Subcutaneous pantoprazole in an elderly, palliative care patient

Abstract

Proton pump inhibitors (PPIs) have become the agents of choice for acid-related diseases. In some clinical situations, PPI therapy by oral or intravenous route may be difficult especially among elderly and patients in palliative care. Off-label PPI subcutaneous injection could be the last alternative to improve patient relief, despite limited published data. We report a case of linitis plastica, peritoneal carcinomatosis and occlusive syndrome who suffered from painful regurgitations which rapidly improved after subcutaneous pantoprazole. No related adverse effects were observed during PPI therapy. Despite some limitations, this report suggests that off-label subcutaneous pantoprazole could be an interesting alternative route when intravenous infusion may be difficult or harmful for elderly and patients in palliative care. Nevertheless, clinical safety and efficiency data on larger populations are needed to validate this use in such population.

Administering esomeprazole subcutaneously via a syringe driver in the palliative demographic: A case series

“…Currently, improvement in dyspeptic symptoms with subcutaneous PPIs has only been shown in a small series ( n = 3) by Agar et al (where patients were given intermittent infusions of omeprazole) and in a single report by Michelon et al (in which a single patient was given pantoprazole as subcutaneous boluses). 7,9 In the latter case, scopolamine and pantoprazole were commenced simultaneously, so it is unclear which drug improved the patient's symptoms. Desmidt & Costans (2009), also reported reduction in abdominal pain (likely secondary to severe gastric ulcers) in one of their patients commenced on esomeprazole 8 .…”

“…Volumes of 50−100 ml have typically been infused over various time durations (20 min-4 h) from a bag. 7,8 Michelon et al, 9 however, administered pantoprazole, reconstituted to 10 ml, as a bolus injection.…”

“…was given pantoprazole as subcutaneous boluses). 7,9 In the latter case, scopolamine and pantoprazole were commenced simultaneously, so it is unclear which drug improved the patient's symptoms. Desmidt & Costans (2009), also reported reduction in abdominal pain (likely secondary to severe gastric ulcers) in one of their patients commenced on esomeprazole.…”

“…Anecdotally, injectable Omeprazole ( n = 3) and Esomeprazole ( n = 2) have been administered as intermittent subcutaneous infusions and pantoprazole ( n = 1) has been administered as a subcutaneous bolus, all with positive outcomes 7–9 …”

“…6 Anecdotally, injectable Omeprazole (n = 3) and Esomeprazole (n = 2) have been administered as intermittent subcutaneous infusions and pantoprazole (n = 1) has been administered as a subcutaneous bolus, all with positive outcomes. [7][8][9] Nonetheless, evidence to support the routine use of subcutaneous PPIs in the palliative demographic remains limited.…”