protium

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.