemcitabine, glycopyrrolate, haloperidol, heparin, hydralazine, hydromorphone, hydroxyzine, idarubicin, ifosfamide, insulin/regular, ketorolac, labetalol, leucovorin, levofloxacin, levorphanol, lidocaine, linezolid, lorazepam, mechlorethamine, melphalan, meperidine, meropenem, methotrexate, methylprednisolone, metoprolol, metronidazole, midazolam, milrinone, mitomycin, mitoxantrone, morphine, mycophenolate, nalbuphine, naloxone, nesiritide, nicardipine, norepinephrine, ondansetron, palonosetron, pancuronium, pemetrexed, pentamidine, phenytoin, potassium acetate, potassium phosphates, prochlorperazine, promethazine, propranolol, quinupristin/dalfopristin, ranitidine, remifentanil, rocuronium, sodium acetate, sodium phosphates, streptozocin, thiotepa, tolazoline, topotecan, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, solutions containing zinc
Patient/Family Teaching
- Instruct patient to take medication as directed for the full course of therapy, even if feeling better.
- Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation.
- Advise patient to report onset of black, tarry stools; diarrhea; or abdominal pain to health care professional promptly. Instruct patient to notify health care professional immediately if rash, diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care professional.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
- Advise female patients to notify health care professional if pregnancy is planned or suspected or if breast feeding.
Evaluation/Desired Outcomes
- Decrease in abdominal pain heartburn, gastric irritation and bleeding in patients with GERD; may require up to 4 wk of therapy.
- Healing in patients with erosive esophagitis. Therapy is continued for up to 8 wk.