The Utilization Evaluation of Intravenous Pantoprazole for Stress Ulcer Prophylaxis in a Major Teaching Hospital

Proton pump inhibitors (PPIs) are one of the first-line drugs for acid-dependent diseases. Inappropriate use of PPIs, especially the Intravenous (IV) formula of pantoprazole, can result in excessive cost. This study aimed to evaluate IV pantoprazole usage's appropriateness and optimize its use in accordance with guidelines at Razi educational and remedial center, Rasht, Iran. 

This cross-sectional study was executed in five months among 344 patients of Razi hospital who received IV pantoprazole for stress ulcer prophylaxis (SUP). Demographic data, route and doses of pantoprazole, risk factors for stress ulcer, and other related medical data were recorded. In addition, the appropriate use of IV pantoprazole was measured according to recommendations arranged by this center and the American Society of Health-System Pharmacists. 

Out of 197 patients who received SUP with an appropriate indication, 183 patients (92.9%) were able to tolerate the drug orally, and only 14 patients (7.1%) had an indication for receiving IV pantoprazole. There was a significant difference between patients who received SUP with an indication regarding having or not having an indication for IV pantoprazole (P = 0.007). 5029 vials (96.5%) with a cost of 17,822 US dollars were used inappropriately and imposed an additional cost on the health care system. 

This study presented that the majority of IV pantoprazole use in this center was not well-matched with guidelines in most cases, containing appropriate indication and right dosing. In order to prescribe this drug as SUP, it is necessary to be more careful about the criteria for prescribing and conforming the prescribed drug and the prescribed dose to the relevant instructions.