Omeprazole or Pantoprazole? Understanding the Differences
Key takeaways:
Pantoprazole (Protonix) and omeprazole (Prilosec) are in a group of medications called proton pump inhibitors (PPIs). They’re effective medications for treating gastroesophageal reflux disease (GERD).
Common side effects of PPIs include headache and diarrhea. They can also cause long-term problems like weakening bones and kidney issues.
Both medications have potential drug interactions, but omeprazole is more likely to interact with other medications.
There are ways to save on pantoprazole and omeprazole, which are available as both brand-name and generic medications. GoodRx can help you find ways to save, with an exclusive cash price for brand-name Protonix.
Table of contents
Gastroesophageal reflux disease (GERD) affects around 20% of the U.S. population. And this estimate might be low, since not all people with GERD have a diagnosis from a healthcare provider.
GERD happens when the acid from your stomach flows backwards to the esophagus (a tube that connects your stomach and mouth). This can lead to heartburn. If you experience heartburn more than twice a week, you might have GERD. Certain lifestyle and diet changes can help improve symptoms — like avoiding alcohol and spicy foods, and not eating meals too close to bedtime.
But if these lifestyle changes don’t work, medications are available. Proton pump inhibitors (PPIs) are a group of medications commonly used to treat GERD. Here, we’ll discuss two PPIs: pantoprazole (Protonix) and omeprazole (Prilosec). These medications work similarly and have some of the same side effects, but there are differences you should know about. Keep reading to learn about the difference between omeprazole and pantoprazole.
What is pantoprazole?
Pantoprazole is only available by prescription in brand-name and generic products. It’s available in oral and intravenous (IV) forms.
The injectable form of pantoprazole has to be administered in an inpatient setting, like in a hospital. The oral forms are delayed-release (DR) products that prevent the medication from being released immediately after taking it. This helps control where it’s released in the body.
Oral pantoprazole products include tablets (20 mg and 40 mg) and granules (40 mg only). The granules should be mixed in apple juice or apple sauce.
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What conditions does pantoprazole treat?
Pantoprazole is FDA-approved to treat active GERD with erosive esophagitis (inflammation of and damage to the esophagus) in adults and children at least 5 years of age. It’s approved for short-term treatment (8 to 16 weeks). It's also approved to prevent repeat esophagitis flares due to GERD in adults.
Pantoprazole is also approved to treat conditions that cause the stomach to produce too much acid, like Zollinger-Ellison Syndrome.
What is omeprazole?
Omeprazole is available in several DR forms. These include:
Capsules: 10 mg, 20 mg, and 40 mg
Tablets: 20 mg
Granule packets (for mixing with water to make an oral liquid): 2.5 mg and 10 mg
The 20 mg tablets, capsules, and ODTs are available over the counter (OTC). The 10 mg and 40 mg capsules, and the packets of granules, are prescription-only.
All formulations of omeprazole are available as generics, except the granule packets, which are brand-name only.
What conditions does omeprazole treat?
Prescription omeprazole is FDA-approved for many health conditions:
GERD in adults and children who are at least 1 year old
GERD with erosive esophagitis, and the prevention of future esophagitis flares in adults and children who are at least 1 month old
Duodenal (small intestine) ulcers
Conditions where the stomach overproduces acid, like Zollinger-Ellison Syndrome
Bacterial infections caused by Helicobacter pylori (must be taken together with antibiotics)
OTC Prilosec is FDA-approved to treat heartburn, which can be a symptom of GERD.
How do PPIs work for GERD?
PPIs, like pantoprazole and omeprazole, block an enzyme (protein) known as the proton pump in the cells of your stomach lining. This enzyme helps release acid into the stomach. By blocking the proton pump, PPIs lower acid levels in the stomach. This relieves symptoms of GERD.
How are pantoprazole and omeprazole dosed?
It’s common to take PPIs at least 30 minutes before the first meal of the day. If you have trouble swallowing pills, you can try pantoprazole or omeprazole packets. You can also open omeprazole capsules and sprinkle the contents on a tablespoon of applesauce. Omeprazole ODTs are also a good option if you have trouble swallowing because they dissolve on the tongue. Pantoprazole tablets should never be cut, crushed, or chewed.
Other important dosing information is below.
| Pantoprazole | Omeprazole | |
|---|---|---|
| Dose | Up to 40 mg once daily for esophagitis due to GERD and prevention of future flares |
20 mg once daily for treatment of GERD, esophagitis due to GERD, prevention of future esophagitis flares |
| Treatment length | Esophagitis due to GERD: Up to 8 weeks Prevention of future esophagitis flares: Patients in clinical trials used it for up to 1 year |
Esophagitis due to GERD: Up to 8 weeks Active GERD without esophagitis: Up to 4 weeks Prevention of future esophagitis flares: Patients in clinical trials used it for up to 1 year |
| With or without food? | Either | Works best on an empty stomach |
How effective are pantoprazole and omeprazole at treating GERD?
PPIs are considered the most effective treatment for GERD, but one PPI isn't necessarily better than another.
A study of over 600 people with esophagitis due to GERD compared pantoprazole 10 mg, 20 mg, and 40 mg to placebo (a pill with nothing in it). The study found all three doses of pantoprazole were better than placebo at healing esophagitis. And, the higher the pantoprazole dose, the more people that responded.
Another study of omeprazole found that omeprazole 10 mg and omeprazole 20 mg were more effective than placebo at improving GERD symptoms. And omeprazole 20 mg was more effective than omeprazole 10 mg.
So, the difference between PPIs may come down to the dose you use, not which PPI you choose. And, though both omeprazole and pantoprazole are effective, you still might tolerate one better than another. For example, omeprazole is known to have more drug interactions than pantoprazole, so pantoprazole may be a better option if you take multiple other medications.
What are the side effects of pantoprazole and omeprazole?
PPIs have similar side effects. Possible side effects of omeprazole and pantoprazole include:
Headache
Diarrhea
Abdominal pain
Vomiting
Gas
Dizziness
Nausea
What are the serious side effects of pantoprazole and omeprazole?
Long-term use of pantoprazole and omeprazole may cause more serious side effects. These include:
Weakening of your bones: This can put you at a higher risk of fractures. You may need calcium and vitamin D supplements to help prevent fractures if using PPIs long-term.
Low B-12 and magnesium levels: Ask your healthcare provider if you need to take B-12 or magnesium supplements while taking a PPI, especially if you’ve been taking them for a long time.
Kidney damage: Talk to your provider if you have pain or blood when urinating, or if you have nausea, fever, or confusion.
Severe diarrhea: Rarely, PPIs can lead to a serious bacterial infection (Clostridioides difficile) that causes severe diarrhea, fever, and stomach pain. Talk to your healthcare provider if you experience these symptoms.
Lupus: Pantoprazole and omeprazole can cause or worsen lupus, an autoimmune disease. Talk to your provider if you experience rash, fever, or extreme fatigue.
Small growths in the stomach: PPIs may cause abnormal tissue growths (polyps) in the stomach. This risk is higher with long-term use.
What interactions do pantoprazole and omeprazole have?
Omeprazole is known to have more drug interactions than pantoprazole. This is because omeprazole is more likely to have an effect on enzymes in the body that are responsible for breaking down many other medications.
High doses of omeprazole may lower the effects of clopidogrel (Plavix), an antiplatelet medication. Pantoprazole has been shown to have less of an effect on clopidogrel.
Both pantoprazole and omeprazole lower the effectiveness of Edurant (rilpivirine), an antiretroviral that treats HIV. Avoid Edurant or combination medications containing rilpivirine if you take one of these PPIs.
Below is a list of other medications that can interact with pantoprazole or omeprazole, but it’s not a complete list. Make sure to show your pharmacist and healthcare provider a list of your current medications before starting any PPI. They can help you figure out if you’re at risk of any drug interactions.
Certain antiretrovirals used to treat HIV
Warfarin (Coumadin, Jantoven)
Methotrexate (Trexall)
Ketoconazole tablets
Mycophenolate (CellCept)
Citalopram (Celexa)
Phenytoin (Dilantin, Phenytek)
Digoxin (Lanoxin)
Diazepam (Valium)
Iron supplements (e.g., ferrous sulfate)
How much do pantoprazole and omeprazole cost?
Pantoprazole and omeprazole are each available as both brand-name and generic medications.
Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase a 30-day supply of Protonix at an exclusive cash price of $200.10. You may also pay as little as $9.00 for a 30-day supply of generic pantoprazole with a free GoodRx coupon.
Prescription omeprazole's price at certain pharmacies is as low as $5.88 with a free GoodRx discount. OTC omeprazole's price at certain pharmacies is as low as $6.38 with a free GoodRx discount. Check out our article on how to use a GoodRx coupon for OTC products.
Can you take pantoprazole and omeprazole together for GERD?
You shouldn’t.
Both medications work similarly to treat GERD. If you take them together, you can put yourself at risk for more side effects. If you’re not getting enough relief from your PPI, talk to your healthcare provider. They may be able to switch you to a different medication that works better.
The bottom line
Pantoprazole and omeprazole are effective treatments for GERD. They’re usually well tolerated, but may cause side effects like headache and diarrhea. You’re at higher risk of serious complications from these medications if you take them for long periods of time. These risks include bone fractures and kidney problems.
Both medications have potential drug interactions, but they’re more common with omeprazole. Make sure your healthcare provider and pharmacist know all the medications you take so they can check for drug interactions.
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References
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Food and Drug Administration. (2017). FDA Drug Safety Communication: Possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors.
Katz, P. O., et al. (2022). ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. The American Journal of Gastroenterology.
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