Tehran University of Medical Sciences Journal of Pharmaceutical Care 2322-4630 13 4 2025 12 31 269 282 Maryam Shahrokhi Clinical Research Development Center of Imam Khomeini Hospital, Jiroft University of Medical Sciences, Jiroft, Iran Shohreh Maleknejad Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran Mahdi Ahmadinia Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Nazanin Nikkhooy Student Research Committee, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran Faezeh Jamali Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran Roja Qobadighadikolaei Department of Clinical Pharmacy, School of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran 2025 10 14 2026 01 07 Background: Proton pump inhibitors (PPIs), including intravenous (IV) pantoprazole, are frequently prescribed in hospital settings. Although effective, IV formulations are often used inappropriately, leading to unnecessary risks and increased financial burden. Data on IV pantoprazole use in pediatric populations remain limited. Methods: This study was designed as a retrospective, descriptive, cross-sectional Drug Utilization Evaluation (DUE) conducted in a tertiary pediatric teaching hospital. All inpatients aged ≥3 months who received at least one dose of IV pantoprazole during hospitalization were included. Prescribing appropriateness was evaluated according to international guidelines with respect to indication, dose, route, and duration. Opportunities for intravenous-to-oral (IV-to-PO) conversion and direct medication costs were also assessed. Results: A total of 260 pediatric patients were analyzed. Overall, 42% of IV pantoprazole prescriptions were classified as appropriate, reflecting the composite appropriateness score across all evaluated domains (indication, dose, route, and duration). The majority of prescribing errors were related to unjustified indications and prolonged duration of therapy. Nearly 81% of eligible patients did not undergo IV-to-PO conversion. Dosing deviations were uncommon. Economic analysis showed that 76.6% of total pantoprazole expenditures were attributable to inappropriate use, corresponding to approximately 1.57 billion Iranian Rials (IRR) [≈8,300 United States dollars (USD)]. The Internal Medicine II ward accounted for the highest absolute excess cost, while the Surgery ward demonstrated 92.3% inappropriate prescribing. Conclusion: PInappropriate use of IV pantoprazole is prevalent among pediatric inpatients, primarily driven by unjustified indications and missed opportunities for IV-to-PO conversion. These practices impose substantial economic costs and raise safety concerns. Implementation of pharmacist-led DUE and stewardship interventions may improve prescribing practices, reduce unnecessary expenditures, and enhance the quality of pediatric patient care. https://jpc.tums.ac.ir/index.php/jpc/article/view/906 https://jpc.tums.ac.ir/index.php/jpc/article/download/906/438