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

DrugLRMCTVRHTotal
Pantoprazole 80 mg Drip Utilization8424581,300
Total Costs
($6.02, 3.01 per 40 mg inj median Price)
5,0602,7537,813
Savings2,5261,3743,900
Report of annualized dispenses of 80 mg in 100 mL drip with savings

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

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.