Neethu Sara George, Sujatha Palatheeya, Ramakrishna Prudhivi, Anjali Maria Mathew
Neethu Sara George1, Sujatha Palatheeya2, Ramakrishna Prudhivi1*, Anjali Maria Mathew3
1Faculty of Pharmacy, College of Pharmaceutical Sciences, Dayananda Sagar University, Bengaluru- 560078, India.
2Assistant Professor, Department of Pharmacy, University College of Pharmaceutical Sciences, Palamuru University, Mahabubnagar -509001, India.
3Intern, Department of Pharmacy Practice, Dayananda Sagar College of Pharmacy, Bengaluru -560078, India.
Volume - 14,
Issue - 3,
Year - 2021
Background: Proton pump inhibitors are currently the most effective agents for acid related disorders. Pantoprazole is a frequently used proton pump inhibitor in healthcare practice. Objectives: To evaluate the usage pattern of intravenous pantoprazole and to assess its appropriateness in accordance with the guidelines and criteria in terms of indication for use, dose and duration of therapy. Methodology: The study was conducted in 141 patients admitted in Sagar hospital, Bengaluru. It was a prospective, observational study for six months. Prescriptions were evaluated for appropriate use of IV Pantoprazole. Results: Out of 141 patients, 32(22.7%) patients were had UGIB and 109(77.30%) patients were Non-UGIB patients. 36.87% of IV Pantoprazole prescriptions were inappropriate either in terms of dose, duration and indication for use. Only 37.58% of the patients with IV pantoprazole therapy were on NPO (Nil PerOs). We observed that all 32 UGIB patients who had clinical signs of gastrointestinal bleeding underwent endoscopy. But endoscopy was not performed in most of the Non-UGIB cases (69/109). Among 72 patients who underwent endoscopy, (45/72), 62.50% patients received IV Pantoprazole prior to endoscopy. Majority (90%) of patients received 40 mg IV pantoprazole twice daily. Conclusion: Institutional guidelines were developed to promote appropriate use of the IV proton pump inhibitor pantoprazole. Inappropriate and unsupervised use of IV pantoprazole can lead to unwanted consequences such as hypersensitivity reactions and prolonged durations of treatment and increased treatment cost. This study suggests that the majority of IV PPI prescriptions were appropriate. But still more satisfactory results can be achieved through adherence of the guidelines.
Cite this article:
Neethu Sara George, Sujatha Palatheeya, Ramakrishna Prudhivi, Anjali Maria Mathew. Evaluation of Appropriateness of Intravenous Pantoprazole in Inpatients of Tertiary Care Hospital. Research J. Pharm. and Tech 2021; 14(3):1441-1446. doi: 10.5958/0974-360X.2021.00257.2
1 Dean and Laura. Proton-pump inhibitor. Available from: URL: https://en.wikipedia.org/wiki/Proton-pump_inhibitor.
2 Scarpignato C, Gatta L, Zullo A and Blandizzi C. Effective and safe proton pump inhibitor therapy in acid-related diseases–A position paper addressing benefits and potential harms of acid suppression. BMC Medicine. 2016;14(1):179.
3 Poole P: Pantoprazole. American journal of health-system pharmacy. 2001;58(11):999-1008.
4 Cheer SM, Prakash A and Faulds D. Pantoprazole: an update of its pharmacological properties and therapeutic use in the among the proton pump inhibitors in terms of management of acid-related disorders. Drugs. 2003; 63:101-32.
5 Metz DC, Pratha V, Martin P, Paul J, Maton PN, Lew E et al. Oral and intravenous dosage forms of pantoprazole are equivalent in their ability to suppress gastric acid secretion in patients with gastroesophageal reflux disease. The American Journal of Gastroenterology. 2000;95(3):626-33.
6 De Vault KR. Pantoprazole: a proton pump inhibitor with oral and intravenous formulations. Expert Review of Gastroenterology and Hepatology. 2007;1(2):197-205.
7 Jensen DM, Pace SC, Soffer E and Comer GM. Continuous infusion of pantoprazole versus ranitidine for prevention of ulcer rebleeding: a US multicenter randomized, double-blind study. American Journal of Gastroenterology. 2006;101(9):1991-9.
8 Andriulli A, Annese V, Caruso N, Pilotto A, Accadia L, Niro AG et al. Proton-pump inhibitors and outcome of endoscopic hemostasis in bleeding peptic ulcers: a series of meta analyses. American Journal of Gastroenterology. 2005;100(1):207-19.
9 Iwakiri K, Kinoshita Y, Habu Y, Oshima T, Manabe N, Fujiwara Y et al. Evidence-based clinical practice guidelines for gastroesophageal reflux disease. Journal of Gastroenterology. 2016; 51(8):751-67.
10 Sodium, G. Protonix I.V. (Pantoprazole Sodium): Side Effects, Interactions, Warning, Dosage and Uses. RxList. Available from: URL: https://www.rxlist.com/protonix-iv-drug.htm
11 Malakar. A, Bokshi. B and Karmakar U. Assessment of dissolution profile of Pantoprazole tablets available in Bangladesh. Journal of Pharmaceutical Sciences. 2011;4(2):58-62.
12 Nirajan Kunwar, M. Kumaraswamy, Surendra Shrestha and Saroj Paudel. Study on proton pump inhibitors in general medicine unit of tertiary care teaching hospital. World Journal of Pharmaceutical Research. 2016;4(6):1519-1534.
13 DeVault KR and Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. American Journal of Gastroenterology. 2005;100:190–200.
14 Vishwanath M, Narayana Reddy S and Sahana Devadas. Assessment of drug utilization in hospitalized children at a tertiary care teaching hospital. Journal of Chemical and Pharmaceutical Research. 2014;6(2):592-8.
15 Protonix (pantoprazole) dosing, indications, interactions, adverse effects, and more. Available from: URL: http:// reference.medscape.com/drug/protonix-pantoprazole-342001.
16 Afif W, Alsulaiman R, Martel M and Barkun AN. Predictors of inappropriate utilization of intravenous proton pump inhibitors. Alimentary pharmacology and therapeutics. 2007;25(5):609-15.
17 Grube RR and May DB. Stress ulcer prophylaxis in hospitalized patients not in intensive care units. American Journal of Health-System Pharmacy. 2007;64(13):1396-400.
18 Lanza FL, Chan FK and Quigley EM. Guidelines for prevention of NSAID-related ulcer complications. American Journal of Gastroenterology. 2009;104(3):728-38.
19 Biswa Mohan Padhy, Hemant Singh Bhadauria and Yogendra Kumar Gupta. Attitude and Knowledge of Indian Emergency care residents towards use of proton pump inhibitors. International Scholarly Research Notices. 2014; 24:968430-36.
20 Seyed Mojtaba Sohrevardi, Alireza Vahidi, Mohammad Hossein Mosadegh, Arefeh Dehghaniand Tafti Anita Dadollahi. Evaluation of prescriptions and use of intravenous pantoprazole in General wards and Intensive Care Unit of Shahid Sadoughi Hospital in Yazd. Journal of Pharmaceutical Care. 2015; 3:7-10.
21 Moradi M, Raeesi S and Sepehri Z. Audit of IV pantoprazole: pattern of administration and compliance with guideline in a teaching hospital. Springer Plus. 2016;5(1):1749.
22 Brook RA, Kleinman NL, Smeeding JE and Talley NJ. Excess comorbidity prevalence and cost associated with functional dyspepsia in an employed population. Digestive Diseases and Sciences. 2012; 57(1):109-18.
23 Welage LS and Berardi RR. Evaluation of omeprazole, lansoprazole, pantoprazole, and rabeprazole in the treatment of acid-related diseases. Journal of the American Pharmaceutical Association. 2000; 40(1):52-62.
24 Afif W, Alsulaiman R, Martel M and Barkun AN. Predictors of inappropriate utilization of intravenous proton pump inhibitors. Alimentary Pharmacology and Therapeutics. 2007;25(5):609-15.
25 Green FW Jr, Kaplan MM, Curtis LE and Levine PH. Effect of acid and pepsin on blood coagulation and platelet aggregation. A possible contributor prolonged gastro-duodenal mucosal hemorrhage. Gastroenterology. 1978; 74:38-43.
26 Lai PS, Wong YY, Low YC, Lau HL, Chin KF and Mahadeva S. Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors. Peer J. 2014; 2:e451.
27 Enns R, Andrews CN, Fishman M, Hahn M, Atkinson K, Kwan P et al. Description of Prescribing Practices in Patients with Upper Gastrointestinal Bleeding Receiving Intravenous Proton-Pump Inhibitors: A Multicentre Evaluation. Canadian Journal of Gastroenterology and Hepatology. 2004; 18(9):567-71.
28 Soumana C Nasser, Jeanette G Nassif and Hani I Dimassi. Clinical and cost impact of intravenous proton pump inhibitor use in non-ICU patients. World Journal of Gastroenterology. 2010;16(8):982-6.
29 Nousheen, Tadvi and Shareef. Use of Proton Pump Inhibitors in general practice. International Journal of Medical Research and Health Sciences. 2014;3(1):37-42
30 Yasamin Dabiri, Fanak Fahimi, Hamidreza Jamaati and Seyed Mohammad Reza Hashemian. Comparison of extemporaneous preparations of omeprazole, pantoprazole oral suspension and intravenous pantoprazole on the gastric pH of critically ill-patients. Indian Journal of Critical Care Medicine. 2015; 19:21-6.
31 Prestin Thomas, Arulraj Ramaa krishnan and K.T. Manisenthilkumar. Prospective observational study to assess the indications and the adverse events of proton pump inhibitors among patients visiting a tertiary care hospital in Coimbatore, India. Asian Journal of Pharmacy and Pharmacology. 2016; 1(02):58-66.