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Pantoprazole (Protonix): Your Most Common Questions Answered

Answers to the Most Commonly Asked Questions Regarding how to Use Pantoprazole

Pantoprazole is a proton-pump inhibitor (PPI) that reduces the amount of acid being produced in your stomach. It is used to treat conditions such as gastroesophageal reflux disease (GERD) and Zollinger-Ellison syndrome.

In this article, we answer some of the most frequently asked questions people have about pantoprazole.

The content on this page is provided for informational purposes only. If you have any questions or concerns about your treatment, you should talk to your doctor, pharmacist, or healthcare professional. This is particularly important if you are taking multiple medications or have any existing medical conditions.

What is pantoprazole?

Pantoprazole (sold under the brand name Protonix) belongs to a class of drugs called proton-pump inhibitors (PPIs). It helps reduce the amount of acid being produced in your stomach.

It comes in the form of tablets or as oral suspension granules. It can also be injected intravenously, although this is only done if it is impossible for it to be taken by mouth and no other treatment options are available.

What is pantoprazole used for?

Pantoprazole is most commonly used to treat gastroesophageal reflux disease (GERD) and Zollinger-Ellison syndrome.

GERD (or GORD in the UK and other countries where esophagus is spelled oesophegus) is a condition that causes acid and food to travel back up the esophagus (commonly called your food pipe or gullet).

Pantoprazole may be used to reduce the amount of acid being produced in your stomach, while other medications and/or surgery may be used to strengthen or tighten your sphincter (the muscle at the bottom of the esophagus. The sphincter not closing properly is what allows acid and food to travel back into your esophagus).

Zollinger-Ellison syndrome is a rare disease that causes tumors, called gastrinomas, to form in your pancreas or the upper part of your small intestine. Gastrinomas secrete a hormone called gastrin that promotes the production of acid in your stomach.

How does pantoprazole work?

One of the key steps in the production of acid in the stomach relates to an enzyme called H+, K+ -ATPase, or the gastric proton-pump, which is responsible for the secretion of acid.

Once pantoprazole is absorbed by the body, it binds to the proton-pump and prevents the secretion of acid, hence the name proton-pump inhibitor. This binding is believed to be largely or completely irreversible, meaning the body must produce (synthesize) more enzymes in order to begin secreting acid again.

This irreversible binding means the effects of pantoprazole last much longer than its short half-life, which is about one hour, would suggest because it takes roughly 24 hours for new proton pumps to be synthesized. Pantoprazole is, therefore, taken only once or twice per day.

One downside to the short half-life of pantoprazole is that it does not have time to inhibit all of the gastric proton pumps. It also makes it difficult to inhibit proton pumps that are activated during the night. In this respect, an older class of drugs that also decrease acid production, called H2 receptor blockers, are more effective and may be more suitable for certain conditions (such as peptic ulcers).

However, PPIs are generally considered stronger and more effective at reducing stomach acid than H2 receptor blockers, so are the preferred option for GERD and Zollinger-Ellison syndrome.

Another common class of drugs used to treat issues caused by stomach acid is antacids. Antacids do not prevent the production of acid, they neutralize it. One of the benefits of antacids is that they tend to work quickly, whereas PPIs can take up to a week. However, while antacids may be able to relieve issues such as heartburn, they are not as effective against conditions such as GERD.

What is pantoprazole sodium?

The terms ‘pantoprazole’ and ‘pantoprazole sodium’ and refer to the same drug. The word ‘sodium’ simply gives more information about its chemical makeup but is often dropped from the name for convenience.

Sodium is the salt chemically attached to pantoprazole. Pantoprazole, like many medications, is made into its salt form to improve its solubility in water in order to increase absorption and provide the maximum therapeutic effect. Sodium is the salt of pantoprazole.

Is pantoprazole available over the counter?

Pantoprazole is only available with a prescription so is not available over the counter in the US, Canada, or the UK. This may vary in other countries (in New Zealand, for example, it is a pharmacy-only or restricted medicine, meaning it does not require a doctor’s prescription but is subject to other restrictions).

Other PPIs, including lansoprazole, esomeprazole, and omeprazole, can be bought over the counter at certain strengths. According to the FDA, they are only intended for a 14-day course and can be used up to three times per year for treating heartburn.

For how long should I take pantoprazole?

How long you take pantoprazole depends on your condition.

Erosive esophagitis caused by GERD

For erosive esophagitis (inflammation, irritation, or swelling of the esophagus) caused by GERD, adults are often prescribed 40 mg pantoprazole, taken once daily for up to eight weeks. If the treatment has not been completely effective, another course of up to eight weeks may be considered.

Children (5 years old and above) weighing between 15 kg and 40 kg may be prescribed 20 mg, taken once daily for up to eight weeks. Children weighing above 40 kg may be prescribed 40 mg once daily for up to eight weeks.

Maintenance of healing of erosive esophagitis

Long-term use of pantoprazole has been found to be an effective treatment for preventing heartburn in people living with GERD. The FDA recommends 40 mg pantoprazole taken once per day for this purpose.

However, doctors may be cautious to prescribe it as such, due to lack of information regarding the long-term safety of pantoprazole and to avoid ‘overtreating’ the condition.

Zollinger-Ellison syndrome

For chronic conditions that cause the body to overproduce stomach acid, most notably Zollinger-Ellison syndrome, pantoprazole is usually taken twice per day for life.

Treatment will usually start at 40 mg or 80 mg per day. It may be increased up to 240 mg per day.

When should I take pantoprazole?

When taken once daily, it is usually recommended that pantoprazole is taken first thing in the morning.

If you take pantoprazole twice daily for Zollinger-Ellison syndrome, you should speak to your doctor about the best way of managing your treatment.

Should I take pantoprazole with food or on an empty stomach?

Pantoprazole tablets can be taken with or without food. Do not crush, split, or chew the tablets.

Pantoprazole oral suspension granules should be taken around 30 minutes before a meal. The granules should be taken in one teaspoon of applesauce or apple juice in order to achieve the pH level required for stability.

When taken with applesauce, the granules should be sprinkled on a teaspoon with the applesauce and taken within 10 minutes of preparation. You should not crush or chew the granules. You should take a few sips of water afterward to make sure all the granules have been consumed.

When taken with apple juice, the granules should be stirred for five seconds with one teaspoon of apple juice in a cup and then swallowed immediately. Rinse the cup once or twice more with apple juice and drink it immediately to make sure you consume all the granules.

What are the side effects of pantoprazole?

Although pantoprazole is usually well tolerated, side effects can occur. The most common are:

  • Headache
  • Vomiting
  • Diarrhea
  • Gas
  • Nausea
  • Dizziness
  • Stomach pain
  • Pain in your joints

You should speak to your doctor if these side effects bother you or do not go away.

Pantoprazole can cause magnesium deficiency, especially when taken long-term. It can be serious, so you should speak to your doctor immediately if you experience the following symptoms:

  • Seizures
  • Dizziness
  • Abnormal or fast heartbeat
  • Jitteriness
  • Jerking movements or shaking (tremors)
  • Muscle weakness
  • Spasms of the hands and feet
  • Cramps or muscle aches
  • Spasm of the voice box

Other rare but serious side effects can include:

  • A rare condition called subacute cutaneous lupus erythematosus (SCLE). Certain drugs, including pantoprazole, can trigger symptoms in individuals with a genetic predisposition to SCLE. Red skin rashes on areas exposed to the sun could be a sign of SCLE
  • Yellow skin or the whites of your eyes turning yellow (possible liver damage)
  • Reduced amount of urine; swelling of your legs, ankles, and feet; or shortness of breath (possible kidney damage)

You should speak to your doctor as soon as possible if you notice any of these symptoms, or other symptoms of SCLE, liver damage, or kidney damage.

Allergic reactions to pantoprazole are rare but can occur. Signs of a serious allergic reaction should be treated as a medical emergency. They include:

  • Skin rash – for example itchy, red, or swollen skin
  • Wheezing
  • Tightness in the chest or throat
  • Trouble breathing or talking
  • Swollen mouth, face, lips, tongue, or throat

This is not an extensive list of possible side effects of pantoprazole. For more information about side effects, please read the information leaflet that comes with the medication or speak to your doctor or pharmacist.

Are there long-term side effects of pantoprazole?

Information on the long-term safety of pantoprazole is somewhat lacking.

There is some evidence linking it to atrophic gastritis, which is chronic inflammation of the mucous membrane layer of the stomach.

Long-term use of pantoprazole has also been linked with vitamin B-12 deficiency and an increased risk of osteoporosis-related fractures of the hip, wrist, or spine.

Because the long-term safety profile of pantoprazole is not well-known, doctors usually avoid prescribing it for prolonged periods of time unless absolutely necessary.

How long does pantoprazole stay in your system?

The half-life of a drug refers to the time it takes for 50% of the drug to be eliminated from the body. With each subsequent half-life, a further 50% of the remaining drug is eliminated.

Pantoprazole has an average half-life of just one hour. It takes approximately 5.5 x the half-life of a drug for it to be cleared from your system, which would mean it takes about five and a half hours for pantoprazole.

However, because of how pantoprazole works and the irreversible nature of the covalent binding (see question three: How does pantoprazole work), the effects last longer than the half-life suggests.

How long does it take for pantoprazole to work?

Pantoprazole usually starts working in two or three days, although it can take up to a week.

It can take up to four weeks for pantoprazole to fully work, so it is possible you will continue to experience symptoms until then.

Can I drink alcohol while taking pantoprazole?

Alcohol does not interact with pantoprazole or interfere with how it works.

However, alcohol does increase the production of stomach acid and can irritate the lining of your stomach. So, while alcohol does not interact with pantoprazole, it could worsen your underlying condition (such as stomach ulcers or GERD).

If you wish to consume alcohol while taking pantoprazole, you should discuss the safest way of doing so with your doctor.

What can interact with pantoprazole?

No foods or drinks are known to interact with pantoprazole.

There are some other drugs that may interact with pantoprazole, including:

  • Atazanavir and nelfinavir: Pantoprazole can reduce the absorption of these antiretroviral drugs, used to treat and prevent HIV/AIDS, making them less effective
  • Methotrexate: Pantoprazole may increase the blood levels of methotrexate and could worsen side effects. However, the nature of the interaction is not fully known
  • Kinase inhibitors: Pantoprazole can reduce the absorption and effectiveness of certain kinase inhibitor drugs, including acalabrutinib, dacomitinib, neratinib, dasatinib, erlotinib, and pazopanib
  • THC (the chemical associated with the high caused by cannabis): There are reports that PPIs, including pantoprazole, can cause a false positive in urine tests for THC. Although these claims are disputed, the FDA recommends an alternative confirmatory method should be considered to verify positive results

Although these are the most common and potentially serious drug interactions with pantoprazole, other interactions can occur. You should speak to your doctor about any other drugs and supplements you are taking along with pantoprazole.

Can I take pantoprazole when pregnant or breastfeeding?

Based on animal studies, there is no evidence that pantoprazole impairs fertility or harms a developing fetus. However, there is also a lack of evidence that it is safe in humans. It is, therefore, recommended that pantoprazole should only be used when clearly needed during pregnancy. You should inform your doctor if you are pregnant or trying to conceive, so an alternative medication with a more defined safety profile may be prescribed.

Another PPI, omeprazole, has a more defined safety profile and may be a suitable alternative.

Pantoprazole is generally considered safe to use while breastfeeding. It only passes into the breast milk in very small amounts which are unlikely to be harmful to the baby. However, you should always talk to your doctor first about any medications that you plan to take while pregnant or breastfeeding.

What’s the difference between pantoprazole and omeprazole?

Pantoprazole and omeprazole are both proton-pump inhibitors and very similar drugs regarding their structure, efficacy, uses, and side effects. Omeprazole has a slightly shorter half-life, but this is largely irrelevant because the effects of both last much longer than the half-life suggests (see question three: How does pantoprazole work).

Unlike omeprazole, pantoprazole can be given intravenously, which may make it the preferred option in certain situations.

As mentioned in the previous question, omeprazole has a more defined safety profile when it comes to using during pregnancy.

In many cases, however, the drugs offer the same therapeutic benefits. You can learn more about omeprazole here: Omeprazole.

The content on this page is provided for informational purposes only. If you have any questions or concerns about your treatment, you should talk to your doctor, pharmacist, or healthcare professional. This is particularly important if you are taking multiple medications or have any existing medical conditions.