·        Pantoprazole (Protonix), injection and oral, is the proton pump inhibitor of choice, with automatic substitution for omeprazole (Prilosecâ), rabeprazole (Aciphexâ),  Lansoprazole (Prevacidâ), and other oral proton pump inhibitors unless the physician has checked the dispense as written block.

Lanoprazole Solutabs, 15 mg or 30 mg, may be mixed with water and placed down a very small bore pediatric feeding tube. The granules do not clump or adhere to the tube.

Pantoprazole IV Criteria for use

·        Criteria for use of IV Proton Pump Inhibitors (PPIs) are list below.  If a patient does not meet criteria the pharmacist will call the physician and/or leave a chart note recommending conversion to oral therapy.

• Initial treatment of patients with active upper GI tract bleeding, until they can tolerate oral therapy, usually after three days of therapy.
• Initial treatment of patients with Zollinger-Ellison syndrome, until they can tolerate oral therapy
• Stress-ulcer prophylaxis for critical care patients
• Patients who require PPI therapy who can not tolerate oral or NG PPI therapy

·        Patients on IV proton pump inhibitors will have an order entered for the oral route allowing the nurse to use the oral route when the patient is tolerating oral therapy. Proton pump inhibitors may be given by the oral route if the patient does not have active gastrointestinal bleeding, malabsorption syndrome, short bowel syndrome, severe diarrhea, uncontrolled nausea and vomiting, continuous nasogastric suctioning, and is not at risk for aspiration. 

    Famotidine, the P&T preferred H₂ antagonist, will be automatically substituted for ranitidine, cimetidine, nizatidine, other H₂ when ordered by the IV or oral route unless the physician has checked the dispense as written block or the patient is allergic to famotidine.

Dosage Conversion:

Cimetidine                                                         Famotidine

            300 mg q6-8H                                       20 mg q12H

            300 mg q12-24H                                    20 mg q24H

            400 mg QHS                                         20 mg QHS

            400 mg BID                                           10 mg BID or 20 mg QHS

            400 mg QID                                          20 mg BID

            800 mg QHS                                         40 mg QHS

            800 mg BID                                           20 mg BID

Ranitidine

            50 mg q6-8H IV                                     20 mg q12H

            50 mg q12-24H IV                                 20 mg q24H

            150 mg QD                                           20 mg QD

            150 mg BID                                           20 mg q12h

            300 mg QHS                                         40 mg QHS

Nizatidine

            150 mg QD                                           20 mg QD

            150 mg BID                                           20 mg BID

            300 mg QHS                                         40 mg QHS

Dialysis of Drugs Text 2006

Peritoneal Dialysis Text 2006