In this episode, I will discuss whether intermittent boluses of pantoprazole be used to treat acute GI bleeding rather than continuous infusions.
The best evidence to support intermittent boluses of PPIs to treat GI bleeding comes from a 2014 meta-analysis. The study compared intermittent doses of PPIs and the regimen of pantoprazole 80-mg intravenous bolus dose of a PPI followed by an infusion of 8 mg/h for 72 hours. The two methods were statistically non-inferior when evaluated for the risk of rebleeding and mortality.
The authors concluded:
Intermittent PPI therapy is comparable to the current guideline-recommended regimen of intravenous bolus plus a continuous infusion of PPIs in patients with endoscopically treated high-risk bleeding ulcers.
A common intermittent regimen is for a bolus of 80 mg pantoprazole IV followed by 40 mg IV q12 hrs. This regimen uses less than half the amount of pantoprazole than a continuous infusion would over a 72 hour period.
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