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
| Drug | LRMC | TVRH | Total |
| Pantoprazole 80 mg Drip Utilization | 842 | 458 | 1,300 |
| Total Costs ($6.02, 3.01 per 40 mg inj median Price) | 5,060 | 2,753 | 7,813 |
| Savings | 2,526 | 1,374 | 3,900 |
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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