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Pantoprazole (Monograph)

Brand name: Protonix
Drug class: Proton-pump Inhibitors
- Antiulcer Agents
- Gastric Antisecretory Agents
- Acid-pump Inhibitors
VA class: GA900
Chemical name: 5-(Difluoromethoxy)-2-[[(3,4-dimethoxy-2-pyridinyl)methyl]sulfinyl]-1H-benzimidazole
CAS number: 164579-32-2

Medically reviewed by Drugs.com on Feb 22, 2024. Written by ASHP.

Warning

A standardized concentration for this drug has been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care. The drug is included in a standard concentration list which may apply to an IV or oral compounded liquid formulation. For additional information, see the ASHP website [Web].

Introduction

Acid- or proton-pump inhibitor; gastric antisecretory agent.1 2 3 4 5 6 7 8 10

Uses for Pantoprazole

Gastroesophageal Reflux (GERD)

Orally for short-term treatment of erosive esophagitis in patients with GERD.1

Orally to maintain healing and decrease recurrence of erosive esophagitis.1

IV for up to 7–10 days in the treatment of GERD in patients with a history of erosive esophagitis.10 Discontinue IV therapy as soon as patient is able to initiate or resume oral therapy with the drug.10

Pathologic GI Hypersecretory Conditions

Orally for long-term treatment of pathologic hypersecretory conditions, including Zollinger-Ellison syndrome.1

IV for up to 6 days in the treatment of pathologic hypersecretory conditions associated with Zollinger-Ellison syndrome or other neoplastic conditions.10

Duodenal Ulcer

Orally for treatment of duodenal ulcer† [off-label].2 3 5 6 8

Gastric Ulcer

Orally for treatment of gastric ulcer† [off-label].2 3 5 6 8

Crohn’s Disease-associated Ulcers

Some evidence for use of proton-pump inhibitors (e.g., omeprazole) for gastric acid suppressive therapy as an adjunct in the management of upper GI Crohn’s disease† [off-label], including esophageal, gastroduodenal, and jejunoileal disease.18 19 20 21 22 23 24

Pantoprazole Dosage and Administration

Administration

Administer orally or IV.1 10 Administer once daily for GERD.1 10 Generally given twice daily for pathologic GI hypersecretory conditions, although may be administered IV every 8 hours if necessary.1 10

Oral Administration

Delayed-release Tablets

Administer delayed-release tablets without regard to meals.1

Antacids may be used concomitantly.1

Swallow tablets whole; do not split, crush, or chew.1 May administer two 20-mg tablets if unable to swallow a 40-mg tablet.1

Delayed-release Oral Suspension

Do not divide the contents of a packet of delayed-release granules for oral suspension to prepare a dose that is smaller than the full labeled dose (e.g., do not use a 40-mg packet to prepare a 20-mg dose for a child who is unable to swallow the delayed-release tablets).1

Administer delayed-release oral suspension 30 minutes before a meal.1

Mix delayed-release granules for oral suspension with applesauce or apple juice; do not mix with any other foods or liquids (including water).1

Sprinkle the contents of a single-dose packet of pantoprazole sodium delayed-release granules for oral suspension onto 1 teaspoonful of applesauce and administer within 10 minutes of preparation.1 Follow with sips of water, repeated as necessary, to ensure complete delivery of the dose.1

Alternatively, sprinkle the packet contents into 5 mL of apple juice, stir for 5 seconds (granules will not dissolve), and swallow the resulting suspension immediately.1 Rinse the container once or twice with apple juice; swallow the rinsings immediately to ensure complete delivery of the dose.1

Swallow granules in the oral suspension intact; do not crush or chew the granules.1

NG Tube

May administer pantoprazole sodium delayed-release granules for oral suspension via a nasogastric or gastrostomy tube (16 French or larger).1

Remove the plunger from a 60-mL syringe and attach the catheter tip of the syringe to the NG or gastrostomy tube.1 Empty the contents of a single-dose packet of the granules into the syringe barrel while holding the syringe as high as possible to prevent bending of the tubing.1 Add 10 mL of apple juice to the syringe; gently tap or shake the syringe to facilitate emptying.1 Rinse the syringe and tubing with 10 mL of apple juice at least 2 more times (until no granules remain).1

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer through a dedicated IV line or a Y-site.10

Use of spiked IV system adapters may result in breakage of the glass vial, and currently is not recommended by the manufacturer.14 15 (See Glass Vial Breakage under Cautions.)

Administer as reconstituted solution or following further dilution.10

Reconstitution

Reconstitute vial containing 40 mg pantoprazole with 10 mL of 0.9% sodium chloride injection to provide a solution containing 4 mg/mL.10

Dilution

GERD: Dilute one vial of reconstituted solution containing pantoprazole 4 mg/mL with 100 mL of 5% dextrose injection, 0.9% sodium chloride injection, or lactated Ringer’s injection to produce a concentration of about 0.4 mg/mL.10

Pathologic hypersecretory conditions: Dilute 2 vials of reconstituted solution containing pantoprazole 4 mg/mL with 80 mL of 5% dextrose injection, 0.9% sodium chloride injection, or lactated Ringer’s injection to produce a concentration of 0.8 mg/mL.10

Rate of Administration

GERD: Administer 40-mg dose IV as the reconstituted (4 mg/mL) solution over not less than 2 minutes10 or as the 0.4-mg/mL dilution over about 15 minutes (7 mL/minute).10

Pathologic hypersecretory conditions: Administer 80-mg dose IV as the reconstituted (4 mg/mL) solution over not less than 2 minutes10 or as the 0.8-mg/mL dilution over about 15 minutes (7 mL/minute).10

Dosage

Available as pantoprazole sodium; dosage expressed in terms of pantoprazole.1 10

Pediatric Patients

GERD
Treatment of Erosive Esophagitis
Oral

Children ≥5 years of age: 20 mg once daily in those weighing 15 to <40 kg; 40 mg once daily in those weighing ≥40 kg.1 Continue for up to 8 weeks; safety beyond 8 weeks not established.1

Adults

GERD
IV

40 mg once daily for 7–10 days.10 Discontinue IV therapy when patient is able to initiate or resume oral therapy; safety and efficacy of IV therapy for >10 days not established.10

Treatment of Erosive Esophagitis
Oral

40 mg once daily for up to 8 weeks.1 2 If not healed, consider additional 8 weeks of therapy.1 2

Maintenance of Healing of Erosive Esophagitis
Oral

40 mg once daily.1 Not studied for >1 year of therapy.1 However, chronic, lifelong therapy with proton-pump inhibitor may be appropriate.12

Pathologic GI Hypersecretory Conditions (e.g., Zollinger-Ellison Syndrome)
Oral

40 mg twice daily.1 Adjust dosage according to patient response and tolerance; continue therapy as long as necessary.1 May require dosages of up to 240 mg daily.1 Patients with Zollinger-Ellison syndrome have been treated for >2 years.1

IV

80 mg every 12 hours.10 80 mg every 8 hours is expected to maintain acid output <10 mEq/hour in patients requiring higher dosage.10 Safety and efficacy of dosages exceeding 240 mg daily or use of IV pantoprazole for >6 days not established.10

Special Populations

Hepatic Impairment

No dosage adjustment necessary.1 2 3 4 10 Dosage exceeding 40 mg daily not studied in patients with hepatic impairment.1 10

Poor Metabolizers

Consider reduced dosage in pediatric patients who are poor metabolizers of CYP2C19 substrates.1

No dosage adjustment required in adults who are poor metabolizers of CYP2C19 substrates.1 10 (See Elimination: Special Populations, under Pharmacokinetics.)

Detailed Pantoprazole dosage information

Cautions for Pantoprazole

Contraindications

Warnings/Precautions

Sensitivity Reactions

Anaphylaxis

Anaphylaxis reported with IV pantoprazole.10 Immediately discontinue drug and institute appropriate medical intervention.10

Gastric Malignancy

Response to pantoprazole does not preclude presence of occult gastric neoplasm.1 10

Atrophic Gastritis

Atrophic gastritis reported occasionally with long-term pantoprazole use, especially in patients infected with Helicobacter pylori.1

Clostridium difficile Infection

Proton-pump inhibitors associated with possible increased (1.4–2.75 times) risk of Clostridium difficile infection, including C. difficile-associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis).335 336 339 340 Many patients also had other risk factors for CDAD.335 May be severe; colectomy and, rarely, death reported.335

Use the lowest effective dosage and shortest duration of therapy appropriate for the patient's clinical condition.335

Consider CDAD if persistent diarrhea develops and manage accordingly; initiate supportive therapy (e.g., fluid and electrolyte management), anti-infective therapy directed against C. difficile (e.g., metronidazole, vancomycin), and surgical evaluation as clinically indicated.335 336

Bone Fracture

Several observational studies suggest that use of proton-pump inhibitors, particularly in high dosages (i.e., multiple daily doses) and/or for prolonged periods of time (i.e., ≥1 year), may be associated with increased risk of osteoporosis-related fractures of the hip, wrist, or spine.1 27 300 301 302 303 304 305 Magnitude of risk is unclear;27 300 301 302 303 304 305 310 causality not established.305 FDA is continuing to evaluate this safety concern.305

Use the lowest effective dosage and shortest duration of therapy appropriate for the patient’s clinical condition.1 27 301 303 305 307

Individuals at risk for osteoporosis-related fractures should receive an adequate intake of calcium and vitamin D; assess and manage these patients’ bone health according to current standards of care.1 27 303 305 307

Hypomagnesemia

Hypomagnesemia, symptomatic and asymptomatic, reported rarely in patients receiving long-term therapy (≥3 months or, in most cases, >1 year) with proton-pump inhibitors, including pantoprazole.1 317 318 319 320 321 322 323 324 325 326 327 328 329 330 Serious adverse effects include tetany, seizures, tremors, carpopedal spasm, arrhythmias (e.g., atrial fibrillation, supraventricular tachycardia), and abnormal QT interval.1 318 319 321 322 323 325 327 328 329 Paresthesia, muscle weakness, muscle cramps, lethargy, fatigue, and unsteadiness may occur.319 320 321 325 330 Most patients required magnesium replacement and discontinuance of the proton-pump inhibitor.1 317 319 321 322 323 324 325 326 327 330 Hypomagnesemia resolved within 1 week (median) following discontinuance and recurred within 2 weeks (median) of rechallenge.327

In patients expected to receive long-term proton-pump inhibitor therapy or in patients currently receiving digoxin or drugs that may cause hypomagnesemia (e.g., diuretics), consider measuring serum magnesium concentrations prior to initiation of prescription proton-pump inhibitor therapy and periodically thereafter.1 319 326 327 328 330

Cyanocobalamin Malabsorption

Deficiency due to malabsorption from prolonged (e.g., >3 years) gastric acid suppression reported rarely.1 Consider possibility if manifestations of cyanocobalamin deficiency occur.1

Injection Site Reactions

Injection site reactions (e.g., thrombophlebitis, abscess) associated with use of IV pantoprazole.10

Edetate Disodium Content

Pantoprazole sodium for injection contains edetate disodium (disodium EDTA), a potent metal ion (e.g., zinc) chelator.10 Consider zinc supplementation in patients prone to zinc deficiency.10 Use caution with other IV products that contain edetate disodium.10

Respiratory Effects

Administration of proton-pump inhibitors has been associated with an increased risk for developing certain infections (e.g., community-acquired pneumonia).25 26

Glass Vial Breakage

Breakage of pantoprazole vials reported during attempts to connect the vials to spiked IV system adapters.14 15 Potential safety issue for health-care professionals attempting to connect these system components manually or with mechanical assistance.14 15 Pantoprazole manufacturer does not recommend use of spiked IV system adapters; if such adapters are used, contact manufacturer of the adapter for assistance.14

Specific Populations

Pregnancy

Category B.1 10

Lactation

Distributed into milk.1 10 Discontinue nursing or the drug because of potential risk in nursing infants.1 10

Pediatric Use

Safety and efficacy of oral pantoprazole for short-term treatment of erosive esophagitis associated with GERD established in pediatric patients 1–16 years of age.1 However, oral pantoprazole is labeled for use only in children ≥5 years of age because an appropriate dosage formulation is not available for children <5 years of age.1 Common adverse effects in pediatric patients include upper respiratory tract infection, headache, fever, diarrhea, vomiting, rash, and abdominal pain.1

Efficacy of oral pantoprazole not established in infants <1 year of age.1 Pantoprazole was not more effective than placebo in a treatment-withdrawal study in infants 1–11 months of age with symptomatic GERD.1

Safety and efficacy of IV pantoprazole not established in pediatric patients.10

Geriatric Use

No substantial differences in safety and efficacy relative to younger adults.1 10

Common Adverse Effects

Oral: Headache,1 diarrhea,1 abdominal pain,1 vomiting,1 flatulence,1 dizziness,1 arthralgia.1

IV: Abdominal pain,10 headache,10 injection site reaction (e.g., thrombophlebitis, abscess),10 constipation,10 dyspepsia,10 nausea,10 diarrhea,10 insomnia,10 dizziness,10 rhinitis.10

Drug Interactions

Extensively metabolized, principally by CYP2C19 and to a minor extent by CYP3A4, 2D6, and 2C9.1 10

Drugs that Cause Hypomagnesemia

Potential pharmacologic interaction (possible increased risk of hypomagnesemia).327 Consider monitoring magnesium concentrations prior to initiation of prescription proton-pump inhibitor therapy and periodically thereafter.1 327 (See Hypomagnesemia under Cautions.)

Specific Drugs and Laboratory Tests

Drug or Test

Interaction

Comments

Alcohol

Pharmacokinetic interaction unlikely1 10

Amoxicillin

Pharmacokinetic interaction unlikely1 10

Antacids

No clinically important effects on oral pantoprazole absorption1

May be used concomitantly1

Antipyrine

Pharmacokinetic interaction unlikely1 10

Atazanavir

Possible altered oral absorption of atazanavir, resulting in decreased plasma atazanavir concentrations; possible loss of virologic response or development of drug resistance1 10 30

Manufacturer of pantoprazole states that concomitant administration with atazanavir is not recommended1 10

Antiretroviral treatment-naive patients: If a proton-pump inhibitor is used concomitantly with atazanavir, administer ritonavir-boosted atazanavir (atazanavir 300 mg and ritonavir 100 mg once daily with food); administer the proton-pump inhibitor approximately 12 hours before ritonavir-boosted atazanavir29 30

For treatment-naive patients, dosage of proton-pump inhibitor should not exceed omeprazole 20 mg daily (or equivalent)29 30

Antiretroviral treatment-experienced patients: Concomitant use of proton-pump inhibitors with atazanavir not recommended29 30

Caffeine

Pharmacokinetic interaction unlikely1 10

Carbamazepine

Pharmacokinetic interaction unlikely1 10

Cisapride

Pharmacokinetic interaction unlikely1 10

Clarithromycin

Pharmacokinetic interaction unlikely1 10

Clopidogrel

Certain CYP2C19 inhibitors (e.g., omeprazole, esomeprazole) reduce exposure to clopidogrel’s active metabolite and decrease platelet inhibitory effects; potentially may reduce clopidogrel’s clinical efficacy35 224 225 228 311 350

Dexlansoprazole, lansoprazole, or pantoprazole had less effect on clopidogrel's antiplatelet activity than did omeprazole or esomeprazole224 350 351

Pantoprazole decreased exposure to the metabolite by about 14%;1 10 351 observed effects on metabolite exposure and clopidogrel-induced platelet inhibition not considered clinically important1 10 351

Manufacturer of pantoprazole states clopidogrel dosage adjustment not required if used with recommended pantoprazole dosages1 10

Assess risks and benefits of concomitant proton-pump inhibitor and clopidogrel use in individual patients237 240 243 248 250

American College of Cardiology Foundation/American College of Gastroenterology/American Heart Association (ACCF/ACG/AHA) states that GI bleeding risk reduction with concomitant proton-pump inhibitor in patients with risk factors for GI bleeding (e.g., advanced age; concomitant use of warfarin, corticosteroids, or NSAIAs; H. pylori infection) may outweigh potential reduction in cardiovascular efficacy of antiplatelet treatment associated with a drug-drug interaction.311 In patients without such risk factors, ACCF/ACG/AHA states that risk/benefit balance may favor use of antiplatelet therapy without a proton-pump inhibitor.311

If concomitant therapy with a proton-pump inhibitor and clopidogrel is deemed necessary, consider using an agent with little or no CYP2C19-inhibitory activity;35 36 46 224 230 350 alternatively, consider using a histamine H2-receptor antagonist (ranitidine, famotidine, nizatidine)35 36 230 but not cimetidine (also a potent CYP2C19 inhibitor)232 233

Diazepam

Pharmacokinetic interaction unlikely1 10

Diclofenac

Pharmacokinetic interaction unlikely1 10

Digoxin

Pharmacokinetic interaction unlikely1 10

Hypomagnesemia (e.g., resulting from long-term use of proton-pump inhibitors) sensitizes the myocardium to digoxin and, thus, may increase risk of digoxin-induced cardiotoxic effects327 331

Consider monitoring magnesium concentrations prior to initiation of prescription proton-pump inhibitor therapy and periodically thereafter1 327

Diuretics (i.e., loop or thiazide diuretics)

Possible increased risk of hypomagnesemia327

Consider monitoring magnesium concentrations prior to initiation of prescription proton-pump inhibitor therapy and periodically thereafter1 327

Fosamprenavir

Use of esomeprazole with fosamprenavir (with or without ritonavir) did not substantially affect concentrations of amprenavir (active metabolite of fosamprenavir)345

No dosage adjustment required when proton-pump inhibitors used concomitantly with fosamprenavir (with or without ritonavir)29 345

Gastric pH-dependent drugs (e.g., ampicillin esters, iron salts, ketoconazole)

Pantoprazole may alter drug absorption1 10

Glyburide

Pharmacokinetic interaction unlikely1 10

Lopinavir

Lopinavir/ritonavir: Omeprazole had no clinically important effect on plasma concentrations or AUC of lopinavir29 344

No dosage adjustment required when proton-pump inhibitors used with lopinavir/ritonavir29

Methotrexate

Possible delayed clearance and increased serum concentrations of methotrexate and/or its metabolite hydroxymethotrexate; possible methotrexate toxicity1 10 333 334

Reported mainly with high-dose methotrexate (300 mg/m2 to 12 g/m2),1 10 333 but also reported with low dosages (e.g., 15 mg per week)333

Manufacturer of pantoprazole recommends considering temporary discontinuance of proton-pump inhibitor therapy in some patients receiving high-dose methotrexate1 10

Some clinicians recommend withholding the proton-pump inhibitor for several days before and after administration of either high-dose or low-dose methotrexate or, alternatively, substituting a histamine H2-receptor antagonist for the proton-pump inhibitor333 334

Metoprolol

Pharmacokinetic interaction unlikely1 10

Metronidazole

Pharmacokinetic interaction unlikely1 10

Midazolam

Pharmacokinetic interaction unlikely1 10

Naproxen

Pharmacokinetic interaction unlikely1 10

Nelfinavir

Omeprazole decreased peak plasma concentrations and AUCs of nelfinavir and its major active metabolite47 347

Concomitant use of nelfinavir with proton-pump inhibitors not recommended1 10

Nifedipine

Pharmacokinetic interaction unlikely1 10

Oral contraceptives (e.g., levonorgestrel/ethinyl estradiol)

Pharmacokinetic interaction unlikely1 10

Phenytoin

Pharmacokinetic interaction unlikely1 10

Piroxicam

Pharmacokinetic interaction unlikely1 10

Raltegravir

Omeprazole increased peak plasma concentration and AUC of raltegravir29 348

No dosage adjustment recommended when proton-pump inhibitors used with raltegravir29 348

Rilpivirine

Omeprazole decreased plasma concentrations and AUC of rilpivirine29 343

Concomitant use of rilpivirine and proton-pump inhibitors contraindicated29 343

Saquinavir

Ritonavir-boosted saquinavir: Omeprazole increased peak plasma concentration and AUC of saquinavir29 346

Caution advised if proton-pump inhibitor used with ritonavir-boosted saquinavir; monitor for saquinavir toxicity29 346

Sucralfate

Possible delayed proton-pump inhibitor absorption and decreased bioavailability17

Administer proton-pump inhibitor at least 30 minutes before sucralfate17

Tests for tetrahydrocannabinol (THC)

Possible false-positive results for urine screening tests for THC1 10

Use alternative confirmatory test for verification of positive results1 10

Theophylline

Pharmacokinetic interaction unlikely1 10

Warfarin

Potential increased INR and PT1 10 17

Monitor for INR and PT increases1 10 17
Pantoprazole drug interactions (more detail)

Pantoprazole Pharmacokinetics

Absorption

Bioavailability

Well absorbed from GI tract (absolute bioavailability about 77%).1 Peak plasma concentrations attained about 2.5 hours after single or multiple 40-mg oral doses (as delayed-release tablets).1 Time to peak concentration is similar (2–2.5 hours) for delayed-release suspension administered orally or via NG tube.1

Administration of delayed-release oral suspension (in apple juice) via NG tube is bioequivalent to oral administration of the same formulation (in applesauce or apple juice).1

AUC after single oral 40-mg dose about 39% higher in children 6–11 years of age and about 10% higher in adolescents 12–16 years of age compared with adults.1

Onset

51% mean inhibition of gastric acid secretion within 2.5 hours after a single 40-mg oral dose; 85% after daily administration for 7 days.1

15–30 minutes after single 20- to 120-mg IV infusion.10 About 96% suppression of pentagastrin-stimulated acid output within 2 hours after 80-mg IV infusion.10

Duration

Acid secretion normalized within one week after discontinuance of oral pantoprazole; no apparent rebound hypersecretion.1

24 hours after single IV infusion.10 Median percentage of time gastric pH ≥4 similar after 40 mg IV or orally daily for 5 days.10

Food

Food delays absorption of delayed-release tablets but does not affect extent or peak plasma concentrations.1

High-fat meal delays absorption of granules (sprinkled on applesauce); also decreases peak concentrations and AUC.1

Special Populations

Pharmacokinetics in patients with severe renal impairment similar to healthy individuals.1 10

Peak plasma concentrations and AUCs increased in patients with mild to severe hepatic impairment, but no more than in slow metabolizers.1 10 Minimal accumulation with once-daily dosing.1 10 (See Hepatic Impairment under Dosage and Administration.)

Distribution

Extent

Mainly extracellular.1 10 Prolonged binding to gastric parietal proton pump enzyme.1 10

Distributed into milk.1 10

Plasma Protein Binding

98%, principally albumin.1 10

Elimination

Metabolism

Metabolized in the liver, principally by CYP2C19, and to a lesser extent by CYP3A4.1 10 Metabolites appear to be inactive.1 10

Elimination Route

Excreted in urine (about 71%) and feces (18%); no unchanged drug excreted in urine.1 10

Half-life

1 hour.1 10

Special Populations

Hepatic impairment increased plasma half-life to 7–9 hours, but no more than in slow metabolizers, and minimal accumulation occurs.1 10

In adults with poor CYP2C19 metabolizer phenotype, metabolism is slower than in those with extensive (or rapid) metabolizer phenotype; elimination half-life is 3.5–10 hours, but minimal accumulation occurs with once-daily dosing.1 10

In pediatric patients, oral clearance in poor metabolizers (CYP2C19 *2/*2 genotype) is about tenfold lower than in extensive metabolizers (CYP2C19 *1/*1) and AUC is more than sixfold higher than in extensive or intermediate (CYP2C19 *1/*x) metabolizers.1 10

Not removed by hemodialysis.1 10

Stability

Storage

Oral

Delayed-release Tablets

20–25°C (may be exposed to 15–30°C).1

Granules for Delayed-release Suspension

20–25°C (may be exposed to 15–30°C).1

Parenteral

Powder for Injection

20–25°C (may be exposed to 15–30°C).10 Protect from light.10

Store reconstituted (4 mg/mL) solution at room temperature for up to 24 hours prior to administration as 4-mg/mL solution.10 If reconstituted solution will be further diluted, store reconstituted solution for up to 6 hours before dilution; then store diluted (0.4 or 0.8 mg/mL) solution at room temperature and use within 24 hours of initial reconstitution.10 Do not freeze reconstituted solution.10 Not necessary to protect reconstituted or diluted solution from light.10

Compatibility

Parenteral

Solution CompatibilityHID

Compatible

Dextrose 5% in water

Sodium chloride 0.9%
Drug Compatibility
Y-Site CompatibilityHID

Compatible

Ampicillin sodium

Anidulafungin

Cefazolin sodium

Ceftriaxone sodium

Dimenhydrinate

Dopamine HCl

Doripenem

Epinephrine HCl

Furosemide

Insulin, regular

Morphine sulfate

Nitroglycerin

Potassium chloride

Vasopressin

Incompatible

Dobutamine HCl

Esmolol HCl

Mannitol

Midazolam HCl

Multivitamins

Vancomycin HCl

Variable

Caspofungin acetate

Norepinephrine bitartrate

Octreotide acetate

Manufacturer states that pantoprazole sodium may be incompatible with zinc-containing preparations.10

Actions

Advice to Patients

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Pantoprazole Sodium

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

For suspension, delayed-release (containing enteric-coated granules)

40 mg (of pantoprazole) per packet

Protonix

Pfizer

Tablets, delayed-release (enteric-coated)

20 mg (of pantoprazole)*

Pantoprazole Sodium Delayed-release Tablets

Protonix

Pfizer

40 mg (of pantoprazole)*

Pantoprazole Sodium Delayed-release Tablets

Protonix

Pfizer

Parenteral

For injection, for IV infusion

40 mg (of pantoprazole)

Protonix I.V.

Pfizer

AHFS DI Essentials™. © Copyright 2024, Selected Revisions March 3, 2022. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

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15. Food and Drug Administration. Protonix IV (pantoprazole sodium) injection [September 24, 2004: Wyeth]. MedWatch. Rockville, MD; September 2004. From FDA website. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm155487.htm

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21. Bianchi G, Ardizzone S, Petrillo M et al. Omeprazole for peptic ulcer in Crohn’s disease. Am J Gastroenterol. 1991; 86: 245-6. http://www.ncbi.nlm.nih.gov/pubmed/1992643?dopt=AbstractPlus

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331. GlaxoSmithKline. Lanoxin (digoxin) tablets prescribing information. Research Triangle Park, NC; 2009 Aug.

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