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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

PANTOPRAZOLE

Indication

  • Management of erosive esophagitis associated with gastroesophageal reflux disease (GERD)

Pharmacology

  • Pantoprazole suppresses gastric acid secretion in the parietal cells through inhibition of the H+/K+ ATPase pump. It is therefore referred to as a proton pump inhibitor (PPI)
  • Pantoprazole is metabolized in the liver by the following cytochrome P450 enzymes (CYP 450) : CYP2C19 (major), as well as by CYP3A4, CYP2C9 and CYP2D6 (all minor)
  • Approximately 70% of a dose is eliminated as inactive metabolites via the kidney; about 20% of the inactive metabolites are eliminated through the bile and feces

Side Effects

  • Generally well tolerated
  • GI: abdominal pain, cramps, bloating, constipation, diarrhea, vomiting
  • CV: hypertension, hypotension
  • Dermatologic: urticaria, prutitus
  • Hematologic: thrombocytopenia, leucopenia, leukocytosis, anemia
  • IV: thrombophlebitis, abscess
  • Endocrine: hyperglycemia, hyperlipidemia

Drug Interactions

  • Fluconazole: may increase the serum concentrations of PPIs (manage by monitoring therapy)
  • Ferrous sulfate: the absorption of may be decreased because gastric acid secretion is inhibited by pantoprazole

Dose

  • Little information is available to provide a dose for neonates. Our best extrapolation from infants and older children suggests the following dose :
  • 0.5 - 1 mg/kg daily IV

Administration

  • Administer as a slow, IV infusion over 15 to 20 minutes

Supplied

  • 1 mg/mL syringe for slow IV administration
    • This is an extemporaneous product which is specially prepared by the Department of Pharmacy

References

  1. Ferron, G. M., S. Schexnayder, J. D. Marshall, J. Blumer, A. Rodarte, M. W. Abell, B. Mako, P. Fraga, J. Getsy, and J. Paul. "Pharmacokinetics of IV Pantoprazole in Pediatric Patients." American Society for Clinical Pharmacology and Therapeutics 73 (2003): P37-37
  2. Lexi-Comp Online. Lexi-Comp, Inc. Retrieved November 12, 2009, from http://online.lexi.com
  3. Pantoprazole Sodium for Injection ® Product Monograph June 2007 (Rev 2009), Sandoz Canada Inc
  4. Pettersen, Géraldine, Mohamad-Samer Mouksassi, Yves Théorêt, Line Labbé, Christophe Faure, Bao Nguyen, and Catherine Litalien. "Population pharmacokinetics of intravenous pantoprazole in paediatric intensive care patients." British Journal of Clinical Pharmacology 67.2 (2009): 216-27
  5. Phelps SJ, Hak EB, Crill CM. Pediatric Injectable Drugs, 8th Edition, American Society of Health-System Pharmacists, 2007

Prepared by : Janica Chan, BScPhm (Dec 2009)
Revised by : David Knoppert, MScPhm (Dec 2009)
Reviewed by : Dr H Roukema (Dec 2009)




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