Can I administer Doxycycline, Protonix (pantoprazole), and insulin to a patient scheduled for an Esophagogastroduodenoscopy (EGD) at 1100 if their blood glucose is out of range?

Administration of Medications Before EGD Procedure

Yes, you can administer morning doses of doxycycline, Protonix (pantoprazole), and insulin if blood glucose is out of range for a patient scheduled for an EGD at 11:00 AM.

Medication Administration Guidelines

Insulin Management

• For patients scheduled for EGD procedures, insulin should be administered if blood glucose is out of range, as maintaining appropriate glycemic control is essential for reducing perioperative complications 1
• A protocolized approach to blood glucose management should target levels ≤180 mg/dL rather than more aggressive targets to avoid hypoglycemia 1
• For patients taking insulin, administer insulin as needed based on blood glucose monitoring, but consider reducing the dose by 25% compared to usual dosing to achieve perioperative blood glucose goals with lower risk of hypoglycemia 1
• Blood glucose should be monitored every 1-2 hours until glucose values stabilize 1

Protonix (Pantoprazole)

• Pantoprazole (Protonix) can be safely administered on the morning of an EGD procedure 1
• There is no need to withhold proton pump inhibitors before endoscopic procedures, as they do not interfere with the procedure 1
• Some evidence suggests pantoprazole may even have beneficial effects on glycemic control, potentially improving beta cell function in diabetic patients, though this should not be the primary reason for administration 2, 3

Doxycycline

• Oral medications such as doxycycline can be administered with a small sip of water on the morning of the procedure 1
• Antibiotics should not be withheld when clinically indicated, even on the day of procedures 1

Important Considerations

Timing of Medication Administration

• Administer these medications with minimal water (small sips only) 1
• Ensure medications are given at least 2 hours before the scheduled EGD procedure time (11:00 AM) to allow for adequate absorption 1

Specific Precautions

• Monitor blood glucose levels before the procedure, as both hyperglycemia and hypoglycemia can increase perioperative complications 1
• For patients with diabetes, the perioperative blood glucose goal should be 100-180 mg/dL (5.6-10.0 mmol/L) 1
• Point-of-care testing of capillary blood glucose should be interpreted with caution, as such measurements may not accurately estimate arterial blood or plasma glucose values 1

Medications to Avoid Before EGD

• Metformin should be held on the day of surgery/procedures 1
• SGLT2 inhibitors should be discontinued 3-4 days before procedures 1
• Other oral glucose-lowering agents (except those specifically needed) should be held the morning of the procedure 1

Post-Procedure Considerations

• Resume normal medication schedules after the procedure once the patient can tolerate oral intake 1
• Monitor for hypoglycemia after the procedure, especially if insulin was administered pre-procedure 1

By following these guidelines, you can safely administer doxycycline, Protonix, and insulin (if needed) before the scheduled EGD procedure while minimizing risks and maintaining appropriate patient care.