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Pantoprazole: What Is It? Uses, Side Effects, and Dosage

It is estimated that anywhere from 15 to 30 percent of Americans have gastroesophageal reflux disease (GERD), a condition that results in experiencing heartburn or indigestion at least twice per week. The number of people experiencing GERD has increased tremendously over the past several decades, due in part to the rising obesity epidemic in the United States; people who are overweight or obese are more likely to suffer from the condition. As more and more people struggle with acid reflux, they are turning to medications like pantoprazole that are designed to alleviate symptoms and provide relief when used in conjunction with lifestyle changes. Pantoprazole has been on the market for decades and provides a safe, effective, and affordable option for people looking to reduce their symptoms.

What Is Pantoprazole?

Pantoprazole, also sold under the brand name Protonix, is a medication belonging to a class of drugs called proton pump inhibitors (PPIs). Pantoprazole was first introduced in 1985 under the brand name Protonix and is considered a first-generation proton pump inhibitor. First-generation proton pump inhibitors have been in use for nearly 40 years and their effectiveness and safety are well documented, but these medications are considered slow to work and may not completely control symptoms associated with excess stomach acid. 

What Is Pantoprazole Used to Treat?

Pantoprazole is used to treat a number of conditions associated with the overproduction of stomach acid, including gastroesophageal reflux disease (GERD) and associated erosive esophagitis (damage to the esophagus as a result of GERD) and Zollinger-Ellison syndrome. A brief description of each condition and its associated symptoms is included below.

Gastroesophageal Reflux Disease: Sometimes referred to as GERD or heartburn, gastroesophageal reflux disease is a condition in which stomach acid and digestive enzymes flow backward from the stomach into the esophagus. Although many people experience heartburn or acid reflux occasionally, the diagnosis of gastroesophageal reflux disease is limited to people who experience these symptoms multiple times per week over a long period of time. In normal people, the muscular ring, or sphincter, that seals off the esophagus from the stomach prevents food and acid from coming back up into the esophagus. However, people with GERD often have an esophageal sphincter that does not function properly and does not seal tightly enough, remaining relaxed between swallows and allowing food and digestive juices to enter the esophagus. Over time, exposure to the acid of the stomach can damage the esophagus and cause inflammation, narrowing, development of open sores, or 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
  • Sharp or burning pain behind the breast bone
  • Tightness in the chest or upper abdomen
  • Regurgitation
  • Difficulty swallowing
  • Hoarseness
  • Sore throat
  • Coughing, wheezing or needing to clear your throat

Zollinger-Ellison Syndrome: Zollinger-Ellison syndrome is a rare condition that causes tumors to form in your pancreas or upper small intestines. These tumors secrete large amounts of a hormone called gastrin that stimulate the overproduction of acid in the stomach. Over time, excess acid can lead to peptic ulcers, diarrhea, and other symptoms. Most people get diagnosed between the ages of 20 and 50, but the disease may present at any time in life. Symptoms associated with Zollinger-Ellison syndrome include:

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

How Does Pantoprazole Work?

Proton pump inhibitors work by stopping the cells in the lining of the stomach from producing too much acid. Proton pump inhibitors block a chemical system in the body called the hydrogen-potassium adenosine triphosphatase enzyme system, also known as the proton pump, and stop the system from producing acid. Decreasing the amount of acid produced by the stomach can help prevent new ulcers from forming and give existing ulcers the chance to heal and reduce acid reflux symptoms such as heartburn and regurgitation.

What Is the Cost of Pantoprazole?

Like most medications, generic name pantoprazole is substantially less expensive than the brand name form of the drug, called Protonix. Pantoprazole is available over the counter at low doses and can be obtained at a higher dosage with a prescription from your healthcare provider. The generic form of the medication is typically covered by most Medicare and insurance plans, but it may be possible to receive a cheaper price on the drug by using a pharmacy discount card or coupon or paying the cash price. The following table compares the costs of a 30 day supply of Pantoprazole and duloxetine.

Costs of a 30-Day Supply of Pantoprazole and Protonix

20 mg oral capsules
40 mg oral capsules

Because there are numerous manufacturers for duloxetine, the prices of the drug are extremely affordable even for those who are uninsured or underinsured. While some people are concerned about taking the generic forms of medication, the FDA subjects generic drugs to the same stringent testing as the brand name form of the drug. The generic medication uses the same active ingredient as the brand name form of the medication in the same amount but may use different inactive ingredients that affect the color, size, shape, or taste of the medication. However, you will receive the same treatment when using a generic medication of the same form and strength as you would with a brand name medication.

What Are the Benefits of Using Pantoprazole?

Pantoprazole has been on the market for about 35 years, which means the drug information has been well studied and the effects of the medication are understood. The risks associated with pantoprazole are considered low enough that the medication is available over the counter at certain strengths. Benefits associated with the use of pantoprazole include:

  • Most people do not experience any side effects when taking pantoprazole.
  • Pantoprazole can be taken with a fast-acting antacid, such as Tums or Maalox if immediate relief of heartburn symptoms is needed.
  • Pantoprazole can be taken with or without food and achieve the same effectiveness, which is different from most other medications in its drug class.
  • Pantoprazole is considered safe for children 5 years of age and older.

How Do I Know What dose of Pantoprazole to Take?

Your health care professional will determine the appropriate dose of pantoprazole for you based on your age, the form of the medication you take,  and the purpose of treatment, but your medication dose may have to be adjusted several times before you get it just right. The usual adult dose for erosive esophagitis, or damage to the esophagus caused by acid reflux, is 40 mg taken by mouth once per day for eight weeks. If healing has not occurred after eight weeks, an additional course of treatment may be recommended. To treat gastroesophageal reflux disease in adults, the recommended dose is 40 mg taken by mouth once per day for eight weeks, or 40 mg via IV infusion once per day for seven to ten days. Some patients do continue to take pantoprazole for extended periods to treat chronic GERD, but this should only be done under a doctor’s supervision due to risks associated with the long term use of the medication. Adults with Zollinger-Ellison syndrome generally take a 40 mg dose twice per day by mouth, with a maximum dose of 240 mg per day to control symptoms. Most patients with Zollinger-Ellison syndrome will take some form of proton pump inhibitor for an extended period of time due to the chronic nature of the condition. Overall you will need to follow the medical advice of your doctor and inform them of all the prescription drugs and over-the-counter medications that you are currently using to avoid any drug interactions or allergic reactions

Are There Any Side Effects I Should Be Aware of?

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

  • Diarrhea
  • Nausea
  • Headache
  • Stomach pain

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

  • Vomiting
  • Gas
  • Dizziness
  • Joint pain

Serious side effects that may require medical help associated with pantoprazole include:

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

Are There Any Risks Associated With Pantoprazole?

While pantoprazole is generally well tolerated and most people don’t experience any side effects while taking the medication, there are some serious health risks associated with long-term use of pantoprazole. The likelihood of experiencing each of these conditions increases with long-term use of pantoprazole and is higher for people taking high doses or taking multiple doses per day. Risks associated with pantoprazole include:

  • Decreased bone density: Like other proton pump inhibitors, long term use of pantoprazole (a year or longer) can diminish bone density over time and increase the risk of bone fractures, particularly in people over the age of 65. Pantoprazole should be used at the lowest dose possible for the shortest amount of time possible.
  • Severe diarrhea: Rarely, pantoprazole can cause a life-threatening bacterial infection called clostridium difficile-associated diarrhea. People who develop watery or persistent diarrhea, fever, or stomach pain should seek medical attention immediately.
  • Lupus: In very rare circumstances, pantoprazole can cause lupus, an autoimmune condition. If you notice sudden fatigue, muscle pain, or a rash that appears on your face or arms while in the sun, talk to your doctor immediately.
  • Low B-12 levels: Pantoprazole can decrease the absorption of vitamin B-12 in your body over time due to the decreased levels of stomach acid in your body. Low B-12 levels can cause anemia. Patients who take pantoprazole for more than three years are at higher risk of developing this condition.
  • Low magnesium levels: When taken for more than three months, pantoprazole can lower the level of magnesium in your body, particularly for people who take water pills (diuretics) or digoxin. Symptoms of low magnesium levels include an abnormal heartbeat, muscle weakness, muscle cramps, dizziness, and shaking. You should seek medical attention right away if you experience any symptoms of low magnesium levels.

How Do I Use Pantoprazole?

Pantoprazole is available in the form of a tablet and in the form of an oral suspension. The tablets can be taken with or without food, unlike most proton pump inhibitors, which must be taken on an empty stomach in order to work. Pantoprazole tablets should be swallowed whole and should not be crushed, divided, or chewed. Pantoprazole will not take effect immediately, so you’ll need to give it about two and a half hours to kick in. If you need immediate relief from your acid reflux symptoms, you can take pantoprazole with a fast-acting acid reducer, such as Tums or Maalox. If taking the oral suspension form of pantoprazole, the medication must be prepared, mixed into apple juice or apple sauce, and taken 30 minutes before a meal.

Who Should Not Take Pantoprazole?

People with certain health conditions and those taking certain medications should not take pantoprazole. People allergic to pantoprazole or other proton pump inhibitors should not take pantoprazole. People taking rilpivirine should not take pantoprazole, so make sure you give your doctor a complete medical history. Methotrexate can also cause dangerous reactions with pantoprazole, especially when taken at high doses. People with the following health conditions should not take pantoprazole:

  • Vitamin B-12 deficiency
  • Interstitial nephritis, a type of kidney inflammation
  • Systemic lupus erythematosus
  • Osteoporosis
  • Weak or brittle bones
  • CYP2C19 poor metabolizers
  • Clostridium-difficile bacteria associated diarrhea
  • Low magnesium levels in the blood
  • Subacute cutaneous lupus erythematosus
  • Other autoimmune disorders

Is Pantoprazole Safe for Pregnant and Nursing Women?

Very little research has been done regarding the use of pantoprazole in pregnant women. While available human testing data show no increased risk for major birth defects, animal testing did show birth defects when pantoprazole was administered during pregnancy. The Food and Drug Administration recommends that pantoprazole only be taken during pregnancy when necessary and when the benefits outweigh the risks.
Pantoprazole has been shown to pass through breast milk when taken by a nursing mother. Although the effects on nursing infants are unknown, it is recommended that you do not take pantoprazole while nursing. Talk to your doctor about what medications might be appropriate to treat your acid reflux while nursing.

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