Neonatal Drug Therapy Manual


Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Panto IV
Gastric acid secretion inhibitor
Original Date: 
November 2008
Revised Date: 
Sept 2023
  • Treatment of GERD, acid suppression in patients who cannot tolerate oral medications and treatment of upper GI bleeding.
  • IV direct: over 2-5 minutes
  • IV intermittent infusion: over 15 minutes
  • IV continuous infusion
  • IV intermittent infusion: 1 - 1.5 mg/kg/day IV once daily or divided Q12H
  • IV continuous infusion:
    •  Little information is available to provide a dose for neonates.  Our best extrapolation from infants and older children suggests the following dose: 2 mg/kg stat then 0.2 mg/kg/hr
Side Effects: 
  • Dermatologic: pruritus, rash
  • Endocrine and metabolic: hyperglycemia, hyperlipemia
  • GI: diarrhea
  • Hematologic: thrombocytopenia, leucopenia, anemia
  • Hepatic: elevated liver enzymes
  • Local: thrombophlebitis
Parameters to Monitor: 
  • Extensively metabolized hepatically
  • In patients with severe hepatic dysfunction (albumin, bilirubin and INR), liver enzymes should be checked regularly and if an increase is noted, pantoprazole should be discontinued
Reconstitution and Stability: 


  • Pantoprazole 40 mg vial (doses < 4 mg)
    • Add 10 mL of 0.9% NaCl to vial
    • Take 4 mL (16 mg) and add to 16 mL of 0.9% NaCl
    • Final concentration: 0.8 mg/mL
  • Pantoprazole 40 mg vial (doses > 4 mg)
    • Add 10 mL 0.9% NaCl to vial
    • Final concentration: 4 mg/mL


  • Pantoprazole 40 mg vial
    • Add 10 mL of 0.9% NaCl to vial

    • Take 4 mL (16 mg) and add to 16 mL of 0.9% NaCl

    • Final concentration: 0.8 mg/mL


- Solutions Compatible: D5W, 0.9% NaCl

- Y-site Compatible: ampicillin, cefazolin, dopamine, epinephrine, furosemide, insulin regular, morphine, potassium chloride, vasopressin

Incompatible: caffeine, calcium gluconate, clindamycin, dobutamine, midazolam, norepinephrine, octreotide, potassium phosphate, SMOF, vancomycin


Stepdown to oral Proton Pump Inhibitor should occur as soon as possible


-Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 22nd Edition. Hudson: Lexi-Comp Inc.; 2015.

-American Society on Health-System Pharmacists (ASHP). Handbook on Injectable Drugs. 19th Edition. Bethesda: American Society of Health-System Pharmacists 2017

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