Study (n=242) – Triple therapy:
40 mg orally twice daily for 7 days, commonly in conjunction with clarithromycin and either amoxicillin or metronidazole to eradicate Helicobacter pylori, followed with 40 mg pantoprazole orally once daily until day 28. Triple therapy has resulted in eradication rates of greater than 95%.
Pantoprazole SODIUM – Uses, Side Effects, and More
Pantoprazole is used to treat certain stomach and esophagus problems (such as acid reflux). It works by decreasing the amount of acid your stomach makes. This medication relieves symptoms such as heartburn, difficulty swallowing, and cough. It helps heal acid damage to the stomach and esophagus, helps prevent ulcers, and may help prevent cancer of the esophagus. Pantoprazole belongs to a class of drugs known as proton pump inhibitors (PPIs).
How to use Pantoprazole SODIUM
Read the Medication Guide provided by your pharmacist before you start taking pantoprazole and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Take this medication by mouth as directed by your doctor, usually once daily. Dosage and length of treatment are based on your medical condition and response to treatment.
If you are taking the tablets, you may take them with or without food. Swallow the tablets whole. Do not split, crush, or chew the medication. Doing so may destroy the drug.
If you are taking the granules, take your dose 30 minutes before a meal. To take it by mouth, open the packet and mix the granules in applesauce or apple juice. Do not mix with other foods or liquids. Do not crush or chew the granules. Sprinkle the granules on 1 teaspoon (5 milliliters) of applesauce and swallow all of the mixture right away (within 10 minutes). Follow with sips of water. Or you can mix the granules with 1 teaspoon (5 milliliters) of apple juice in a small cup, stir for 5 seconds, and swallow all of the mixture right away. To make sure you take the entire dose, rinse the cup once or twice with apple juice to mix any remaining granules, and swallow the juice. Do not prepare the mixture ahead of time for later use.
If you are giving the granules through a tube into the stomach (nasogastric or gastric tube), ask your health care professional for detailed instructions on how to properly mix and give it.
If needed, antacids may be taken along with this medication. If you are also taking sucralfate, take pantoprazole at least 30 minutes before sucralfate.
Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. Continue to take this medication for the prescribed length of treatment even if you are feeling better.
Tell your doctor if your condition lasts or gets worse. The risk of side effects goes up over time. Ask your doctor how long you should take this medication.
Side Effects
Headache or diarrhea may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.
Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if you have any serious side effects, including: symptoms of a low magnesium blood level (such as muscle spasms, irregular heartbeat, seizures), signs of lupus (such as rash on nose and cheeks, new or worsening joint pain).
This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn’t stop, abdominal or stomach pain/cramping, blood/mucus in your stool.
If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.
Rarely, proton pump inhibitors (such as pantoprazole) have caused vitamin B-12 deficiency. The risk is increased if they are taken every day for a long time (3 years or longer). Tell your doctor right away if you develop symptoms of vitamin B-12 deficiency (such as unusual weakness, sore tongue, or numbness/tingling of the hands/feet).
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing, signs of kidney problems (such as change in the amount of urine).
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Precautions
Before taking pantoprazole, tell your doctor or pharmacist if you are allergic to it; or to similar drugs (such as lansoprazole, omeprazole); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, lupus.
Some symptoms may actually be signs of a more serious condition. Get medical help right away if you have: heartburn with lightheadedness/sweating/dizziness, chest/jaw/arm/shoulder pain (especially with shortness of breath, unusual sweating), unexplained weight loss.
Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
Proton pump inhibitors (such as pantoprazole) may increase your risk for bone fractures, especially with longer use, higher doses, and in older adults. Talk with your doctor or pharmacist about ways to prevent bone loss/fracture, such as by taking calcium (such as calcium citrate) and vitamin D supplements.
Older adults may be more sensitive to the side effects of this drug, especially bone loss and fractures (see above), and C. difficile infection (see Side Effects section).
During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.
This medication passes into breast milk. Consult your doctor before breast-feeding.
Interactions
See also How to Use section.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
A product that may interact with this drug is: methotrexate (especially high-dose treatment).
Some products need stomach acid so that the body can absorb them properly. Pantoprazole decreases stomach acid, so it may change how well these products work. Some affected products include ampicillin, atazanavir, erlotinib, levoketoconazole, nelfinavir, pazopanib, rilpivirine, sparsentan, certain azole antifungals (itraconazole, ketoconazole, posaconazole), among others.
This medication may interfere with certain laboratory tests (including urine test for tetrahydrocannabinol-THC, blood test to find certain tumors), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.
Pantoprazole
Medically reviewed by Philip Thornton, DipPharm. Last updated on Jan 24, 2023.
What is pantoprazole?
Pantoprazole is a proton pump inhibitor that decreases the amount of acid produced in the stomach.
Pantoprazole is used to treat erosive esophagitis (damage to the esophagus from stomach acid caused by gastroesophageal reflux disease, or GERD) in adults and children who are at least 5 years old. Pantoprazole is usually given for up to 8 weeks at a time while your esophagus heals.
Pantoprazole is also used to treat Zollinger-Ellison syndrome and other conditions involving excess stomach acid.
Warnings
Pantoprazole is not for the immediate relief of heartburn symptoms.
Heartburn is often confused with the first symptoms of a heart attack. Seek emergency medical attention if you have chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, and a general ill feeling.
Long-term treatment with pantoprazole may also make it harder for your body to absorb vitamin B-12, resulting in a deficiency of this vitamin. Talk with your doctor if you need long-term pantoprazole treatment and you have concerns about vitamin B-12 deficiency.
Pantoprazole can cause kidney problems. Tell your doctor if you are urinating less than usual, or if you have blood in your urine.
Diarrhea may be a sign of a new infection. Call your doctor if you have diarrhea that is watery or has blood in it.
Pantoprazole may cause new or worsening symptoms of lupus. Tell your doctor if you have joint pain and a skin rash on your cheeks or arms that worsens in sunlight.
You may be more likely to have a broken bone while taking this medicine long term or more than once per day.
Before taking this medicine
Heartburn can mimic early symptoms of a heart attack. Get emergency medical help if you have chest pain that spreads to your jaw or shoulder and you feel anxious or light-headed.
You should not use this medicine if:
- you also take medicine that contains rilpivirine (Edurant, Complera, Juluca, Odefsey);
- if you had breathing problems, kidney problems, or a severe allergic reaction after taking pantoprazole in the past; or
- you are allergic to pantoprazole or similar medicines (lansoprazole, omeprazole, Nexium, Prevacid, Prilosec, and others).
Tell your doctor if you have ever had:
- low levels of magnesium in your blood;
- lupus; or
- osteoporosis or low bone mineral density.
You may be more likely to have a broken bone while using pantoprazole long-term or more than once per day. Talk with your doctor about ways to keep your bones healthy, especially if you are an adult over 50.
It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
You should not breast-feed while using this medicine.
Pantoprazole is not approved for use by anyone younger than 5 years old.
How should I use pantoprazole?
Take pantoprazole exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.
Use the lowest dose for the shortest amount of time needed to treat your condition.
Pantoprazole is taken by mouth (oral) or given as an infusion into a vein (injection). A healthcare provider may teach you how to properly use the injection by yourself.
Pantoprazole tablets are taken by mouth, with or without food. The oral granules should be taken 30 minutes before a meal.
Do not crush, chew, or break the tablet. Swallow it whole.
The oral granules should be mixed with applesauce or apple juice and given either by mouth or through a nasogastric (NG) tube.
Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you have any questions.
Use this medicine for the full prescribed length of time, even if your symptoms quickly improve.
Call your doctor if your symptoms do not improve or if they get worse while you are using this medicine.
Pantoprazole can cause false results with certain medical tests. Tell the doctor or laboratory staff that you are using this medicine.
Pantoprazole may also affect a drug-screening urine test and you may have false results. Tell the laboratory staff that you use this medicine.
Store this medicine at room temperature away from moisture, heat, and light.
Dosing information
Usual Adult Dose for Erosive Esophagitis:
Treatment of Erosive Esophagitis:
40 mg orally once a day for up to 8 weeks; however an additional 8 weeks may be considered for patients who have not healed after the initial treatment. Safety and efficacy beyond 16 weeks of therapy have not been established.
Maintenance of Healing of Erosive Esophagitis:
40 mg orally once a day. Controlled studies have been limited to 12 months of pantoprazole therapy.
Usual Adult Dose for Gastroesophageal Reflux Disease:
Parenteral: 40 mg once a day for 7 to 10 days, administered via intravenous infusion over a period of 15 minutes. Intravenous therapy should be discontinued as soon as the patient is able to resume oral therapy.
Oral: 40 mg orally once a day, for short-term administration (up to 8 weeks); however an additional 8 weeks may be considered for patients who have not healed after the initial treatment. Safety and efficacy beyond 16 weeks of therapy have not been established.
Usual Adult Dose for Duodenal Ulcer:
Study (n=54)
40 mg orally once a day, dose was increased every 12 weeks by 40 mg increments to a maximum of 120 mg per day, for 28 weeks. Data have revealed that monotherapy with daily doses of 40 mg have been associated with complete duodenal ulcer healing in up to 87% and 94% of patients after 4 weeks and 8 weeks respectively.
Usual Adult Dose for Gastric Ulcer:
40 mg orally once a day. Data have revealed that monotherapy with daily doses of 40 mg have been associated with complete gastric ulcer healing in up to 87% and 97% of patients after 4 weeks and 8 weeks respectively.
Usual Adult Dose for Helicobacter pylori Infection:
Study (n=242) – Triple therapy:
40 mg orally twice daily for 7 days, commonly in conjunction with clarithromycin and either amoxicillin or metronidazole to eradicate Helicobacter pylori, followed with 40 mg pantoprazole orally once daily until day 28. Triple therapy has resulted in eradication rates of greater than 95%.
The QUADRATE Study (n=405) – Quadruple therapy:
40 mg orally twice daily for 7 days, concomitantly with bismuth subcitrate and tetracycline, both four times daily, and metronidazole 200 mg three times daily and 400 mg at bedtime. Helicobacter Pylori eradication was achieved in 82% of patients.
Usual Adult Dose for Zollinger-Ellison Syndrome:
Parenteral: 80 mg every 12 hours, administered by 15-minute infusion. Daily doses higher than 240 mg administered in equally divided doses by 15-minute infusion, or administered for more than 6 days have not been studied.
Oral: 40 mg twice daily, to a maximum of 240 mg per day. Some patients have received treatment with pantoprazole for more than 2 years.
Usual Adult Dose for Stress Ulcer Prophylaxis:
Study (n=21) – Stress Ulcer bleeding prophylaxis in the Critical Care Setting:
80 mg twice daily, as a bolus infusion over a period of 15 minutes, to a maximum daily dose of 240 mg, divided into three equal doses.
Study (n=20 ) – Peptic Ulcer rebleeding prophylaxis after hemostasis in the Critical Care Setting:
80 mg IV bolus, followed by continuous infusion of 8 mg/hr for 3 days, after which therapy may be continued with an oral PPI.
Usual Adult Dose for Peptic Ulcer:
Study (n=21) – Stress Ulcer bleeding prophylaxis in the Critical Care Setting:
80 mg twice daily, as a bolus infusion over a period of 15 minutes, to a maximum daily dose of 240 mg, divided into three equal doses.
Study (n=20 ) – Peptic Ulcer rebleeding prophylaxis after hemostasis in the Critical Care Setting:
80 mg IV bolus, followed by continuous infusion of 8 mg/hr for 3 days, after which therapy may be continued with an oral PPI.
What happens if I miss a dose?
Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while using pantoprazole?
This medicine can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.
Pantoprazole side effects
Get emergency medical help if you have signs of an allergic reaction to pantoprazole: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
- severe stomach pain, diarrhea that is watery or bloody;
- sudden pain or trouble moving your hip, wrist, or back;
- bruising or swelling where intravenous pantoprazole was injected;
- kidney problems – fever, rash, nausea, loss of appetite, joint pain, urinating less than usual, blood in your urine, weight gain;
- low magnesium – dizziness, fast or irregular heart rate, tremors (shaking) or jerking muscle movements, feeling jittery, muscle cramps, muscle spasms in your hands and feet, cough or choking feeling; or
- new or worsening symptoms of lupus – joint pain, and a skin rash on your cheeks or arms that worsens in sunlight.
Taking pantoprazole long-term may cause you to develop stomach growths called fundic gland polyps. Talk with your doctor about this risk.
If you use pantoprazole for longer than 3 years, you could develop a vitamin B-12 deficiency. Talk to your doctor about how to manage this condition if you develop it.
Common pantoprazole side effects may include:
- headache, dizziness;
- stomach pain, gas, nausea, vomiting, diarrhea;
- joint pain; or
- fever, rash, or cold symptoms (most common in children).
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect pantoprazole?
Tell your doctor about all your other medicines. Some may interact with pantoprazole, especially:
- digoxin;
- methotrexate; or
- a diuretic or “water pill.”
This list is not complete. Other drugs may affect pantoprazole, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.
Popular FAQ
When should you take pantoprazole?
Take pantoprazole tablets immediately before a meal, preferably in the morning. Pantoprazole tablets may be taken with food or on an empty stomach. Swallow the tablet whole. Do not crush, break, or chew the tablet.
Can pantoprazole cause anxiety?
Pantoprazole may cause side effects, but it does not seem to cause anxiety. Some people in clinical trials reported headaches while taking pantoprazole. Less than 2% of people in clinical trials also reported depression and vertigo (dizziness).
There is some clinical evidence that shows that people with gastroesophageal reflux disease (GERD) sometimes also have anxiety and depression. In one clinical study, pantoprazole and the antidepressant drug amitriptyline were found to be safe and effective in treating people with both GERD and anxiety.
How long does pantoprazole take to work?
Pantoprazole starts to work within 2 and a half (2.5) hours – this is the time it takes for it to block the secretion of acid in the stomach – and lasts for 24 hours. Pantoprazole does not provide fast-acting relief from indigestion, acid reflux, or dyspepsia symptoms like antacids such as Tums or Maalox do, and will not treat current symptoms. It may take up to 4 weeks for pantoprazole to work properly so you may still have some symptoms during this time.
Pantoprazole and omeprazole are both medicines from the class of medications called proton pump inhibitors (PPIs). The approved uses for pantoprazole and omeprazole differ slightly, but they are all disorders related to too much stomach acid. Continue reading
The usual dosage for pantoprazole 40mg is 40mg once a day if you are buying it without a prescription or a physician’s evaluation of your symptoms. The only conditions that pantoprazole 40mg twice a day is recommended for are those characterized by excessively high gastric acid secretion such as Zollinger Ellison syndrome, and if you have these conditions then you should be under the care of a physician. Studies have shown that for reflux, dyspepsia, or GERD, dosages higher than 40mg did not offer any further significant lowering of stomach acid than 40mg dosages. Continue reading
You should only take pantoprazole for up to 8 weeks if you are buying it without a prescription or a physician evaluation of your symptoms. This is because certain stomach symptoms that persist for more than 4 to 8 weeks should be investigated by a doctor, as they may be a sign of something more serious, such as cancer. Pantoprazole is very good at relieving and hiding serious stomach symptoms, which may make you think you don’t need to see a physician. Long-term use of pantoprazole has also been associated with vitamin B12 deficiency; low magnesium, calcium, iron, or vitamin C levels; and an increased risk of fractures of the hip, wrist, or spine. Elderly, the malnourished, or those on dialysis are more at risk. Continue reading
Bloating has been reported as a side effect of regular pantoprazole use. One study reported bloating in 43% of patients taking a similar proton pump inhibitor to pantoprazole (called esomeprazole) after 8 weeks. By 6 months, over 50% reporting bloating. Other similar side effects reported with pantoprazole that also can have bloating as a side effect include flatulence, abdominal pain, and diarrhea. Symptoms of bloating include tightness, fullness, or swelling of your stomach area. Continue reading
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