Neonatal Drug Therapy Manual

Pantoprazole

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Updated September 25, 2023 - 10:00am

Alternate Name(s): 
Panto IV
Classification: 
Gastric acid secretion inhibitor
Original Date: 
November 2008
Revised Date: 
Sept 2023
Indications: 
  • Treatment of GERD, acid suppression in patients who cannot tolerate oral medications and treatment of upper GI bleeding.
Administration: 
  • IV direct: over 2-5 minutes
  • IV intermittent infusion: over 15 minutes
  • IV continuous infusion
Dosage: 
  • 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: 

CHEO:

  • 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

TOH:

  • 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

Compatibility: 

- 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

Notes: 

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

References: 

-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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