Episode 25: Pantoprazole Continuous infusion vs Intermittent Bolus Formulary Nugget by Oscar Santalo

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By Jimmy Pruitt & Oscar Santalo, Jimmy Pruitt, and Oscar Santalo. Discovered by Player FM and our community — copyright is owned by the publisher, not Player FM, and audio is streamed directly from their servers. Hit the Subscribe button to track updates in Player FM, or paste the feed URL into other podcast apps.

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

DrugLRMCTVRHTotal
Pantoprazole 80 mg Drip Utilization8424581,300
Total Costs
($6.02, 3.01 per 40 mg inj median Price)
5,0602,7537,813
Savings2,5261,3743,900
Report of annualized dispenses of 80 mg in 100 mL drip with savings

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

The post Episode 25: Pantoprazole Continuous infusion vs Intermittent Bolus Formulary Nugget by Oscar Santalo appeared first on The Pharm So Hard Podcast.

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