Toward Reducing the Use of IV Protonix
QI Project by Zhaneta Dzmitryieva, MD and James Jewell, MD
Protonix (Pantoprazole) is a proton pump inhibitor which reduces gastric acid secretion and increases gastric mucus and bicarbonate production, creating protective coating of gastric mucosa.
It can be used IV or PO.
Indications for Protonix use:Upper GI bleeding;Prevention of re-bleeding in peptic ulcer bleed;Hypersecretory disorders (including Zollinger-Ellison);Erosive esophagitis associated with GERD;H. pylori eradication;Stress ulcer prophylaxis in the intensive care unit
Indications for IV Protonix use: Prevention of re-bleeding (which requires 80 mg of IV Protonix); In pts who are unable to take Protonix PO;Stress ulcer prophylaxis is indicated for any critically ill patient who has one or more of the following risk factors: 1. Mechanically ventilated for more than 48 hours. 2.Coagulopathy (platelet count less than 50,000 per m3, INR more than 1.5 or partial thromboplastin time (PTT) more than 2 times of control value)3.GI ulceration or bleeding within the past year 4.Traumatic brain injury 5.Traumatic spinal cord injury 6.Severe burns
It has been noted within our system that IV Protonix is frequently used for GI prophylaxis and/or bleeding by our medical staff when in some cases oral Protonix may be adequate and more cost effective.
We reviewed several studies on gastric acid suppression showing that Pantoprazole taken orally produced acid suppression sufficient for pts with complicated acid-peptic disease at considerably less cost than IV Pantoprazole.
Efficacy studies are also available.
Reference: Douglas Bair, Cindy James, David Armstrong (McMaster University, Hamilton, ON)