Episode 25: Pantoprazole Continuous infusion vs Intermittent Bolus Formulary Nugget by Oscar Santalo

Situation

• Situation
  • Pantoprazole 80 mg in NS 100 mL drip is being used for GI Bleeds due to ulcers
  • Problem:
    • Evidence not being clear on optimal dosing strategy
  • Opportunity to:
    • Standardize dosing strategies for upper and lower GI bleeds
    • Follow best practice strategies

Background

• Dosing Strategies for GI Bleeds
• Bleeding ulcer: Note: For clinically significant upper GI bleeding prior to endoscopy. Optimal IV dosing regimen has not been established;
• IV: Intermittent dosing:
  • Loading dose of 80 mg, followed by 40 mg every 12 hours
• IV: Continuous infusion:
  • Loading dose of 80 mg, followed by 8 mg/hour infusion

Assessment

Recommendation

• Remove 80 mg in NS 100 mL order product
• Pursue intermittent strategy
  • Loading dose of 80 mg, followed by 40 mg every 12 hours
• Increase medication access in Pyxis
• Can be prepared on the unit

References

• Br J Clin Pharmacol. 2010;69(3):245-251. doi: 10.1111/j.1365-2125.2009.03575
• J Med Assoc Thai. 2012;95(3):349-357
• ANZ J Surg. 2007;77(8):677-681. doi: 10.1111/j.1445-2197.2007.04185
• Ann Intern Med. 2010;152(2):101-113. doi: 10.7326/0003-4819-152-2-201001190-00009
• Ann Intern Med, 2009, 150(7):455-64.
• JAMA Intern Med. 2014 Nov;174(11):1755-62. doi: 10.1001/jamainternmed.2014.4056.
• Adv Biomed Res. 2017 Sep 21;6:120. doi: 10.4103/abr.abr_59_16
• Gut Liver. 2019 Jan 15;13(1):40-47. doi: 10.5009/gnl18222

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