Protonix, First-pantoprazole

Introduction

Written by Sarah Lewis, PharmD
Medically reviewed by Melissa Badowski, PharmD, MPH, FCCP
Updated on July 25, 2023

Pantoprazole (pan TOE pra zole) is a generic medication prescribed for acid reflux and other conditions related to stomach acid. Pantoprazole belongs to a group of drugs called proton pump inhibitors.

The Food and Drug Administration (FDA) has approved pantoprazole to:

• treat erosive esophagitis related to gastroesophageal reflux disease (also called acid reflux) in adults and certain children
• maintain healing of erosive esophagitis in adults
• treat Zollinger-Ellison syndrome and other similar stomach acid conditions in adults

These approved uses differ based on the form of pantoprazole your doctor prescribes.

Side effects of pantoprazole

Pantoprazole may cause mild or serious side effects. More common mild side effects of pantoprazole and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about pantoprazole’s side effects, see this article or ask your doctor or pharmacist. You can also refer to the prescribing information for pantoprazole listed in the “Resources” section.

Mild side effects

More common mild side effects reported with some forms of pantoprazole are listed below. These side effects may differ based on the form of pantoprazole you’re prescribed.

This article doesn’t include all possible mild side effects of the drug. To learn more about pantoprazole’s side effects, refer to the prescribing information for pantoprazole listed in the “Resources” section.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Mild side effects of pantoprazole delayed-release* oral tablet and pantoprazole injection† include:

• diarrhea
• dizziness
• headache
• joint pain
• mild allergic reaction‡

* With delayed release, the drug is released once it passes through your stomach.
† Pantoprazole injection is given by intravenous (IV) infusion. An IV infusion is an injection given into your vein over time.
‡ For details about this side effect, see the “Interactions and warnings for pantoprazole” section.

Serious side effects

Serious side effects of pantoprazole are listed below. These side effects may differ based on the form of pantoprazole you’re prescribed.

This article doesn’t include all possible serious side effects of the drug. To learn more about pantoprazole’s side effects based on the form, refer to the prescribing information for pantoprazole listed in the “Resources” section.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, pantoprazole’s serious side effects include:

• new or worsening lupus (a type of autoimmune disease)
• acute nephritis (sudden inflammation of the kidneys)
• severe, watery, or bloody diarrhea due to Clostridioides difficile (a type of bacteria)
• increased risk of broken bones in the spine, wrist, or hip due to osteoporosis*
• low levels of magnesium†
• low levels of vitamin B12†
• polyps (noncancerous growths) in the lining of the upper part of the stomach†
• severe allergic reaction, including severe skin rashes‡

* The risk of this side effect increases with high doses of the drug or with long-term use.
† The risk of this side effect is higher with long-term use of the drug.
‡ For details about this side effect, see the “Interactions and warnings for pantoprazole” section.

Uses of pantoprazole

The Food and Drug Administration (FDA) approves prescription drugs such as pantoprazole for certain conditions. Approved uses for pantoprazole are described below. These uses differ based on the form of pantoprazole prescribed.

Use for certain digestive conditions

Doctors may prescribe pantoprazole delayed-release (DR)* oral tablet and DR oral liquid suspension† for the following uses:

• To treat erosive esophagitis (damage to the esophagus from stomach acid) related to gastroesophageal reflux disease (GERD). (GERD is commonly called acid reflux.) They’re used for this purpose in adults and children ages 5 years and older. They’re usually prescribed as a short-term treatment.
• To maintain healing of erosive esophagitis. They’re used for this purpose in adults and are usually prescribed as a long-term treatment.
• To treat Zollinger-Ellison syndrome (a rare condition that causes too much stomach acid) and other similar conditions. They’re used for this purpose in adults and are usually prescribed as a long-term treatment.

* With delayed release, the drug is released once it passes through your stomach.
† A liquid suspension is a type of liquid mixture.

Doctors may prescribe pantoprazole injection* for treating:

• GERD in people who’ve had erosive esophagitis. It’s used for this purpose in adults and is usually prescribed as a short-term treatment.
• Zollinger-Ellison syndrome and other similar conditions. It’s used for this purpose in adults and is usually prescribed as a short-term treatment.

With these acid-related digestive conditions, stomach acid irritates the lining of the stomach or esophagus. This can cause symptoms such as heartburn or sour burps. Eventually, the irritation can lead to tissue damage. Pantoprazole can help relieve the symptoms of these conditions and heal the digestive tract lining.

Doctors may not prescribe pantoprazole DR oral tablet, pantoprazole DR oral liquid suspension, or pantoprazole injection to certain people. This includes people who take drugs containing rilpivirine.

* Pantoprazole injection is given by intravenous (IV) infusion. An IV infusion is an injection given into your vein over time.

Common questions about pantoprazole

Below you’ll find answers to a few commonly asked questions about pantoprazole.

Are there certain foods to avoid while taking pantoprazole?

No, there aren’t any specific foods to avoid while taking pantoprazole. But your doctor may recommend avoiding certain foods depending on your condition. For example, if you have acid reflux, your doctor may recommend avoiding foods that trigger symptoms of the condition. Common food triggers include fried, fatty, spicy, or acidic foods.

Talk with your doctor to learn more about foods that could trigger your symptoms.

What brand names are available for pantoprazole?

Pantoprazole is available as the brand-name medication Protonix. Pantoprazole is a generic medication. Generics tend to cost less than brand-name versions.

To find out more about the brand-name version of pantoprazole, talk with your doctor or pharmacist.

Is pantoprazole safe for older adults?

Yes, pantoprazole is generally safe for older adults. In adults ages 65 years and older, the safety and effectiveness of pantoprazole is similar to that of younger adults. For details, see the drug’s prescribing information in the “Resources” section.

If you have concerns about your age and taking pantoprazole, talk with your doctor.

How does pantoprazole work? And how long does it take to start working?

Pantoprazole works by reducing how much stomach acid your body makes. It does this by binding to sites on stomach cells called proton pumps. Proton pumps are used in the last step in the process of making stomach acid. Pantoprazole stops this step when it binds to the proton pumps.

Pantoprazole will usually start to work within 2–3 hours of taking it. But it can take up to a week for your symptoms to ease.

If you’d like to know more about this, talk with your doctor or pharmacist.

Interactions and warnings for pantoprazole

Below, you’ll find information about pantoprazole’s possible interactions and warnings.

Interactions of pantoprazole

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.

Before you take pantoprazole, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription or over-the-counter drugs
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for pantoprazole” section below.

Warnings for pantoprazole

Some people should not take pantoprazole, and others should take it cautiously.

Pantoprazole could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether pantoprazole is a safe option for you.

Ask your doctor about specific warnings for pantoprazole, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Pantoprazole can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to pantoprazole or any of its ingredients, your doctor will likely not prescribe pantoprazole. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• severe skin rashes that may blister and peel and be fatal in rare cases*
• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to pantoprazole, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

* These severe skin rashes include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP).

Overdose of pantoprazole

If you take pantoprazole by mouth, you should not take more pantoprazole than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.

If you think you’ve taken too much pantoprazole, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Pregnancy or breastfeeding and pantoprazole

Information about pantoprazole and pregnancy and breastfeeding is described below.

Pantoprazole and pregnancy

It’s not known whether pantoprazole should be taken during pregnancy. If you’re planning a pregnancy or can become pregnant, talk with your doctor before taking this medication.

Pantoprazole and breastfeeding

It’s not known whether pantoprazole should be taken while breastfeeding. If you’re currently breastfeeding or planning to do so, talk with your doctor before taking this medication.

What to ask your doctor

Let your doctor know if you have questions about pantoprazole or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• How should I take pantoprazole?
• How long will I need to take pantoprazole?
• Do I have a higher risk of side effects than other people?
• Do any of my other medications interact with pantoprazole?

Resources

• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• Pantoprazole sodium granule, delayed release. (2022). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/38353b9e-63bd-47e8-b7cb-b198d1e901f9/spl-doc
• Pantoprazole sodium injection, powder, lyophilized, for solution. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/eb3f58d4-0c69-4377-be45-c36099c98d33/spl-doc 
• Pantoprazole sodium tablet, delayed release. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/5ff3cf6c-6f0a-4374-8b80-4e1eb1df6245/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.