How long should Protonix (pantoprazole) be continued prophylactically in the Intensive Care Unit (ICU) after initiating oral nutrition?

Protonix (pantoprazole) prophylaxis in the ICU should generally be discontinued within 24-48 hours after a patient tolerates enteral nutrition. Once a patient is tolerating oral intake or enteral feeds, the risk of stress-related mucosal damage decreases significantly, making continued acid suppression unnecessary for most patients. When discontinuing prophylaxis, it's reasonable to observe the patient for 24 hours while on a diet to ensure adequate tolerance before stopping the medication. For patients with other indications for acid suppression (such as active gastrointestinal bleeding, history of peptic ulcer disease, or concurrent use of medications that increase bleeding risk like anticoagulants or steroids), continuation of Protonix may be warranted beyond ICU discharge. Unnecessary prolongation of stress ulcer prophylaxis can lead to adverse effects including increased risk of hospital-acquired pneumonia, Clostridioides difficile infection, and hypomagnesemia. The primary purpose of stress ulcer prophylaxis is to prevent gastrointestinal bleeding during critical illness when patients are NPO and experiencing physiologic stress, so once these conditions resolve, the medication should be discontinued in most cases.