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Fact Checked

What Is the Best Time of Day to Take Pantoprazole?

If you’ve ever been woken up by a burning feeling in your chest or felt that distinctive sour taste at the back of your throat, it’s likely that you have experienced acid reflux. When acid reflux occurs at least twice per week for an extended period of time, it is called gastroesophageal reflux disease (GERD), a condition that affects an estimated 15 to 30 percent of Americans. There are a number of factors that contribute to the rising rates of GERD in the United States over the past several decades, including the ongoing obesity epidemic and poor diets. People who are overweight or obese are more likely to suffer from GERD, and as the numbers increase, a rising number of patients are turning to medications like pantoprazole that are designed to alleviate symptoms and provide relief when used in conjunction with lifestyle changes. If you are considering taking medication for your GERD, it’s important to research and ask questions like “What is the best time of day to take pantoprazole?”

What Is Pantoprazole?

Pantoprazole is a generic medication also sold under the brand name Protonix. The medication belongs to a class of drugs called proton pump inhibitors (PPIs), which treat digestive conditions including GERD. Protonix was first approved by the U.S. Food and Drug Administration (FDA) in 1985 and is considered a first-generation proton pump inhibitor; the generic pantoprazole was introduced following the expiration of the Protonix patent. First-generation proton pump inhibitors have been used to treat digestive conditions for over 40 years, and although their safety is well documented, they are no longer the most effective medications on the markets, as they sometimes work slowly and may not completely control symptoms associated with excess stomach acid. 

What Conditions Are Treated With Pantoprazole?

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

  • Gastroesophageal Reflux Disease: Often called GERD or heartburn, gastroesophageal reflux disease is a condition in which the esophageal sphincter, a ring of muscle that seals off the esophagus from the stomach, does not work properly and allows stomach acid and food to come back up into the esophagus. While experiencing heartburn or acid reflux occasionally is normal after a heavy, spicy, or acidic meal, the diagnosis of gastroesophageal reflux disease is limited to people who experience these symptoms multiple times per week over a long period of time. People with GERD may have an esophageal sphincter that does not function properly or does not seal tightly enough, which leaves the sphincter relaxed between swallows and allows food and digestive juices to enter the esophagus. GERD is a dangerous condition because the esophagus can become damaged and inflamed over time, causing narrowing, the development of open sores, or a condition called Barrett’s esophagus, which increases the risk of esophageal cancer. Symptoms of GERD include:
    • Regurgitation
    • Difficulty swallowing
    • Hoarseness
    • Sore throat
    • 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
    • Coughing, wheezing or needing to clear your throat
  • Zollinger-Ellison Syndrome: Zollinger-Ellison syndrome is a rare condition that causes tumors to form in the pancreas or upper small intestines. Tumors caused by Zollinger-Ellison secrete large amounts of a hormone called gastrin, which stimulates the overproduction of stomach acid. The excess acid can cause peptic ulcers, diarrhea, and other symptoms. Zollinger-Ellison syndrome can be diagnosed at any time in a person’s life, but most people are diagnosed between the ages of 20 and 50. Symptoms associated with Zollinger-Ellison syndrome include:
    • Diarrhea
    • Acid reflux and heartburn
    • Bleeding in the digestive tract
    • Decreased appetite
    • Abdominal pain
    • Burning, aching, or discomfort in the upper abdomen
    • Nausea and vomiting

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How Does Pantoprazole Work?

Proton pump inhibitors like pantoprazole block a chemical system in the body called the hydrogen-potassium adenosine triphosphatase enzyme system, also known as the proton pump. These proton pumps line the stomach and are responsible for the production of hydrochloric acid, which is one of the main components of stomach acid. Proton pump inhibitors work by stopping the cells in the lining of the stomach from producing too much acid. When the amount of acid in the stomach is reduced, existing ulcers have a chance to heal, new ulcers are prevented from forming, and acid reflux symptoms, such as heartburn and regurgitation, are reduced.

What Is the Best Time of Day to Take Pantoprazole?

Pantoprazole is somewhat unique among proton pump inhibitors because it can be taken with or without food, while most medications in the same class must be taken on an empty stomach. The best time of day to take pantoprazole is in the morning before or during breakfast, but it can be taken any time of day as long as it is taken immediately before the meal. Patients may take pantoprazole in the form of a tablet or an oral suspension. Pantoprazole tablets should be swallowed whole and should not be crushed, divided, or chewed. It takes approximately two and a half hours for pantoprazole to begin to take effect, so it should not be used for treatment of current acid reflux symptoms.  Patients needing immediate relief from their acid reflux symptoms may take pantoprazole with a fast-acting acid reducer like 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.

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. Most conditions treated by pantoprazole are treated with a dose of 40 mg taken once per day for eight weeks, although 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. While some patients may use pantoprazole for an extended period of time to treat chronic GERD, this should only be done with a doctor’s approval. 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

How Much Does Pantoprazole Cost?

Because there are numerous manufacturers for pantoprazole, the prices of the drug are extremely affordable even for those who are uninsured or underinsured. Like most medications, generic name pantoprazole is substantially less expensive than the brand name form of the drug, Protonix. Patients can purchase pantoprazole over the counter at low doses or at a higher dosage with a prescription from a 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. 

Are There Any Side Effects Associated With Pantoprazole?

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:

  • Dizziness
  • Joint pain
  • Vomiting
  • Gas

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

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

What Are the Benefits of Using Pantoprazole?

Pantoprazole has been on the market for approximately 35 years, so researchers have had ample time to study the drug, and its effects are well understood. Pantoprazole is available over the counter at certain strengths due to the low risk associated with taking the medication, which makes it more accessible for patients. Benefits associated with the use of pantoprazole include:

  • 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.
  • 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.

Are There Any Risks Associated With Pantoprazole?

Most people do not experience any side effects while taking pantoprazole and the medication is generally well-tolerated, but there are some serious health risks associated with long-term use of proton pump inhibitors like pantoprazole. The longer a patient uses pantoprazole, the more likely they are to experience any of the following conditions, and the likelihood increases for people taking high doses or taking multiple doses per day. Risks associated with pantoprazole include:

  • Decreased bone density: Using pantoprazole for 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.
  • Lupus: It is very rare, but it is possible for pantoprazole to 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: Our bodies need stomach acid to help absorb vitamin B-12, so the reduced stomach acid associated with the use of pantoprazole can cause lower levels of B-12. Low B-12 levels can cause anemia. Patients who take pantoprazole for more than three years are at higher risk of developing this condition.
  • 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.
  • Low magnesium levels: People who take water pills (diuretics) or digoxin are at increased risk of low magnesium levels when taking pantoprazole for more than three months. 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.

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 with the following health conditions should not take pantoprazole:

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

Certain drugs are also known to interact with 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.

Is Pantoprazole Safe for Pregnant and Nursing Women?

Little research regarding the safety of pantoprazole for pregnant women has been conducted. The Food and Drug Administration recommends that pantoprazole only be taken during pregnancy when necessary and when the benefits outweigh the risks. 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. 
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.

Published July 15th, 2020 by Bridget Reed
Fact Checked by Chris Riley

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