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How should continuous infusions of proton pump inhibitors be given for acute upper gastrointestinal bleeding?

Publisher: Wessex Drug and Medicines Information Centre

Keywords: proton-pump-inhibitor; omeprazole; pantoprazole; esomeprazole; infusions-intravenous

Date published: 14/09/2009 13:47

Expires on: 30/11/2010 14:00

Summary
by: Sandra Hicks
  • For omeprazole, pantoprazole and esomeprazole, limited evidence suggests that optimal effect is achieved with an iv bolus dose of 80mg, followed by continuous infusion of 8mg/hour for 3 days.

 

  • After administration of the initial bolus dose, the continuous infusion can be prepared by reconstituting a 40mg vial of either omeprazole (Losec®) or pantoprazole and further diluting in 100ml of sodium chloride 0.9%. This can be given at a rate of 8mg/hour (i.e. over 5 hours), and repeated with a fresh vial after that time. Depending on the host organisation’s attitude to microbiological stability, infusions could be made up and run over 24-48 hours if necessary since omeprazole (Losec®) and pantoprazole are chemically stable in sodium chloride 0.9% for this period.

 

  • After administration of the initial bolus infusion of 80mg esomeprazole, the contents of two 40mg vials of esomeprazole are dissolved in up to 100ml of 0.9% sodium chloride and given at a rate of 8mg/hour (i.e. over 10 hours). This is repeated with fresh vials after that time.

 

  • The infusion may be followed by conversion to oral PPI therapy. The exact oral dose and length of treatment may be determined by the individual clinician, on a case by case basis.

 

  • The use of omeprazole and pantoprazole in the manner described above is unlicensed, and is therefore the responsibility of the prescribing physician.

 

  • However, esomeprazole has a licence for this method of administration.  It is indicated for the prevention of rebleeding, following therapeutic endoscopy for acute bleeding gastric or duodenal ulcers.

 

  • To date no large-scale head-to-head comparisons of continuous infusions of intravenous PPIs have been performed in patients with peptic ulcer bleeding.
About this library entry
Category: 1.3.5 Proton pump inhibitors | FAQs | Peptic Ulceration
NeLM area:  Evidence > Medicines Q & A
QA41_5_IntravenousPPIs.doc
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