| Summary: | 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 histamine2 receptor antagonists with respect to
acid suppressive effects and is not associated with tolerance development.
Another advantage over the histamine2 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).
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