What is the typical dose of Pantoprazole (Pantocid) for hospitalized patients?

Pantoprazole (Pantocid) Dosing in Hospitalized Patients

For hospitalized patients requiring stress ulcer prophylaxis or acid suppression, administer pantoprazole 40 mg intravenously once daily. 1

Standard Intravenous Dosing

• The FDA-approved dose is 40 mg IV once daily, administered over 15 minutes, for patients unable to take oral medication. 1, 2
• This dosing regimen effectively suppresses gastric acid secretion and maintains basal acid output below target levels for at least 24 hours. 1
• The 40 mg IV dose produces comparable antisecretory effects to 40 mg oral pantoprazole, with significant reduction in both maximum acid output and basal acid output compared to placebo. 1

Specific Clinical Scenarios

Stress Ulcer Prophylaxis in ICU Patients

• Administer 40 mg IV pantoprazole once daily during the ICU stay for patients at risk of gastrointestinal bleeding. 3
• This reduces clinically important gastrointestinal bleeding from 4.2% (placebo) to 2.5% (pantoprazole). 3
• However, mortality at 90 days is similar between pantoprazole and placebo (31.1% vs 30.4%), so the decision to use prophylaxis should weigh bleeding risk against potential adverse effects. 3

Pathological Hypersecretion (Zollinger-Ellison Syndrome)

• Start with 80 mg IV every 12 hours (total 160 mg/day) in divided doses. 1
• Doses of 160-240 mg daily in divided doses maintain basal acid secretion below target levels (≤10 mEq/h without prior gastric surgery; ≤5 mEq/h with prior surgery). 1
• Greater than 80% of patients achieve acid control with the 80 mg every 12 hours starting regimen. 1

Upper GI Bleeding with High-Risk Endoscopic Stigmata

• For patients with high-risk lesions after endoscopic hemostasis, use 80 mg IV bolus followed by 8 mg/hour continuous infusion for 72 hours. 4
• This high-dose regimen significantly reduces rebleeding rates and need for surgery compared to H2-receptor antagonists or placebo. 4
• The American College of Gastroenterology consensus supports this as a class effect achievable with either omeprazole or pantoprazole. 4

Transition to Oral Therapy

• Once the patient can tolerate oral intake, switch to pantoprazole 40 mg orally once daily, taken 30 minutes before breakfast on an empty stomach. 5
• The oral bioavailability is 77%, and switching from IV to oral maintains equivalent acid suppression. 1, 6
• For acute conditions like gastritis or esophagitis, continue treatment for 4-8 weeks. 5

Important Dosing Considerations

• Pantoprazole has lower relative potency than other PPIs (40 mg pantoprazole = 9 mg omeprazole equivalent). 7, 5
• No dose adjustment is needed for renal failure, as pharmacokinetics are unaltered. 6
• In severe liver cirrhosis, the half-life increases from 1.1 hours to 7-9 hours, but routine dose adjustment is typically not required. 6
• The elimination half-life is approximately 1.1 hours, with clearance of 0.1 L/h/kg. 6

Common Pitfalls to Avoid

• Do not administer pantoprazole with food or antacids, as this significantly reduces absorption and efficacy. 5
• Avoid empiric twice-daily dosing unless treating H. pylori infection or high-risk upper GI bleeding post-endoscopy, as this increases costs and adverse event risk without proven benefit for standard indications. 5
• Consider de-prescribing or dose reduction once acute symptoms resolve, as most hospitalized patients do not require long-term PPI therapy. 7
• Monitor for return of symptoms when transitioning from IV to oral or reducing dose, which would indicate need to return to higher dose. 7