Pantoprazole | Side Effects, Dosage, Uses & More
Advertisement

Generic Name:

pantoprazole, Oral tablet

All Brands

  • Protonix
SECTION 1 of 5

Highlights for pantoprazole

Oral tablet
1

Pantoprazole is used to reduce the amount of stomach acid your body makes. It helps treat painful symptoms caused by conditions such as gastroesophageal reflux disease (GERD).

2

Pantoprazole comes as a tablet or a liquid suspension that you prepare from granules. You take these forms by mouth. Pantoprazole also comes in an intravenous (IV) form, which is only given by a healthcare provider.

3

Pantoprazole is available as the brand-name drug Protonix. It’s also available as a generic drug.

IMPORTANT INFORMATION

Long-term use warning

Long-term use of pantoprazole can lead to an increased risk of certain side effects and complications. These include:

  • increased risk of bone fracture in people taking higher, multiple daily doses for more than one year
  • vitamin B-12 deficiency, which can lead to serious nerve damage and deteriorating brain functions. This has been seen in some people taking pantoprazole for longer than three years.
  • chronic inflammation of the stomach's lining (atrophic gastritis) when taking pantoprazole long term. People with H. pylori are particularly at risk.
  • low blood magnesium (hypomagnesemia). This has been seen in some people taking pantoprazole for as few as three months. More often, it occurs after a year or more of treatment.

Severe diarrhea warning

Severe diarrhea caused by Clostridium difficile bacteria can occur in some people treated with pantoprazole, especially hospitalized people.

Allergy warning

Though it’s rare, pantoprazole can cause an allergic reaction. Symptoms could include rash, swelling, or breathing problems. This can progress to interstitial nephritis, a kidney disorder that can lead to kidney failure. Symptoms of this condition include:

  • nausea or vomiting
  • fever
  • rash
  • confusion
  • blood in your urine
  • bloating
  • elevated blood pressure

Drug features

Pantoprazole is a prescription drug. It comes as a tablet or a liquid suspension you prepare from granules. You take these forms by mouth. Pantoprazole also comes in an intravenous (IV) form, which is only given by a healthcare provider.

Pantoprazole oral tablet is available as the brand-name drug Protonix. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version.

Why it's used

Pantoprazole is used to treat gastroesophageal reflux disease (GERD), a condition that causes gastric juices to flow upward from your stomach and into the esophagus. It also treats conditions in which the stomach makes excess acid, such as Zollinger-Ellison syndrome.

How it works

Pantoprazole belongs to a class of drugs called proton pump inhibitors. It works to shut off the acid-pumping cells in your stomach. It reduces the amount of stomach acid and helps to reduce painful symptoms related to gastroesophageal reflux disease (GERD).

Advertisement
SECTION 2 of 5

pantoprazole Side Effects

Oral tablet

Most Common Side Effects

MOST COMMON SIDE EFFECTS

(to see Serious Side Effects click here or keep scrolling)

The following side effects may occur, but don’t usually require emergency care. Talk with your doctor or healthcare provider if these side effects continue or if they bother you.

Image

Excessive tiredness
Pantoprazole may lower your body's levels of calcium, magnesium, iron, or vitamin B12. Low levels of these important nutrients can make you feel weak or tired.

Fever
Pantoprazole can cause fever in some people. It isn't fully understood why this happens.

Headache
Pantoprazole can cause headaches. This may happen because the drug makes your body absorb nutrients more slowly, or because the drug lowers the amount of nutrients that get absorbed.

Joint pain
Pantoprazole can cause joint pain. This may occur partly because the drug lowers the amount of calcium and magnesium your body absorbs. Low levels of these important nutrients can weaken both your bones and the muscles that support your joints. These effects can cause pain in your joints.

SERIOUS SIDE EFFECTS

The following are severe side effects that require emergency care. Contact your doctor or healthcare provider right away if you have any of these side effects:

Brittle bones
Pantoprazole can cause your body to absorb less calcium from the foods you eat. This can lead to brittle bones, a condition also known as osteoporosis. The risk of brittle bones is highest in your wrists, hips, and spine. When your bones become brittle, minor falls can lead to fractures. Your risk of these problems may increase if you take high doses of this drug for more than one year.

Allergic reaction
  1. Blistering or peeling skin
  2. Rash
  3. Facial swelling
  4. Trouble breathing
  5. Swelling of the hands or feet
  6. Hives
These side effects may be caused by an allergic reaction to pantoprazole. They may also be a sign of Stevens-Johnson syndrome (SJS), which is a medical emergency where the skin peels away and exposes the muscles underneath. If you have these signs or symptoms, call 9-1-1 right away or go to the nearest emergency room.

Irregular or pounding heartbeat
Pantoprazole may prevent your body from absorbing enough vitamin B12. This can cause low levels of this important nutrient. A pounding or rapid heartbeat is a symptom of a vitamin B12 deficiency.

Low magnesium levels
  1. Dizziness
  2. Muscle spasms
  3. Seizures
Pantoprazole can prevent your body from absorbing enough magnesium from the foods you eat. If your levels of magnesium become too low, you may have muscle spasms, severe dizziness, or seizures.

Gastrointestinal infections
  1. Gas
  2. Nausea
  3. Vomiting
  4. Severe diarrhea
Pantoprazole can upset the balance of bacteria in your stomach and intestines. This can lead to gastrointestinal infections. Symptoms can include gas, nausea, vomiting, severe diarrhea, or intestinal cramps.

Bloody or black stools
Stools that are bright red, or black and tarry, may mean you have bleeding in your digestive tract.

Jaundice
In very rare cases (less than 1% of users), pantoprazole can cause enough liver damage to cause abnormal results from liver function tests, as well as jaundice. This condition causes yellowing of your skin and the whites of your eyes. This may also be a sign of intestinal bleeding.

MOST COMMON SIDE EFFECTS

The following side effects may occur, but don’t usually require emergency care. Talk with your doctor or healthcare provider if these side effects continue or if they bother you.

Image Excessive tiredness

Pantoprazole may lower your body’s levels of calcium, magnesium, iron, or vitamin B12. Low levels of these important nutrients can make you feel weak or tired.

Image
Image Fever

Pantoprazole can cause fever in some people. It isn’t fully understood why this happens

Image Headache

Pantoprazole can cause headaches. This may happen because the drug makes your body absorb nutrients more slowly, or because the drug lowers the amount of nutrients that get absorbed.

Image
Image Joint pain

Pantoprazole can cause joint pain. This may occur partly because the drug lowers the amount of calcium and magnesium your body absorbs. Low levels of these important nutrients can weaken both your bones and the muscles that support your joints. These effects can cause pain in your joints.

Image

SERIOUS SIDE EFFECTS

The following are severe side effects that require emergency care. Contact your doctor or healthcare provider right away if you have any of these side effects:

Image Brittle bones

Pantoprazole can cause your body to absorb less calcium from the foods you eat. This can lead to brittle bones, a condition also known as osteoporosis. The risk of brittle bones is highest in your wrists, hips, and spine. When your bones become brittle, minor falls can lead to fractures. Your risk of these problems may increase if you take high doses of this drug for more than one year.

Image
Image Allergic reaction
  1. Blistering or peeling skin
  2. Rash
  3. Facial swelling
  4. Trouble breathing
  5. Swelling of the hands or feet
  6. Hives

These side effects may be caused by an allergic reaction to pantoprazole. They may also be a sign of Stevens-Johnson syndrome (SJS), which is a medical emergency where the skin peels away and exposes the muscles underneath. If you have these signs or symptoms, call 9-1-1 right away or go to the nearest emergency room.

Image
Image Irregular heartbeat

Pantoprazole may prevent your body from absorbing enough vitamin B12. This can cause low levels of this important nutrient. A pounding or rapid heartbeat is a symptom of a vitamin B12 deficiency.

Image
Image Low magnesium levels
  1. Dizziness
  2. Muscle spasms
  3. Seizures

Pantoprazole can prevent your body from absorbing enough magnesium from the foods you eat. If your levels of magnesium become too low, you may have muscle spasms, severe dizziness, or seizures.

Image
Image GI infections
  1. Gas
  2. Nausea
  3. Vomiting
  4. Severe diarrhea

Pantoprazole can upset the balance of bacteria in your stomach and intestines. This can lead to gastrointestinal infections. Symptoms can include gas, nausea, vomiting, severe diarrhea, or intestinal cramps.

Image
Image Bloody or black stools

Stools that are bright red, or black and tarry, may mean you have bleeding in your digestive tract.

Image
Image Jaundice

In very rare cases (less than 1% of users), pantoprazole can cause enough liver damage to cause abnormal results from liver function tests, as well as jaundice. This condition causes yellowing of your skin and the whites of your eyes. This may also be a sign of intestinal bleeding.

Image

Serious Side Effects

Pharmacist's Advice
Healthline Pharmacist Editorial Team

Pantoprazole does not cause drowsiness.

Most people tolerate pantoprazole well, and its side effects usually only last for a short time. 

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 5

pantoprazole May Interact with Other Medications

Oral tablet

Pantoprazole can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Medications That Might Interact with This Drug

Human immunodeficiency virus (HIV) drugs
  • atazanavir
  • nelfinavir

Combining these drugs with pantoprazole is not recommended. Pantoprazole may significantly decrease atazanavir or nelfinavir blood levels and reduce their ability to control HIV infection.

Anticoagulants
  • warfarin

Some people taking warfarin with pantoprazole experience increases in INR and prothrombin time (PT). This can lead to an increased risk of possibly severe bleeding. People taking proton pump inhibitors and warfarin should be monitored for increases in INR and PT.

Drugs affected by stomach pH

These drugs include:

  • ketoconazole
  • ampicillin
  • atazanavir
  • iron salts
  • erlotinib
  • mycophenolate mofetil

Pantoprazole affects stomach acid levels. It can reduce the absorption of certain drugs that are sensitive to the effects of decreased stomach acid. Because of this, absorption of certain drugs can be reduced when used in combination with pantoprazole.

Methotrexate

Pantoprazole may increase blood levels of methotrexate. If you’re taking high doses of methotrexate, your doctor may have you stop taking pantoprazole during methotrexate therapy.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Pantoprazole Warnings
osteoporosis
People with osteoporosis

Pantoprazole can increase a person's risk for osteoporosis, a condition that causes bones to become brittle. Let your healthcare provider know if you have a history of osteoporosis.

low blood magnesium
People with low blood magnesium (hypomagnesemia)

Pantoprazole can lower blood magnesium levels. Let your healthcare provider know if you have a history of hypomagnesemia.

pregnant woman
Pregnant women

Pantoprazole is a pregnancy category B drug. That means two things:

  1. Studies of the drug in pregnant animals have not shown risk to the fetus.
  2. There aren’t enough studies done in pregnant women to show the drug poses a risk to the fetus.

If you’re pregnant or plan to become pregnant, speak with your doctor about this drug.

breastfeeding
Women who are nursing

Pantoprazole may pass through breast milk and could be passed to a breastfeeding baby.

Talk to your healthcare provider about other treatment options while breastfeeding.

children
For Children

Pantoprazole is sometimes used for short-term treatment of erosive esophagitis in children ages 5 and older. This condition is associated with GERD. It causes irritation and damage to the throat from stomach acid. Your child’s doctor will provide the correct dose.

allergies
Allergies

Though it’s rare, pantoprazole can cause an allergic reaction. Symptoms may include rash, swelling or breathing problems.

This allergic reaction can progress to interstitial nephritis, a kidney disorder that can lead to kidney failure. Symptoms of this condition include:

  • nausea or vomiting
  • fever
  • rash
  • confusion
  • blood in your urine
  • bloating
  • elevated blood pressure

If you experience any of these symptoms, call your doctor right away. If your symptoms seem severe or life threatening, go to an emergency room or call 9-1-1.

SECTION 4 of 5

How to Take pantoprazole (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What Are You Taking This Medication For?

Gastroesophageal reflux disease (GERD)
Form: Oral Tablet
Strengths: 20 mg and 40 mg
Adult Dosage (ages 18 years and older)

20 mg to 40 mg per day taken once a day with or without food.

Child Dosage (ages 5-17 years)
  • For children who weigh 40 kilogram and more, the dose is 40 mg taken once per day for up to 8 weeks.
  • For children who weigh between 15 and 40 kilograms, the dose is 20 mg taken once per day for up to 8 weeks.
Child Dosage (ages 0-4 years)

A safe and effective dose hasn’t been established.

Excess acid production, such as Zollinger-Ellison syndrome
Form: Oral Tablet
Strengths: 20 mg and 40 mg
Adult Dosage (ages 18 years and older)

20 mg to 40 mg per day taken once a day with or without food.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Pantoprazole comes with serious risks if you don’t take it as prescribed.

If You Don’t Take It or Stop Taking It

If you don’t take the drug at all or stop taking it, you risk decreased ability to control your symptoms of GERD.

If You Don’t Take It on Schedule

Not taking pantoprazole every day, skipping days, or taking doses at different times of day may also decrease your control of GERD.

What to Do If You Miss a Dose

If you miss a dose, take the next dose as planned. Don’t double your dose.

How to Tell If the Drug Is Working

You can tell that pantoprazole is working if it reduces your GERD symptoms, such as:

  • heartburn
  • nausea
  • difficulty swallowing
  • regurgitation
  • sensation of a lump in your throat

This drug may be prescribed for either short-term or long-term use.

How long you take it will depend on the type and severity of your condition.

Important Considerations for Taking Pantoprazole
take with or without food
You can take this form with or without food
timing
Take at the same time every day for best effects
do not crush
Don’t cut, crush, or chew this medication
storage
Store at room temperature: 68–77°F (20–25°C)
See Details
refillable
Prescription is refillable
clinical monitoring
Clinical Monitoring
See Details

Store at room temperature: 68–77°F (20–25°C)

You can store it for a short time in temperatures as low as 59°F (15°C) and as high as 86°F (30°C).

Clinical Monitoring

Pantoprazole can lower magnesium levels in certain people. Your doctor may suggest having your blood magnesium levels monitored if you’re treated with pantoprazole for three months or more.

Are There Any Alternatives?

Possible alternatives to the oral tablet include:

  • lansoprazole (Prevacid)
  • esomeprazole (Nexium)
  • omeprazole (Prilosec)
  • rabeprazole (Aciphex)
  • dexlansoprazole (Dexilant)

What does the pill look like?

Showing - out of 44
SECTION 5 of 5

How Much Does pantoprazole Cost?

Oral tablet

We've partnered with GoodRx so you can compare prices, find discounts and save up to 80% on your next prescription. Check out the low coupon prices below — no insurance required.

Compare prices and save up to 80% on your next refill!

Lowest price for pantoprazole

Walmart $9.88
Kroger Pharmacy $9.90
Membership warehouse $10.15
These prices represent the lowest priced national pharmacies for pantoprazole on GoodRx. They may be lower than your insurance.

Enter your zip code to find the best deal near you.

These prices represent the lowest priced national pharmacies for pantoprazole on GoodRx. They may be lower than your insurance.

Show Sources

  • Pantoprazole sodium- pantoprazole sodium tablet, delayed release. (2015, January). Retrieved from http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=eda64039-771b-41d7-b9c4-970cfbf5fbb9
  • Protonix delayed-release- pantoprazole sodium tablet, delayed release: Protonix delayed-release- pantoprazole sodium granule, delayed release. (2015, January). Retrieved from http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=08098cb2-c048-4640-f387-6beec4a38936
  • Huber, R., Hartmann, M., Bliesath, H., Lühmann, R., Steinijans, V. W., & Zech, K. (1996). Pharmacokinetics of pantoprazole in man. International journal of clinical pharmacology and therapeutics, 34(1 Suppl), S7-16.
  • Corleto, V. D., Festa, S., Di Giulio, E., & Annibale, B. (2014). Proton pump inhibitor therapy and potential long-term harm. Current opinion in endocrinology, diabetes and obesity, 21(1), 3-8.
  • Dhaliwal, A., & Nwokolo, C. (2014). Commentary: daily pantoprazole vs. esomeprazole for GERD. Alimentary pharmacology & therapeutics, 39(2), 226-226.
  • U.S. Food and Drug Administration. (2011, March). FDA drug safety communication: possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors. Retrieved from http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm213206.htm
  • Mockenhaupt, M., Viboud, C., Dunant, A., Naldi, L., Halevy, S., Bouwes Bavinck, J. N., Sidoroff, A., . . . Flahault A. (2008, January). Stevens-Johnson syndrome and toxic epidermal necrolysis: assessment of medication risks with emphasis on recently marketed drugs. The EuroSCAR-study. Journal of Investigative Dermatology – Nature, 128(1), 35-44.

Content developed in collaboration with Stacey Boudreaux, PharmD

Medically reviewed by Susan J. Bliss, RPh, MBA on February 9, 2015

Disclaimer: Healthline 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 other 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.
Advertisement
Advertisement
Advertisement