5 Pantoprazole Interactions You Should Know About
Key takeaways:
Pantoprazole (Protonix) is a proton pump inhibitor (PPI) medication. While some PPIs are available over the counter, pantoprazole is only available with a prescription.
Pantoprazole works by decreasing the amount of acid released in your stomach. This can affect how other medications are absorbed by your body.
Compared to other PPIs, interactions may be less likely with pantoprazole. But your healthcare provider may still need to monitor or adjust your medications.
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Compared to other proton pump inhibitors (PPIs), pantoprazole (Protonix) has a few advantages. You can take it with or without food at any time of day. And it also tends to have fewer interactions, too. But that doesn’t mean there aren’t any pantoprazole interactions at all.
Pantoprazole works by decreasing the amount of acid in your stomach. And certain medications — including some that treat HIV and cancer — need acid to be absorbed. Does this mean you need to avoid pantoprazole altogether? Not usually.
Let’s discuss a few important pantoprazole interactions and how to manage them.
1. Warfarin
Warfarin (Coumadin, Jantoven) is a blood thinner used to prevent and treat blood clots. It requires regular monitoring to ensure your warfarin dosage is safe and effective. That’s because many things, including certain foods and medications, can interact with it.
PPIs, like omeprazole (Prilosec), are known to interact with warfarin. This interaction tends to be less likely with pantoprazole, but it may still be possible. In this case, warfarin may stick around in your body longer, putting you at risk for serious bleeding or bruising.
Tell your healthcare provider if you plan to start taking a PPI like pantoprazole. They can tell you if it’s safe for you to take. If you’re already taking this combination, let them know if you notice any new or unusual bruising or bleeding. This could be a sign your warfarin dosage is too high. And you should let them know if you plan to stop taking pantoprazole, too.
2. HIV medications
HIV can be treated with many different medications. A few of them are known to interact with PPIs like pantoprazole. Examples include rilpivirine (Edurant), atazanavir (Reyataz), or combination medications that contain them.
Both rilpivirine and atazanavir require acid to be absorbed from your stomach into your body. So, pantoprazole’s acid-blocking effects can decrease the amount that’s absorbed. This can result in lower HIV medication levels in your body. Your HIV may not be as controlled, and the virus could become resistant to your medication.
Avoid taking pantoprazole with rilpivirine. Your healthcare provider will determine if or when it’s safe for you to take pantoprazole with atazanavir. In some cases, they may have you separate both medications by at least 12 hours.
Interactions are common with HIV medications. Speak with your healthcare provider before starting any new medication — whether it be prescription or over the counter (OTC) — or supplement. That goes for stopping them, too.
3. Mycophenolate mofetil
Mycophenolate mofetil (CellCept) is an immunosuppressant medication. It’s often used to prevent organ transplant rejection. It’s best absorbed when there’s a consistent amount of acid in your stomach. So, pantoprazole may prevent mycophenolate mofetil from being absorbed as well. This may lessen its effectiveness.
Your healthcare provider will be monitoring your blood work during treatment. And they’ll ensure the medications you’re taking are compatible with your transplant regimen. If needed, they may adjust your mycophenolate mofetil dosage to ensure it’s safe and effective for you.
This interaction is possible with all medications that decrease stomach acid. Your healthcare provider can suggest options that are safe with your transplant medications. Let them know if you start or stop taking any other medications.
4. Certain oral cancer medications
Erlotinib (Tarceva), dasatinib (Sprycel), and nilotinib (Tasigna) treat different types of cancer. Like mycophenolate mofetil, they need acid to be properly absorbed by your body. PPIs like pantoprazole can prevent them from being absorbed as well.
It’s estimated that up to 33% of people with cancer are taking acid-blocking medications — with PPIs used the most. But if there’s an interaction with a cancer medication, it’s generally recommended to avoid PPIs if possible.
There are many other potential interactions between PPIs and cancer medications. Your cancer specialist can suggest safer alternatives that are compatible with your cancer treatment.
5. Iron supplements
Iron supplements are sometimes taken by people with iron-deficiency anemia. This is when low iron levels in your blood result in your body making fewer red blood cells. They’re most commonly taken by mouth.
Oral iron supplements are best absorbed in an acidic environment. So, you may not absorb as much iron if you take them with pantoprazole.
Your healthcare provider can recommend how to manage this interaction. This may depend on how long you’ve been taking pantoprazole and your iron levels. In some cases, iron infusions may be given if you’re unable to absorb oral iron supplements.
When should I contact my healthcare provider about a pantoprazole interaction?
It’s best to catch potential medication interactions ahead of time. Be sure to give your healthcare provider your current medication list for review. That way, they’ll be able to check for interactions with any new medications. Your pharmacist is also a great resource.
Many pantoprazole interactions involve medications that are closely monitored for safety and effectiveness. Your healthcare provider will likely make adjustments to your regimen as necessary. But if you notice any new changes or side effects after starting pantoprazole, let them know.
The bottom line
Pantoprazole can interact with warfarin, HIV drugs, iron supplements, and more. Many of pantoprazole’s interactions are related to its ability to lower acid in your stomach. Several medications need stomach acid to be absorbed.
Compared to other PPIs, pantoprazole tends to have fewer interactions. But when needed, your healthcare provider may adjust your regimen to ensure it’s safe and effective for you. Some medications need to be avoided when taking pantoprazole. Others should be monitored more closely.
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References
Camber Pharmaceuticals, Inc. (2022). Atazanavir [package insert].
Clinical Info. (2021). Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV.
Ems, T., et al. (2022). Biochemistry, iron absorption. StatPearls.
Genentech USA, Inc. (2022). Cellcept [package insert].
Uchiyama, A. A. T., et al. (2021). Proton pump inhibitors and oncologic treatment efficacy: A practical review of the literature for oncologists. Current Oncology.
Wedemeyer, R. S., et al. (2014). Pharmacokinetic drug interaction profiles of proton pump inhibitors: An update. Drug Safety.
Wyeth Pharmaceuticals LLC. (2022). Protonix [package insert].
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