Pantoprazole Nursing Implications |Patient Teachings |Nursing Assessment & Interventions

Introduction

In this article, you’ll learn about pantoprazole nursing implications and patient teachings. Also, its dosage, indications, mechanism of action, interactions, and side effects.

Generic Name: Pantoprazole

Brand Names: Panto IV (CAN), Pantoloc (CAN), Protonix, Prontonix IV, Tecta (CAN)

Pantoprazole Class and Category

Pharmacologic class: Benzimidazole

Therapeutic class: Proton pump inhibitor (Antiulcer agent)

Pregnancy category: B

Pantoprazole Dosage

To treat erosive esophagitis associated with GERD

  • Adults: PO: 40mg, bid, for 8 – 16 weeks. Maintenance dose for healing: 40mg, OD.
  • Adults: IV: 40mg, OD, for 7– 10 days.
  • Children (5 years and above): PO: 20 mg, OD, up to 8 weeks, if weight is between 15– 40 kg; 40 mg OD, up to 8 weeks, if weight is 40 kg or more.

To treat hypersecretory conditions

  • Adults: PO: 40mg, bid. Maximum dose 240mg/day.
  • Adults: IV: 80mg, bid. Maximum dose 240mg/day.

Pantoprazole Pharmacokinetics and Pharmacodynamics

RouteOnsetPeakDuration
PO2.5 hrsUnknown1 week
IV15 – 30 mins2 hrs1 week
Pantoprazole pharmacokinetics & pharmacodynamics

Absorption: Pantoprazole is well absorbed from the GI tract.

Distribution: Protein binding is 98% and distributed mainly to extracellular fluid with a total distribution of 11- 23.6 L.

Metabolism: Hepatic.

Half-life: 1 hour.

Excretion: Around 71% is excreted via urine and 18% is eliminated through biliary excretion in the feces.

Pantoprazole Mechanism of Action

Pantoprazole inhibits the hydrogen/potassium adenosine triphosphate [(H+, K+)-ATPase] enzyme system on the secretory surface of the gastric parietal cell, which inhibits gastric secretion.

Pantoprazole is classified as a proton pump inhibitor (PPI) because it blocks gastric acid secretion at the end of the acid production process.

The therapeutic effects of pantoprazole include:

  • Increased gastric pH.
  • Decreased gastric acid production in hypersecretory conditions.
  • Reduced acid reflux
  • Promotes healing of esophagitis and duodenal ulcers.

What are the indications of Pantoprazole?

Pantoprazole indications include:

  • To treat erosive esophagitis
  • To treat gastroesophageal reflux disease (GERD)
  • To treat gastric hypersecretory conditions such as Zollinger-Ellison syndrome.

Off-label uses of pantoprazole

  • To treat peptic ulcers
  • To treat active ulcer bleeding
  • As an adjunct in the treatment of Helicobacter pylori
  • Stress ulcer prophylaxis in critically ill patients

What are the contraindications of Pantoprazole?

The contraindications of pantoprazole are:

  • Hypersensitivity to pantoprazole and its components or benzimidazole
  • Liver disease.
  • Osteoporosis or having a broken bone
  • Inadequate Vitamin B12
  • Hypomagnesemia
  • Zinc deficiency
  • Interstitial nephritis
  • Clostridium difficile-associated diarrhea (CDAD)
  • Lupus disease

Caution:

  • GI infections
  • Increased risk of fractures
  • Lon-term use increases the risk of vitamin B12 deficiency

What are the precautions for pantoprazole?

Precautions

  • Pregnancy
  • Lactation
  • Children
  • Proton pump hypersensitivity

Pantoprazole Interactions

  • Pantoprazole may increase bleeding risk, INR, and prothrombin time (PT) of people taking warfarin.
  • Pantoprazole reduces the effectiveness of clopidogrel.
  • Absorption of ketoconazole, iron salts, ampicillin, atazanavir, and erlotinib is decreased by Pantoprazole.
  • Pantoprazole increases methotrexate levels in the blood, increasing the risk of toxicity.
  • Pantoprazole reduces the effectiveness of antiretroviral drugs like atazanavir, nelfinavir, and rilpivirine. It also increases the risk of drug resistance.
  • Concomitant use of saquinavir may increase the risk of antiretroviral toxicity.
  • Hypomagnesemia increases the risk of digoxin toxicity.

Lab interactions

Pantoprazole may increase:

  • Serum creatinine
  • Cholesterol
  • Uric acid
  • Blood glucose
  • Lipoprotein
  • LFTs
  • Serum chromogranin A levels

Herbal/food interactions

St. John’s wort reduces the effectiveness of pantoprazole.

What are the Pantoprazole side effects?

Pantoprazole side effects/ adverse reactions include:

  • Abdominal pain
  • Nausea/ vomiting
  • Diarrhea/ constipation
  • Blurred vision
  • Headache
  • Dizziness   
  • Dry mouth
  • Insomnia
  • Malaise
  • Hyperglycemia
  • Changes in body weight
  • Taste disorder
  • Tinnitus
  • Hypomagnesemia
  • Hyponatremia
  • Myalgia
  • Acute interstitial nephritis
  • Vitamin B12 deficiency (with long-term use)
  • Factures (with long-term use)

Life-threatening adverse effects:

  • Clostridium difficile–associated diarrhea (CDAD)
  • Pancreatitis
  • Acute renal failure
  • Stevens-Johnson syndrome
  • Toxic epidermal necrolysis

Pantoprazole Nursing Implications [Nursing Considerations]

Pantoprazole nursing implications are divided into nursing assessment, interventions, and evaluation. 

Pantoprazolenursing assessment

  • Obtain medical history, including the previous history of fractures or osteoporosis, lupus disease, and current medications such as warfarin.
  • Assess the pain, including type, duration, characteristics, severity, and frequency. Ulcer pain is more common after meals and at night.
  • Obtain baseline LFTs, RFTs, serum magnesium levels, vitamin B12 levels, and blood glucose levels.

Pantoprazolenursing diagnosis

  • Acute pain (indication)
  • Impaired swallowing (indication)
  • Deficient knowledge

Pantoprazole nursing interventions/ actions

  • For patients who are unable to swallow tablets and capsules; administer pantoprazole delayed-release oral preparations 30 minutes before a meal with apple juice or applesauce only. Use apple juice for NG tube administration. Also,
    • Do not use other liquids, because appropriate pH is required for stability.
    • Administer within 10 minutes after mixing with applesauce and immediately after mixing with about 5ml of apple juice.
    • Note that granules will note dissolve in the juice.
    • Ensure that the full dose has been administered.
  • Monitor urine output during pantoprazole therapy. Because it can cause acute interstitial nephritis. Notify the doctor if the patient’s urine output decreases or if hematuria develops.
  • Monitor patient for signs of serious skin reactions such as fever, sore throat, fatigue, lesions in the mouth, and lips. Because pantoprazole therapy may cause severe reactions such as toxic epidermal necrolysis, Stevens-Johnson syndrome, and exfoliative dermatitis.
  • Monitor for bone fractures in patients who have been taking pantoprazole for more than a year. PPIs, such as pantoprazole, lead to an increased risk of osteoporosis-related fractures.
  • Monitor for CDAD. Patients receiving pantoprazole therapy are at risk of developing CDAD with or without antibiotics. Notify the doctor if severe diarrhea occurs.
  • Monitor serum magnesium and sodium as advised if the patient is on pantoprazole therapy for more than 3 months. Because pantoprazole may cause hypomagnesemia and hyponatremia, which may result in serious complications.
  • Monitor PT or INR as advised if the patient is on oral anticoagulant such as warfarin.
  • Antibiotics, bismuth preparations, and proton pump inhibitors suppress Helicobacter pylori and may induce false-negative results if given within 4 weeks of a Helicobacter pylori test.
  • Pantoprazole may also induce false-positive results in tetrahydrocannabinol (THC) urine screening tests.
  • Monitor the patient for vitamin B12 deficiency, if the pantoprazole therapy lasts more than 3 years. Because the patient may be unable to absorb vitamin B12 due to achlorhydria or hypochlorhydria.
  • The patient may need to stop taking pantoprazole for at least 14 days before serum chromogranin A testing. Because chromogranin A increases with low gastric acidity. As a result, diagnostic studies for neuroendocrine tumors are altered.

IV administration considerations for Pantoprazole

  • Reconstitute intravenous pantoprazole vial with 10 ml of 0.9% sodium chloride. The injection can be stored at room temperature up to 6 hours after reconstitution.
  • Before and after administration, flush the IV line with NS, D5W, or LR.
  • Administer reconstituted pantoprazole as IV push over 2 minutes.
  • For administration over 15 minutes, further, dilute with a compatible solution; 100 ml for GERD and 80 ml for Zollinger–Ellison syndrome. Diluted solution can be stored at room temperature for up to 24 hours.
  • Check for color change or presence of any precipitates before use. Discard if discolored or precipitates have formed.
  • Assess cannula site for any signs of complications.
  • Store the vials of the Pantoprazole injection at 20° – 25°C (68° – 77°F) and away from direct sunlight.
  • Do not freeze the medicine.

Evaluation

Evaluate the effectiveness of pantoprazole:

  • For alleviation of pain and relief from hyperacidity symptoms such as gastric irritation, heartburn.
  • For the progress of the healing process in erosive esophagitis.
  • Remained free of adverse effects.

Pregnancy/breastfeeding considerations for Pantoprazole:

  • There is insufficient evidence to determine whether pantoprazole crosses the placental barrier and causes harm to the fetus.
  • Do not take pantoprazole during pregnancy unless directed by a doctor.
  • Pantoprazole is excreted via breastmilk.
  • Considering the drug’s benefit to the mother, it should be decided whether to stop breastfeeding or stop taking the medicine.

What is the patient teaching for Pantoprazole?

  • Instruct the patient to take pantoprazole as advised by the prescriber. Exceeding the dosage or taking longer than prescribed increases the risk of adverse reactions associated with long-term use.
  • Tell the patient not to chew, crush, or break the tablet and it should be swallowed whole 30 minutes before food.
  • The best time to take pantoprazole is before breakfast.
  • Instruct the patients who are unable to swallow tablets and capsules to take pantoprazole delayed-release oral preparations 30 minutes before a meal with apple juice or applesauce only. Also,
    • Not to other liquids, because appropriate pH is required for stability.
    • To take within 10 minutes after mixing with applesauce.
    • If mixing with apple juice, add medicine to 1 teaspoon of apple juice and stir for 5 seconds. Note that granules will not dissolve.
    • To take immediately after mixing with apple juice.
    •  Ensure that the full dose has been administered
  • Teach the patient/family about adverse effects (e.g.; decreased urine output, hematuria, myalgia, joint pain) pantoprazole, and when to seek medical attention.
  • Advise the patient to notify the doctor if diarrhea persists or becomes severe.
  • Advise the patient not to take sucralfate along with pantoprazole, keep a 30 minutes gap between both.
  • Tell the patient to avoid OTC medications (e.g.; salicylates, NSAIDs) and herbal supplements without the prescriber’s advice.
  • Advise the patient to avoid alcohol during pantoprazole therapy.
  • Advise the patient to avoid food and beverages that aggravate GI irritation.
  • Emphasize the importance of continuing medication even if he/she is feeling better
  • Tell the female patients of childbearing age to notify the prescriber if pregnancy is suspected or planned.
  • Advice not to take pantoprazole during lactation without consulting with a doctor.

Conclusion

You’ve learned about pantoprazole nursing implications and patient teaching in this article. In addition, you’ve learned about pantoprazole’s mechanism of action, pharmacokinetics, dosage, indications, contraindications, and side effects.

Recommended Readings & Reference

FDA Protonix (pantoprazole sodium) information

FDA Pantoprazole Sodium for Injection information

Kee, J., Hayes, E., & McCuistion, L. (2015). PHARMACOLOGY A Patient-Centered Nursing Process Approach (8th ed.). Elsevier Inc/Saunders.

Kizior, R., & Hodgson, K. (2021). SAUNDERS NURSING DRUG HANDBOOK 2021. Elsevier Inc.

Jones & Bartlett Learning. (2021). Nurse’s Drug Handbook (20th ed.). Jones & Bartlett Learning, LLC.

Skidmore-Roth, L. (2021). MOSBY’S 2021 NURSING DRUG REFERENCE (34th ed.). Elsevier Inc.

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