pantoprazole
Pantoprazole (Protonix) is a proton-pump inhibitor (PPI). It's used to treat symptoms of gastroesophageal reflux disease (GERD) in adults and children. It's also used to treat other conditions involving too much stomach acid, such as erosive esophagitis, in adults only. Pantoprazole (Protonix) is taken by mouth, typically once daily for most conditions. Some of the more common side effects of this medication include headache and diarrhea. Pantoprazole (Protonix) isn't available over-the-counter (OTC).
What is Pantoprazole (Protonix)?
What is Pantoprazole (Protonix) used for?
- Short-term treatment of gastroesophageal reflux disease (GERD)
- Erosive esophagitis
- Other medical conditions that cause too much stomach acid (e.g., Zollinger-Ellison syndrome)
How Pantoprazole (Protonix) works
Pantoprazole (Protonix) is a proton pump inhibitor (PPI). It lowers the amount of acid in your stomach by blocking the final step of stomach acid production. This helps relieve heartburn and other stomach problems.
Drug facts
Side effects of Pantoprazole (Protonix)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Headache (12%)
- Diarrhea (9%)
- Nausea (7%)
- Belly pain (6%)
Please note: Side effect percentages are listed for adults with GERD.
Less Common Side Effects
- Vomiting
- Excessive gas
- Dizziness
- Joint pain
Pantoprazole (Protonix) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Severe stomach pain or diarrhea
- Kidney problems: urinating more or less than usual, fever, poor appetite
- Lupus symptoms: joint pain, skin rash on arms or cheeks that gets worse in the sunlight
- Serious skin reactions: blistering, peeling, or bleeding skin, fever, chills
More on Pantoprazole (Protonix) side effects
The following Pantoprazole (Protonix) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Blurred vision
flushed, dry skin
fruit-like breath odor
increased hunger
increased thirst
increased urination
stomach pain
sweating
trouble breathing
unexplained weight loss
vomiting
Incidence not known
Absence of or decrease in body movements
blindness
blistering, peeling, or loosening of the skin
bloody or cloudy urine
bloody, black, or tarry stools
blurred vision
chills
clay-colored stools
continuous ringing or buzzing or other unexplained noise in the ears
dark urine
decreased vision
difficulty with speaking
difficulty with swallowing
dizziness or lightheadedness
drowsiness
fast heartbeat
feeling of constant movement of self or surroundings
general feeling of tiredness or weakness
greatly decreased frequency of urination or amount of urine
headache
hearing loss
high fever
indigestion
joint pain
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
light-colored stools
loss of appetite
mood or mental changes
muscle cramp, pain, or stiffness
muscle spasms (tetany) or twitching
pains in the stomach, side, or abdomen, possibly radiating to the back
pale skin
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
red skin lesions, often with a purple center
red, irritated eyes
seizures
sensation of spinning
sores, ulcers, or white spots on the lips or in the mouth
stomach pain, continuing
swelling of the feet or lower legs
swollen glands
tightness in the chest
trembling
unexplained bleeding or bruising
unpleasant breath odor
unusual tiredness or weakness
vomiting of blood
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Belching
bloated or full feeling
excess air or gas in the stomach or bowels
passing gas
trouble sleeping
Incidence not known
Increased watering of the mouth
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Get your GoodRx coupon
Pros and cons of Pantoprazole (Protonix)
Pros
- Can continue to use with antacids, such as calcium carbonate
- Available as a lower-cost generic medication
- Oral tablets can be taken without regard to food
- Available in oral granules and suspension for people with trouble swallowing
Cons
- Long-term use might weaken bones and raise the risk of bone fractures
- Might cause or worsen lupus
- Interacts with warfarin (Coumadin), which can raise the risk of bleeding
- Not available over-the-counter
Pharmacist tips for Pantoprazole (Protonix)
- Swallow the pantoprazole (Protonix) oral tablets whole. Don't chew or crush the tablets. Doing so can change how the medication gets absorbed into your body.
- Typically, pantoprazole (Protonix) oral tablets can be taken with or without food. But pantoprazole (Protonix) oral granules and suspension should be taken 30 minutes before your meal.
- Pantoprazole (Protonix) oral granules or suspension: Mix and stir the granules or suspension with 5 mL of applesauce. Take the entire dose within 10 minutes of mixing. Make sure to wash down the granules with water. Alternatively, you can mix the granules or suspension with 5 mL of apple juice. Make sure to drink the entire dose immediately. Rinse the cup 1 to 2 more times with apple juice to get all the remaining granules.
- Pantoprazole (Protonix) can interact with many medications. Let your care team know what medications you take or plan to take. These medications include over-the-counter products and supplements. Talk with your care team if you have any questions about interactions with this medication.
More on Pantoprazole (Protonix) tips
Common questions about Pantoprazole (Protonix)
No, pantoprazole (Protonix) isn't available over the counter. You'll need a prescription from your HCP for this medication.
Pantoprazole (Protonix) is typically taken once daily. But for certain medical conditions that cause too much stomach acid (e.g., Zollinger-Ellison syndrome), you may take pantoprazole (Protonix) twice a day. Don't stop, start, or change how your take pantoprazole (Protonix) on your own without first speaking to your care team.
How long it takes for pantoprazole (Protonix) to work can differ for each person, depending on what condition you have and how severe your symptoms. In general, people who take this medication notice their heartburn or GERD symptoms getting better 2 to 6 hours after a dose. But it might take a few days to feel a more noticeable effect. If you're looking for more immediate relief, ask your healthcare professional (HCP) about taking quicker-acting antacids, such as Tums, along with pantoprazole (Protonix) until the medication effect kicks in.
In general, your primary care provider (PCP) will recommend that you take pantoprazole (Protonix) for the shortest amount of time needed to treat your condition. While more research is needed, some evidence suggests that taking PPIs long-term might raise the risk of serious side effects, such as bone fractures. For most conditions, your HCP will only prescribe pantoprazole (Protonix) for up to 2 months. But sometimes, you might need to take this medication for a longer period of time. Talk with your care team if you're not sure how long you should take pantoprazole (Protonix).
You can take pantoprazole (Protonix) oral tablets with or without food at any time of the day. On the other hand, pantoprazole (Protonix) oral granules and suspension work better if you take them 30 minutes before your meal.
A few studies suggest that taking PPIs, like pantoprazole (Protonix), might be linked to depression and anxiety. In general, people who took a PPI daily for 4 months or longer were more likely to report these mental health conditions. More research is needed to understand the link between PPIs and mental health. But one possible explanation is that PPIs, like pantoprazole (Protonix), lower stomach acid. This can change the make up of the bacteria in the gut, which might affect your mood. Let your primary care HCP or psychiatrist know if you experience symptoms of depression or worsening mood while taking pantoprazole (Protonix).
Though rare, some studies show that people who took PPIs have reported weight gain. But it's unclear whether the weight gain was caused by PPIs, like pantoprazole (Protonix), or by other factors. Let your HCP know if you notice any unexpected changes in your weight because this might be symptom of other side effects of pantoprazole (Protonix) that might require more medical attention, including stomach problems, kidney problems, or infectious diarrhea. Talk with your HCP if you're concerned about pantoprazole (Protonix) and weight changes.
Pantoprazole (Protonix) and omeprazole (Prilosec) are both PPIs used to lower stomach acid, but they aren't the same. One main difference is that omeprazole (Prilosec) is available both over the counter (OTC) and by prescription, while pantoprazole (Protonix) is prescription only. Another difference is that omeprazole (Prilosec) is FDA-approved to treat a few more conditions, such as Helicobacter pylori (H. pylori) infection, compared to pantoprazole (Protonix). Lastly, omeprazole (Prilosec) has more medication interactions than pantoprazole (Protonix). The American College of Gastroenterology doesn't recommend one over another when it comes to treating GERD symptoms. Your care team can help you decide if one PPI might be more appropriate for you.
How to save using GoodRx
Risks and warnings for Pantoprazole (Protonix)
Pantoprazole (Protonix) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of hiding symptoms of a more serious problem
Frequent episodes of heartburn can be a symptom of stomach cancer. If your heartburn gets worse or comes back after taking pantoprazole (Protonix), let your healthcare professional (HCP) know. Also contact your HCP if you have poor appetite, unexplained weight loss, or weakness along with your heartburn. They can check if there are other serious medical problems going on.
Sudden kidney problems
Some people taking PPIs like pantoprazole (Protonix) have had sudden kidney problems. These problems can happen at any point during treatment. Talk with your HCP if you're urinating more or less than usual, feel nauseous or weak, or have a fever, rash, or joint pain. These can be symptoms of kidney problems.
Severe infectious diarrhea
- Risk factors: Older people | Recent stay at a hospital or nursing home | People with a weakened immune system (e.g., HIV, cancer)
Some clinical studies showed that PPIs, such as pantoprazole (Protonix), can raise the risk of getting a bacterial infection called Clostridioides difficile (C. diff). This infection can cause severe diarrhea. Your risk is higher if you're over 65 years old, have recently stayed at a hospital or nursing home, or have a weakened immune system. To lower your risk of C. diff diarrhea, take the lowest possible dose of pantoprazole (Protonix) for the shortest amount of time that works well for you. If you experience severe or watery diarrhea, fever, belly pain, loss of appetite, or nausea, let your primary care provider know right away.
Bone fractures
- Risk factors: Taking high doses of pantoprazole (Protonix) | Taking pantoprazole (Protonix) for longer than a year | Risk for osteoporosis
PPIs like pantoprazole (Protonix) might raise the risk of bone fractures in the hip, wrist, or spine. Your risk is higher if you take more than one dose of pantoprazole (Protonix) per day or if you take it for more than a year. To prevent the risk of bone fractures, take the lowest possible dose of pantoprazole (Protonix) for the shortest amount of time for your symptoms. If you've had bone fractures before or have osteoporosis (weak bones), talk to your provider about your risk before using this medication.
Skin reactions
PPIs, such as pantoprazole (Protonix), have rarely caused serious skin reactions. These reactions include Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Symptoms can include fever, body aches, rash, peeling skin, painful blisters, and swelling of the face. If you notice any of these symptoms, get medical help immediately.
Lupus
Some people taking PPIs like pantoprazole (Protonix) developed new or worsening lupus, a condition where your immune system attacks your own body. Lupus symptoms can occur any time during treatment with pantoprazole (Protonix). Some typical symptoms include joint pain or rash, but they often improve within 1 to 3 months of stopping this medication. If you experience any lupus symptoms while taking pantoprazole (Protonix), stop the medication and contact your provider.
Low vitamin B12 and magnesium levels
- Risk factor: Long-term use | Taking medications that can lower magnesium levels
Using acid-lowering medications like pantoprazole (Protonix) for a long period of time can cause your vitamin B12 levels to drop. Pantoprazole (Protonix) lowers the amount of acid in your stomach, which is needed for vitamin B12 absorption. If you've been taking this medication for longer than 3 years, or if you have symptoms of vitamin B12 deficiency (e.g., dizziness, muscle weakness, pale skin, tiredness, tingling in arms or legs), talk to your primary care provider.
Taking pantoprazole (Protonix) can also lower your magnesium levels. This can happen 3 months after taking pantoprazole (Protonix), but it's more likely after a year of treatment. Low magnesium levels can sometimes lead to other electrolyte problems. You're at risk for low magnesium levels if you take other medications that can affect electrolyte levels, such as digoxin (Lanoxin) or water pills. Your primary care provider might check your blood during treatment with pantoprazole (Protonix) to make sure your electrolyte levels are in the normal range. Watch for symptoms of electrolyte problems like irregular heart rate, muscle cramps, and tremors. Let your primary care provider know right away if they occur.
Interaction with other medications
Pantoprazole (Protonix) can interfere with how other medications work. An important interaction to note is with pantoprazole (Protonix) is Edurant (rilpivirine), a medication that treat human immunodeficiency virus (HIV). Pantoprazole (Protonix) can lower the amount of Edurant (rilpivirine) in your body and cause the medication to not work as well, which can lead to virus spreading in your body. Make sure to avoid taking these medications together.
In addition, pantoprazole (Protonix) can also interact with warfarin (Coumadin), which can raise your risk of abnormal bleeding. Your provider will monitor your bloodwork (e.g., INR) to make sure these medications are safe to take together. Watch out for nosebleeds, dizziness, unusual bruising, or bleeding from cuts that take a long time to stop.
Finally, pantoprazole (Protonix) can raise the risk of methotrexate toxicity when taken together with methotrexate.
Inaccurate lab work
Pantoprazole (Protonix) can get in the way of certain tumor screenings or drug testing, which can lead to inaccurate results. Talk with your HCP or radiologist about your medication history before getting any testing done. In some cases, your care team might ask you to temporarily stop pantoprazole (Protonix) 2 weeks before your blood work.
Pantoprazole (Protonix) dosage
Typical dosage for Pantoprazole (Protonix)
Pantoprazole (Protonix) is available by prescription as oral tablets, suspension, and granules. It's also available as an injection that's administered into the veins by a provider in a healthcare setting.
Adults
- Gastroesophageal reflux disease (GERD): The typical dose is 40 mg by mouth once daily for up to 2 months. If needed, your care team might ask you to continue treatment for another 2 months.
- Maintenance of healing of inflamed esophagus due to GERD: The typical dose is 40 mg by mouth once daily.
- Medical conditions that cause too much stomach acid: The typical starting dose is 40 mg by mouth twice daily.
Children ages 5 years and older
- Gastroesophageal reflux disease (GERD): Your child's pediatrician will determine the dose based on their body weight.
- Weighing between 15 kg to less than 40 kg: The typical dose is 20 mg by mouth once daily for up to 2 months.
- Weighing 40 kg or more: The typical dose is 40 mg by mouth once daily for up to 2 months.
More on Pantoprazole (Protonix) dosage
Interactions between Pantoprazole (Protonix) and other drugs
More on Pantoprazole (Protonix) interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Rilpivirine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acalabrutinib
- Amphetamine
- Atazanavir
- Benzphetamine
- Bosutinib
- Capecitabine
- Cilostazol
- Citalopram
- Dacomitinib
- Dasatinib
- Dextroamphetamine
- Erlotinib
- Eslicarbazepine Acetate
- Gefitinib
- Ketoconazole
- Ledipasvir
- Lisdexamfetamine
- Methamphetamine
- Methotrexate
- Mycophenolate Mofetil
- Nelfinavir
- Neratinib
- Nilotinib
- Octreotide
- Pazopanib
- Pexidartinib
- Saquinavir
- Secretin Human
- Selpercatinib
- Sunitinib
- Velpatasvir
- Vismodegib
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Pantoprazole (Protonix) cost?
Pantoprazole (Protonix) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Pantoprazole (Protonix) will not be safe for you to take.
- History of allergy to PPIs
- People receiving Edurant (rilpivirine) or rilpivirine-containing medications (e.g., Complera)
What are alternatives to Pantoprazole (Protonix)?
News about Pantoprazole (Protonix)
Pantoprazole (Protonix) images
