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How Long Does it Take for Pantoprazole to Work?

Waking up in the middle of the night with a sour taste in the back of your mouth or a burning feeling in your chest happens to most people at some point in their lives, as nearly all of us will eventually experience acid reflux. This unpleasant sensation, also called heartburn, happens to many people occasionally after eating a particularly heavy, spicy, or acidic meal. However, in some people, it becomes chronic even when they eat foods that should not cause reflux. 

Chronic acid reflux is defined as gastroesophageal reflux disease, or GERD, when it occurs at least twice per week for an extended period of time. The condition is estimated to impact 15 to 30 percent of Americans, and rates are rising. It is believed that the obesity epidemic and poor dietary habits are contributing to the rising rates of GERD in the United States. A growing number of patients are considering the use of medications like pantoprazole that can help control

GERD symptoms and provide relief when combined with lifestyle changes. 

However, there is some confusion surrounding which medications should be used to treat long term symptoms and which should be used to treat current symptoms, so how long does it take for pantoprazole to work?

What Is Pantoprazole?

Pantoprazole is a generic medication that belongs to a class of drugs called proton pump inhibitors (PPIs). Like other proton pump inhibitors, pantoprazole/pantoprazole sodium, also sold under the brand name Protonix, is used to treat digestive conditions, including GERD. The medication was first approved under the brand name Protonix by the U.S. Food and Drug Administration (FDA) in 1985, making it a first-generation proton pump inhibitor. Following the expiration of the Protonix patent, the generic pantoprazole was introduced. 

Doctors have been treating digestive conditions with first-generation proton pump inhibitors for over 40 years, but while they are widely known to be safe, these medications no longer provide the most effective relief for the conditions they treat. First generation PPIs have fallen out of favor with many physicians because they sometimes work slowly and may not completely control symptoms associated with excess stomach acid. 

Some other common proton pump inhibitors include Prilosec (omeprazole), Prevacid (lansoprazole), Nexium (esomeprazole), and Aciphex (rabeprazole). 

What is Pantoprazole Used to Treat?

Pantoprazole is used to treat digestive conditions that are characterized by the overproduction of stomach acid, including gastroesophageal reflux disease, associated erosive esophagitis (damage to the esophagus as a result of GERD), and Zollinger-Ellison syndrome. Each condition and its symptoms are briefly described below. 

Gastroesophageal Reflux Disease: Sometimes referred to as GERD or heartburn, gastroesophageal reflux disease is a condition characterized by a malfunctioning esophageal sphincter. The esophageal sphincter is a ring of muscle that seals off the esophagus from the stomach, and in individuals with GERD, the sphincter does not work properly, allowing stomach acid and food to flow backward into the esophagus. Although many people experience occasional heartburn after a meal that is particularly spicy, heavy, or acidic, people with GERD experience these symptoms multiple times per week for a prolonged period of time. In these individuals, the esophageal sphincter either does not seal tightly enough or does not function properly. As a result, the sphincter remains relaxed between swallows, and digestive juices and food are able to enter the esophagus. When the esophagus is exposed to stomach acid regularly for a prolonged period of time, it can become damaged and inflamed and start to narrow, develop open sores, or develop a condition called Barrett's esophagus, which increases the risk of esophageal cancer. 

Symptoms of GERD include:

  • Nausea
  • A repeated sour or bitter taste in the mouth
  • Hoarseness
  • Sore throat
  • Sharp or burning pain behind the breast bone
  • Regurgitation
  • Difficulty swallowing
  • Tightness in the chest or upper abdomen
  • Coughing, wheezing or needing to clear your throat

Zollinger-Ellison Syndrome: This rare medical condition is characterized by tumors that form in the pancreas or upper small intestines. These tumors secrete large amounts of a hormone called gastrin, which encourages the overproduction of acid in the stomach. As a result of the excess acid, people with Zollinger-Ellison syndrome may experience peptic ulcers, diarrhea, and other symptoms. People can be diagnosed with Zollinger-Ellison syndrome at any stage of life, but most people are diagnosed between the ages of 20 and 50. 

Symptoms associated with Zollinger-Ellison syndrome include:

  • Decreased appetite
  • Abdominal pain
  • Bleeding in the digestive tract
  • Burning, aching, or discomfort in the upper abdomen
  • Nausea and vomiting
  • Diarrhea
  • Acid reflux and heartburn

How Does Pantoprazole Work?

Proton pump inhibitors like pantoprazole work by blocking the action of the proton pumps in the body, which are actually a chemical system called the hydrogen-potassium adenosine triphosphatase enzyme system. The stomach is lined with proton pumps, which are responsible for producing hydrochloric acid; hydrochloric acid is one of the main components of stomach acid. Medications like pantoprazole stop the proton pumps from producing too much acid, helping to lower the levels in the stomach. With less acid in the stomach, existing ulcers can begin to heal, new ulcers are less likely to form, and acid reflux symptoms, such as heartburn and regurgitation, are reduced.

How Long Does Pantoprazole Take to Work?

Pantoprazole is not intended to act as a fast-acting antacid like Tums or Maalox, so it should not be used for immediate relief or short-term treatment. Proton pump inhibitors like pantoprazole are intended for the long term treatment of acid reflux symptoms. The medication takes approximately two and a half hours to begin working, so it won't be effective for current symptoms. However, patients who need immediate relief from their acid reflux symptoms can combine pantoprazole with fast-acting Tums or Maalox to reduce the amount of acid.

Unlike other proton pump inhibitors, which must be taken on an empty stomach in order to be effective, pantoprazole can be taken with or without food. The best time of day to take pantoprazole is in the morning before or during breakfast, but the medication can be taken before any meal during the day and still be effective. Pantoprazole is available as both a tablet and as an oral suspension. Pantoprazole tablets should be swallowed whole and should not be crushed, divided, or chewed. 

What Dose of Pantoprazole Should I Take?

The correct dose of pantoprazole for you will be determined by your health care professional based on your age, the form of the medication you take, and the purpose of treatment. Some patients will need to have their medication dosage adjusted several times before finding the most effective dose. In general, the conditions treated by pantoprazole require a dose of 40 mg taken once per day for eight weeks. Patients with Zollinger-Ellison syndrome are more likely to take a 40 mg dose twice per day by mouth but may take up to 240 mg per day to control symptoms. Because Zollinger-Ellison syndrome is a chronic disease, most patients with the condition will take a proton pump inhibitor for an extended period of time. GERD can also be chronic, but it should only be treated with long term use of proton pump inhibitors like pantoprazole with a doctor's approval. Be sure to inform your health care professional and pharmacist of all the prescription drugs and over-the-counter medications that you are currently using to avoid any drug interactions or allergic reactions

How Much Does Pantoprazole Cost?

Pantoprazole is a generic medication that is produced by several different manufacturers. As a result, even those patients who are uninsured or underinsured generally find the prices of the drug affordable. The brand name form of the medication, Protonix, is substantially more expensive than generic pantoprazole, which can also be purchased over the counter at low doses; higher doses require a prescription from a healthcare provider. Most Medicare and insurance plans cover the cost of the generic pantoprazole, but it may be possible to receive a cheaper price on the drug by paying the cash price or using a pharmacy discount card or coupon. 

What Side Effects Are Associated With Pantoprazole?

Possible side effects associated with pantoprazole generally fall into two categories: common and less common adverse effects. 

Common side effects associated with pantoprazole include:

  • Headache
  • Stomach pain
  • Diarrhea
  • Nausea

Less common side effects that may occur in long-term users of pantoprazole include:

  • Vomiting
  • Dizziness
  • Joint pain
  • Gas
  • Hypomagnesemia (low magnesium), primarily with extended use over one year
  • Vitamin B12 deficiency, primarily with extended use over one year

Serious side effects where you should seek medical advice or medical help include:

  • Fruit-like breath odor
  • Unexplained weight loss
  • Vomiting
  • Blurred vision
  • Dry mouth
  • Flushed, dry skin
  • Increased hunger
  • Increased thirst
  • Increased urination
  • Sweating
  • Trouble breathing
  • Chest pain

Additionally, possible drug interactions may exist between pantoprazole and the following drugs, especially in respect to increased risk of absorption issues, which is why it's important to disclose any medications you're taking with your healthcare provider: atazanavir/nelfinavir, methotrexate (primarily with high doses of pantoprazole), ketoconazole, rilpivirine, and digoxin.

What Are the Benefits of Using Pantoprazole?

Pantoprazole is one of the oldest proton pump inhibitors on the market, having been sold for 35 years. As a result, researchers have had plenty of time to solidify drug information and study the effects of the drug and thoroughly understand its impacts on the body. Pantoprazole can be purchased over the counter at certain strengths due to the low risk of side effects and other issues associated with taking the medication, making it more accessible for patients. Benefits associated with the use of pantoprazole include:

  • Children ages five and older can safely use pantoprazole, though you should always keep this and other drugs out of reach of children.
  • Pantoprazole is equally effective when taken with or without food, unlike other drugs in its class. There's even an oral suspension version that can be released into apple juice or applesauce for oral administration. 
  • Unlike some other medications, patients can take pantoprazole with a fast-acting antacid like Tums or Maalox if they need immediate relief from heartburn symptoms.
  • Most people taking pantoprazole do not experience any side effects.

References:

https://www.aboutgerd.org/prevalence.html 

https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940 

https://www.drugs.com/medical-answers/when-should-you-take-pantoprazole-first-thing-in-103182/ 

https://medlineplus.gov/drugreactions.html

Published August 31st, 2020 by Chris Riley

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