What to know about pantoprazole

Pantoprazole is the generic name for Protonix, a drug that helps treat problems related to acid reflux and peptic ulcers. It works by decreasing acid in the stomach.

Pantoprazole is a proton pump inhibitor (PPI). People use it to treat and manage the symptoms of erosive esophagitis and Zollinger–Ellison syndrome.

Doctors also prescribe pantoprazole to stop ulcers from forming.

In this article, we take a look at the uses of pantoprazole, possible side effects, and warnings when taking this drug.

What are its uses?

a woman holding a Pantoprazole pill.
A doctor may prescribe pantoprazole to treat erosive esophagitis.

Adults and children aged 5 years and older can take pantoprazole to treat erosive esophagitis. Erosive esophagitis is inflammation of the esophagus, which is the tube that connects the mouth and stomach. Erosive esophagitis occurs when stomach acid rises up into the esophagus.

Usually, doctors will prescribe pantoprazole sodium tablets for erosive esophagitis for a period of 8 weeks. Sometimes, however, adults need to take it for an additional 8 weeks for further healing.

Doctors should limit the use of pantoprazole in children with erosive esophagitis to a maximum of 8 weeks.

People can also use pantoprazole to treat chronic conditions such as Zollinger–Ellison syndrome. People with Zollinger–Ellison syndrome may have stomach ulcers, acid reflux, and chronic diarrhea.

Doctors can also prescribe pantoprazole, alongside antibiotics, to treat Helicobacter pylori infections.

Off label, doctors can prescribe pantoprazole to prevent bleeding stomach ulcers and to stop stomach ulcers from forming after a person takes nonsteroidal anti-inflammatory drugs.

How does pantoprazole work?

Pantoprazole, like other PPIs, works by blocking the pumps in the stomach lining that release acid. These pumps are called hydrogen-potassium pumps.

PPIs can reduce acid secretion in the stomach for up to 24 hours. Within that time, the stomach will produce more pumps, so people need to take another dose to stop the production of acid in the stomach.

How to take pantoprazole

Pantoprazole sodium is available in the form of coated delayed release tablets in 20 milligram (mg) and 40 mg strengths. An oral suspension is available in 40 mg doses for people unable to take tablets.

People must take the delayed release tablets whole. They should not split, chew, or crush the tablets because pantoprazole is unstable in acidic environments. The coating protects the medicine from degrading in the stomach.

People can take the tablets with or without food. For the oral suspension, take it in 1 teaspoon of applesauce or apple juice around 30 minutes before a meal.

Each diagnosis will require a different dosage of pantoprazole, so healthcare providers must make an accurate diagnosis before prescribing the drug.

In rare, critical circumstances, a doctor may give someone injectable pantoprazole for 7–10 days in a hospital setting until the person can take capsules or oral suspension drugs.

Erosive esophagitis

For erosive esophagitis, doctors can prescribe tablets or oral suspension pantoprazole.

Adults can take 20 mg or 40 mg daily depending on the severity of the condition. Doctors will typically prescribe pantoprazole for 8 weeks.

If the drug is not effective after 8 weeks, a person can, in some cases, continue taking the lowest effective dosage for another 8 weeks.

Zollinger–Ellison syndrome

When treating chronic conditions such as Zollinger–Ellison syndrome, people should take 40 mg of pantoprazole twice per day.

Side effects

headache after crying
A person taking pantoprazole may experience headaches as a side effect.

Most people tolerate pantoprazole well, but some may experience the following side effects:

  • diarrhea
  • headache
  • respiratory infections
  • abdominal pain

When people use pantoprazole for long periods, they are at an increased risk of the following side effects:

  • Clostridium difficile diarrhea
  • colitis
  • overgrowth of bacteria in the small intestine
  • bone loss
  • kidney disorders

People who take pantoprazole for an extended period of time are at risk of the drug becoming carcinogenic and causing rare types of gastrointestinal tumors.

Based on a recent major change to its prescribing information, people are also at increased risk of stomach growths called fundic gland polyps when taking PPIs for a long period — especially for longer than 1 year.

Taking pantoprazole for extended periods can cause vitamin and mineral deficiencies, such as:


Doctors should follow up with people taking pantoprazole. After completing the treatment, if a person still has symptoms, the doctors should investigate whether or not the diagnosis was indeed accurate.

Sometimes, people may feel much better after the treatment is complete, but their symptoms may quickly return. Doctors may perform further tests, including an endoscopy.

An endoscopy involves passing a flexible tube with a camera attached, called an endoscope, into the stomach through the mouth to see the inside of the body.

Kidney conditions

Taking pantoprazole can lead to a kidney condition called acute interstitial nephritis. This may occur in people with a sensitivity to PPIs.

If a doctor detects this condition, they will stop the medication immediately.

Bacterial infections

Several studies have linked the use of pantoprazole with C. difficile diarrhea. This infective diarrhea can be fatal, particularly among older adults.

Doctors should prescribe the lowest effective dosage for the shortest time possible to prevent this infection.

Bone problems

People taking high doses, multiple times per day, and for extended periods are also at risk of fractures of the hip, wrist, or spine.

Skin problems

A severe skin condition called cutaneous lupus erythematosus has occurred in some people taking pantoprazole.

This condition may develop after a few weeks to a few years of continuous use of this drug. Once the person stops taking the drug, symptoms will improve in about 4–12 weeks.

Drug interactions

When combining pantoprazole with other medications, a doctor needs to consider the possible interactions. Some drugs need acidic conditions for the intestine to absorb them.

By reducing the acidity of the stomach contents, pantoprazole may affect how well the body absorbs the following drugs:

  • iron
  • ketoconazole
  • certain anticancer drugs
  • certain immunosuppressant drugs

Pantoprazole might give a false-positive urine drug test for THC.

People taking antiretrovirals such as rilpivirine or nelfinavir should not use pantoprazole, or any other PPI. PPIs can reduce how well the body absorbs these antiretrovirals.

Doctors need to frequently monitor people taking warfarin and pantoprazole at the same time, as the combination can cause increased bleeding. If both drugs are required, the doctor may need to adjust the warfarin dosage.

Taking methotrexate and pantoprazole together can cause increased levels of methotrexate, which can be toxic. Doctors should closely monitor people who are taking high dosages of methotrexate with pantoprazole.

Some studies have shown an interaction between clopidogrel and pantoprazole. However, the effects are not yet clear.

Some people combine over-the-counter antacids with pantoprazole. There are no interactions between these two types of drug.

Pregnancy and breastfeeding

Pantoprazole sodium (Protonix) is a pregnancy category C drug.

According to the Food and Drug Administration (FDA), this means that animal studies suggest that the drug could harm a fetus.

However, researchers have not studied how safe the drug is for pregnant women. In some cases, the potential benefits might allow for the use of pantoprazole during pregnancy.

Pantoprazole is released into human breast milk, but the effects on the infant remain unclear. If a person is breastfeeding and considering taking pantoprazole, they should speak with their doctor to evaluate the risks versus benefits to the nursing child.


According to GoodRx, the lowest cost of 30 tablets of generic pantoprazole 20 mg is around $9.91. It costs as little as $7.07 for the 40 mg tablets.

Compared with other PPIs

doctor speaking with his patient who is concerned about micropenis
A person should seek medical advice about which PPI will work best for them.

Doctors have used PPIs for over 25 years. They are a safe and effective medication that can help people manage a range of acid-related medical conditions.

All PPIs act in a similar way, though there are some differences in their properties, how the body breaks them down, and their FDA-approved uses.

There is currently no strong evidence to suggest that one PPI is better than another for managing GERD, peptic ulcers, or healing esophagitis.

Other PPIs include:

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

A doctor can advise on which type may be best for an individual based on their medical history.


Pantoprazole is an effective medication for treating erosive esophagitis.

Most people experience no side effects, but they should follow up with their doctor while taking the drug to make sure that it is working and that the diagnosis is correct.

If the symptoms quickly return after the treatment is complete, the doctor will need to do some tests to see if the initial diagnosis was accurate.

When people use pantoprazole for long periods of time, they might be at risk of vitamin and mineral deficiencies. Doctors need to detect and correct deficiencies as quickly as possible.

Pantoprazole may interfere with some drugs, so it is important that a doctor has a complete drug history before prescribing pantoprazole or any other PPI.

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