How does this medication work? What will it do for me?

Pantoprazole belongs to the family of medications called proton pump inhibitors (PPIs). Proton pump inhibitors are used to treat conditions such as stomach ulcers, intestinal ulcers, and gastroesophageal reflux disease (GERD, reflux esophagitis) by reducing the amount of acid the stomach produces. Pantoprazole is also sometimes used along with antibiotics to treat stomach ulcers that are caused by bacteria known as H. pylori.

Pantoprazole can also be used to treat or reduce the risk of stomach ulcers due to medications known as nonsteroidal anti-inflammatory drugs (NSAIDs), which irritate the stomach.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Each 15 mL vial contains 40 mg pantoprazole (45.11 mg pantoprazole sodium sesquihydrate) as a lyophilized powder. Stopper contains no dry natural rubber.

How should I use this medication?

The recommended dose of pantoprazole to treat reflux esophagitis is 40 mg once daily in the morning for 4 to 8 weeks. Treatment may be continued at a dose of 20 mg to 40 mg once daily to prevent the symptoms from returning.

To treat GERD or heartburn, the recommended dose is 40 mg once daily for up to 4 weeks.

To prevent stomach ulcers associated with NSAID use, the dose is 20 mg once daily in the morning.

To treat duodenal (intestinal) ulcers, the recommended dose is 40 mg once daily in the morning for 2 to 4 weeks.

To treat gastric (stomach) ulcers, the recommended dose is 40 mg once daily in the morning for 4 to 8 weeks.

To treat duodenal (intestinal) ulcers caused by H. pylori in adults, the dose of pantoprazole is 40 mg twice daily taken with amoxicillin 1,000 mg twice daily and clarithromycin 500 mg twice daily, or pantoprazole 40 mg twice daily taken with metronidazole 500 mg twice daily and clarithromycin 500 mg twice daily. The usual duration of this treatment is 7 days.

Do not chew or crush the tablets. Swallow them whole with a glass of water  in the morning either before, during, or after breakfast.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you are allergic to pantoprazole or any ingredients of the medication.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • diarrhea (mild)
  • dizziness
  • headache
  • itching
  • nausea

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • any changes in vision
  • diarrhea (watery and severe; may also be bloody)
  • rash
  • symptoms of liver damage (such as yellow skin or eyes, abdominal pain, dark urine, clay-coloured stools, loss of appetite)
  • symptoms of muscle damage (unexplained muscle pain, tenderness or weakness, or brown or discoloured urine - especially if you also have a fever or a general feeling of being unwell)

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • severe skin rash, including skin blistering and peeling (possibly with headache, fever, coughing, or aching before the rash begins)
  • symptoms of a serious allergic reaction (such as swelling of the face or throat, hives, or difficulty breathing)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Diarrhea: When gastric acid is decreased, the number of bacteria normally in the digestive system increases. Occasionally, this can cause serious infection in the digestive tract.  If you experience severe watery or bloody diarrhea, fever, or abdominal pain while taking pantoprazole, contact your doctor as soon as possible.

Electrolyte balance: Long term use of pantoprazole may cause the levels of electrolytes such as potassium, calcium and magnesium in the blood to decrease. If you experience symptoms of fluid and electrolyte imbalance such as muscle pains or cramps; dry mouth; numb hands, feet, or lips; or racing heartbeat, contact your doctor as soon as possible. Your doctor may do blood tests periodically to monitor the levels of these electrolytes in your blood while you are taking this medication.

Kidney function: If you have kidney disease or decreased kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: People with severe liver disease should generally not take more than 20 mg of pantoprazole daily. If you have liver disease or decreased liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Methotrexate interaction: Pantoprazole, like other medications in this group, may interact with methotrexate when the two medications are used at the same time. This combination may lead to higher than expected amounts of methotrexate in the body and can cause serious side effects, including kidney damage, irregular heartbeat, anemia, or infection. If you take pantoprazole and are also going to receive a dose of methotrexate, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Osteoporosis fractures: Long term use of pantoprazole may be related to an increased risk of bone fractures in the hip, wrist or spine, as a result of weakened bones. This risk is further increased if you are at risk of developing osteoporosis. If you have osteoporosis or have risk factors for developing osteoporosis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Severe stomach problems: If you have recurrent vomiting, difficulty swallowing, blood in the stool, significant unintentional weight loss, fatigue (anemia), or are coughing up blood, check with your doctor right away.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking pantoprazole, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication has not been established for children.

What other drugs could interact with this medication?

There may be an interaction between pantoprazole and any of the following:

  • amphetamines
  • "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
  • bisphosphonates (e.g., alendronate, etidronate, risedronate)
  • carbamazepine
  • clopidogrel
  • dabigatran
  • dabrafenib
  • delaviridine
  • HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
  • iron salts
  • ledipasvir
  • mesalamine
  • methotrexate
  • methylphenidate
  • multivitamins with minerals
  • mycophenolate
  • nilotinib
  • pazopanib
  • phenytoin
  • rifampin
  • rilpivirine
  • riociguat
  • "statin" anti-cholesterol medications (e.g., atorvastatin, lovastatin, simvastatin)
  • topotecan
  • certain tyrosine kinase inhibitors (e.g., bosutinib, dasatinib, nilotinib)
  • warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.