Pantoprazole IV question!

[RNinRubySlippers]

How long does your hospital run Pantoloc (Pantoprazole) IV for? The new hosp I work at runs it ver 5 hours! 100mL @ 20cc/hr Its nuts, The other 2 hsopitals I worked at just ran it over 30-60 mins! Any imput? Or rationale as to why this may be? I am gonna ask pharmacy on my next day shift. Thanks all!

[AussieKylie]

I just read this post. I am nursing student and wondering what does it mean by Filtering. Is this with a butterol (burrette)?

Interesting topic. :)

[lady_jezebel]

We run it in as fast as over 15 min. I thought that you didn't need a filter anymore as long as it wasn't mixed with anything else .

15 min is our policy too, and filters are no longer needed

[caroladybelle, BSN, RN]

I just read this post. I am nursing student and wondering what does it mean by Filtering. Is this with a butterol (burrette)?

No, a filter is different.

A filter is just that...a filter placed inside of a chamber of the IV tubing that sieves out particulate matter. Some IVs are always filtered, some are not.

Most blood tubing has a blood filter, TPN (but not lipids) is filtered. In some hospitals where blood is not leukoreduced by the Blood bank, a PAL white cell filter is used on blood tubing, to sieve out the white blood cells (that would make the recipient more likely to have certain transfusion reactions).

The original formulation of protonix had to be filtered - with a special filter that came up to the floor from the pharmacy with the drug. The newer formulation does not require a filter.

They are also a few drugs that are NEVER filtered.

[mommatrauma, RN]

per Wyeth's website(company that makes Protonix) this is their administration recommendations:

15 minute infusion

PROTONIX I.V. for Injection should be reconstituted with 10 mL of 0.9% Sodium Chloride

Injection, USP, and further diluted (admixed) with 100 mL of 5% Dextrose Injection, USP,

0.9% Sodium Chloride Injection, USP, or Lactated Ringer's Injection, USP, to a final

concentration of approximately 0.4 mg/mL. The reconstituted solution may be stored for up to

2 hours at room temperature prior to further dilution; the admixed solution may be stored for up

to 22 hours at room temperature prior to intravenous infusion. Both the reconstituted solution

and the admixed solution do not need to be protected from light.

PROTONIX I.V. for Injection admixtures should be administered intravenously over a period of

approximately 15 minutes at a rate of approximately 7 mL/min.

Two Minute Infusion

PROTONIX I.V. for Injection should be reconstituted with 10 mL of 0.9% Sodium Chloride

Injection, USP, to a final concentration of approximately 4 mg/mL. The reconstituted solution

may be stored for up to 2 hours at room temperature prior to intravenous infusion and does not

need to be protected from light. PROTONIX I.V. for Injection should be administered

intravenously over a period of at least 2 minutes.

no filter needed since they changed the formulation of the IV version in 2004(Summer I think). I also looked up interactions with KCL but couldn't find any...however it is compatible with Ringer's, but probably to be on safe side, I'd not run it with a K rider, the combination of the two can be very painful to the veins...

[begalli]

I cannot recall the dosage right now, but we have Protonix drips that run either continuously or over many hours for active GI bleeders in the ICU.

So how many mg is the patient getting over these 5 hours? If it's only the usual prophylactic dose of 40mg, then that doesn't sound quite right.

[begalli]

here's an interesting link:

http://www.uic.edu/pharmacy/services/di/protonix.htm

even though the drug has not been "approved" for use as continuous infusion, that webiste says that methods of administering it this way have been developed.

at that link it describes "supportive therapy with upper gastrointestinal (ugi) bleeding." this sounds like what we do.

[actioncat]

15 min is our policy too, and filters are no longer needed

Same here. We lost the filters about 8 months ago.

[RNinRubySlippers, BSN, RN]

Yes it is only a 40mg vial that is reconstituted

I cannot recall the dosage right now, but we have Protonix drips that run either continuously or over many hours for active GI bleeders in the ICU.

So how many mg is the patient getting over these 5 hours? If it's only the usual prophylactic dose of 40mg, then that doesn't sound quite right.

[begalli]

Yes it is only a 40mg vial that is reconstituted

I wonder if the patient got/gets a loading dose (bolus) before the infusion begins?

Maybe your docs are using a modified version of what I described and as is mentioned in the link I provided?

Is the patient a GI bleed?

[KacyLynnRN]

My hospital runs protonix over 30 minutes, it ends up being 200mL/hr. We just started not using a filter too. I don't know why.

[pricklypear]

We run it at 7mg/hr for GI bleeds, continuously - that's 20cc/hr. Depending on the patient, we will run Protonix like that for up to 2-3 days. And we've never used filters for Protonix, only Prevacid.

[begalli]

I looked into exactly what we do.

For UGI bleeds we give a loading dose of 80mg (bolus over ~ 3-5 minutes) and then start a drip at 8mg/hr (100mg/100ml = 8ml/hr) and run the drip for 72 hours (very much like it's described in that earlier link).

We used to use filters, not any more.

When we have a protonix drip it is almost always running with an octreotide drip. We also give a loading dose of octreotide (100 mcg over ~ 5 minutes) and then run the drip at 50 mcg/hr (10mg/100ml = 5ml/hr).

They are usually both d/c'd at the same time.

As I was looking around on the internet, I did come across one study (can't find it now) that used 5mg/hr as a continuous drip for protonix. But it was continuous, not intermittent.

Hey, thanks for the topic. Good review of these drugs for me as we do get UGI's, just not every day.

:)