Pantoprazole Dilution in D5NS (5% Dextrose in Normal Saline)
Yes, pantoprazole can be diluted in D5NS, as the FDA-approved labeling explicitly lists 5% Dextrose Injection as a compatible diluent for both reconstitution and further dilution of pantoprazole for intravenous administration. 1
FDA-Approved Dilution Instructions
The FDA label provides clear guidance for pantoprazole preparation:
For 15-minute infusion: Reconstitute each vial with 10 mL of 0.9% Sodium Chloride, then combine and further dilute with 80 mL of either 5% Dextrose Injection, 0.9% Sodium Chloride, or Lactated Ringer's to achieve a final concentration of approximately 0.8 mg/mL 1
For 2-minute infusion: Reconstitute with 10 mL of 0.9% Sodium Chloride to achieve 4 mg/mL concentration 1
Y-site compatibility: When administered through a Y-site, pantoprazole is compatible with 5% Dextrose Injection, 0.9% Sodium Chloride, or Lactated Ringer's 1
Stability Considerations in Dextrose Solutions
The chemical stability of pantoprazole varies significantly based on diluent choice:
In 5% dextrose (D5W): Pantoprazole at 0.8 mg/mL remains stable for 3 days at room temperature (20-25°C) or 28 days when refrigerated (2-8°C) 2
In normal saline: Pantoprazole demonstrates superior stability, remaining stable for 3 days at room temperature or 28 days refrigerated at both 0.4 and 0.8 mg/mL concentrations 2
Extended stability data: Solutions in D5W at concentrations between 0.16-0.80 mg/mL can be stored for up to 11 days at 4°C plus an additional 6 hours at 23°C 3
Critical Administration Requirements
Flush the intravenous line before and after pantoprazole administration with either 5% Dextrose, 0.9% Sodium Chloride, or Lactated Ringer's to prevent incompatibilities. 1
Administer through a dedicated line or Y-site only 1
Inspect solutions visually for particulate matter and discoloration before and during administration 1
Do not freeze reconstituted or diluted solutions 1
Important Incompatibilities and Pitfalls
Avoid mixing pantoprazole with products containing zinc or midazolam HCl, as these are incompatible with pantoprazole. 1
Immediately discontinue infusion if precipitation or discoloration occurs during Y-site administration 1
Do not add pantoprazole to parenteral nutrition solutions, as rapid degradation occurs (less than 50% remaining after 24 hours) 4
The pH-dependent stability of pantoprazole (pKa ≈ 4) makes it vulnerable to degradation in solutions with pH 6.0-6.5 4
Storage and Handling
Reconstituted solution (4 mg/mL): Store up to 24 hours at room temperature 1
Diluted solution for 15-minute infusion: Use within 24 hours from initial reconstitution 1
Solutions do not require protection from light during storage 1, 2
Refrigeration extends stability significantly compared to room temperature storage, particularly for dextrose-based solutions 2, 3