More is not always better. Study shows single-dose pantoprazole just as good as doubled dose for preventing serious bleeding after surgery for stomach cancer.

Lowering cost of Protonix IV by halving the dose


  • After surgery for stomach cancer, intravenous (IV) formulations of acid reflux drugs are sometimes used to prevent further bleeding.
  • One acid reflux drug, Protonix IV (pantoprazole), can be given once or twice every 24 hours. The benefit of doubling the dose is unknown.
  • A study showed that Protonix IV once every 24 hours was just as effective as the doubled dose, presenting a cost-saving opportunity for hospitals.

For early-stage stomach cancer, surgery is the treatment of choice. One type of surgery is called endoscopic resection.

But endoscopic resection is not without its risks. One serious side effect is the risk of delayed post-surgical bleeding, caused by ulcers that can form days after the surgery. These ulcers usually need an additional procedure called emergency hemostasis to stop the bleeding.

It’s been reported that delayed bleeding may occur in up to 15% of patients undergoing endoscopic resection.

Drugs called proton-pump inhibitors (PPIs) have been used in this setting to help prevent delayed bleeding. Protonix IV is one such drug, which can be given once or twice every 24 hours.

However, using Protonix IV to prevent post-surgical bleeding is off-label, and there are no guidelines on the proper dose of Protonix IV for this purpose. As such, some physicians have used it at double the dose, presumably hoping that it may offer better protection against delayed bleeding.

While this may sound intuitive, more drug doesn’t always mean better efficacy.

To find the proper dose for using PPIs to prevent delayed bleeding, Dr. Jung and colleagues conducted this study published in the Journal of Gastroenterology and Hepatology.

In this study, patients either received Protonix IV once every 24 hours, or at double the dose, every 12 hours.

Two days after their surgery for stomach cancer, the proportion of patients experiencing a delayed bleed were similar either dosage groups.

The rate of bleeding ulcers between patient groups were likewise comparable between dosage groups.


Bottom line

  • Using Protonix IV once every 24 hours may be just as effective as doubling the dose.
  • Cutting the dose of Protonix IV for prevention of post-surgical bleeding may help hospitals free up some resources for other life-saving procedures and/or treatments.

Source study: Jung SW, et al. J Gastroenterol Hepatol 2016. Published ahead of print: September 16, 2016. A paid subscription may be required.

References: 1. Jung SW, et al. J Gastroenterol Hepatol 2016. Published ahead of print: September 16, 2016. 2. Pantoprazole IV Prescribing Information, 2014. 3. National Comprehensive Cancer Network. NCCN guidelines: Gastric cancer version 3.2016. Available at: https://www.nccn.org. Accessed on October 2, 2016.

Photo adapted from original by Irekia, used under license.

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