Until now, oral
proton pump inhibitors have not been available as parenteral
therapy in the acute care setting.
Pantoprazole is the first parenteral
proton pump inhibitor to become available in Canada. This agent is superior to the parenteral
histamine 2 receptor antagonists with respect to
acid suppressive effects and is not associated with tolerance development. Another advantage over the
histamine 2 receptor antagonists is that
pantoprazole does not require dosage adjustment in patients with renal impairment. Dosage adjustments are also not required for elderly patients or those with hepatic impairment when the
drug is used at the usual dose for a limited period of time. Contrary to intravenous
cimetidine and
ranitidine, which have negative inotropic and chronotropic effects, intravenous
pantoprazole is well tolerated and has no significant effect on heart rate, contractility or blood pressure. The lack of drug interactions for this agent also simplifies its use, especially in patients who may require multiple drugs during hospitalization. Parenteral
pantoprazole is effective in the treatment of
reflux esophagitis. It is also promising for the treatment of upper gastrointestinal
bleeding and in the
perioperative care of patients with
Zollinger-Ellison syndrome, but further research in these areas is necessary. Once the patient is able to tolerate oral medications, parenteral
therapy can be easily converted to oral
therapy using an oral dose that was equivalent to the parenteral dose (ie, 40 mg given intravenously is equivalent to 40 mg given orally).