Switching between intravenous and oral pantoprazole

Abstract

Proton pump inhibitors (PPIs) are the most effective antisecretory drugs available for controlling gastric acid acidity and volume. They are the drugs of choice in the treatment of moderate-to-severe gastroesophageal reflux disease, hypersecretory disorders, and peptic ulcers. Currently in the United States, they are only available in an oral formulation. However, pantoprazole will soon be available in an intravenous formulation and will extend the power of PPIs to inpatient hospital settings. Intravenous pantoprazole has been shown to be effective and safe in clinical trials. Intravenous pantoprazole is indicated for the treatment of patients who require PPI therapy but who are unable to take oral medication. Intravenous pantoprazole has been shown to maintain acid suppression in patients switched from oral PPIs, so no change in dosage is required when switching from one formulation to the other. Potential hospital-based uses for intravenous PPI therapy include perioperative use as prophylaxis for acid aspiration syndrome during induction of anesthesia, prophylaxis for stress-related mucosal disease, and management of gastrointestinal bleeding from stress or acid peptic disease.

FIG. 1.

Dose equivalency of pantoprazole oral and intravenous formulations as measured by MAO subsequent to the final dose of a 10-day oral treatment period, and on the first and seventh day of an intravenous treatment period. Patient enrollment was 20 mg oral (n = 32), 40 mg oral (n = 31), 20 mg intravenous (n = 24), 20 mg placebo (n = 8), 40 mg intravenous (n = 24), and 40 mg placebo (n = 7). Asterisk indicates p < 0.05 versus respective seventh day intravenous dose; MAO, maximal acid output; IV, intravenous; ▤, oral pantoprazole; ■, intravenous pantoprazole; ☐, intravenous placebo. Reprinted with permission from Am J Gastroenterol. Copyright 2000, The American College of Gastroenterology.

FIG. 2.

Dose equivalency of pantoprazole oral and intravenous formulations as measured by BAO subsequent to the final dose of a 10-day oral treatment period, and on the first and seventh day of an intravenous treatment period. Patient enrollment was 20 mg oral (n = 32), 40 mg oral (n = 31), 20 mg intravenous (n = 24), 20 mg placebo (n = 8), 40 mg intravenous (n = 24), and 40 mg placebo (n = 7). Asterisk indicates p < 0.05 versus respective seventh day intravenous dose; BAO, basal acid output; IV, intravenous; ▤, oral pantoprazole; ■, intravenous pantoprazole; ☐, intravenous placebo. Reprinted with permission from Am J Gastroenterol. Copyright 2000, The American College of Gastroenterology

FIG. 3.

Twenty-four hour mean cumulative acid output after 20-, 40-, 80-, and 120-mg intravenous doses of pantoprazole and placebo. Adapted from Am J Gastroenterol. Copyright 1999, The American College of Gastroenterology.