Pantoprazole

Pantoprazole is a prescription medication used to treat gastroesophageal reflux disease and Zollinger-Ellison Syndrome. Pantoprazole belongs to a group of drugs called proton pump inhibitors. These work by decreasing the amount of acid made in the stomach.

This medication comes in a delayed release tablet and oral (by mouth) suspension form. It is usually taken once or twice daily, with or without food.

This medication is also available in an injectable form to be given directly into a vein (IV) by a healthcare professional.

Common side effects of pantoprazole include headache, diarrhea, and nausea.

CYP2C19 is an enzyme in the blood that is responsible for breaking down pantoprazole and other drugs in the body. Some patients have less of this protein in their bodies, affecting how much of the drug gets eliminated. Levels of CYP2C19 can vary greatly between individuals, and those having less of this protein are known as "poor metabolizers." 

CYP2C19 testing is done to determine whether you are a poor metabolizer. If you are a poor metabolizer, the levels of pantoprazole in your blood can become too high. As a result you may be at an increased risk of having more side effects from pantoprazole. 

Your doctor may adjust your dose of pantoprazole if you are a poor metabolizer.

Pantoprazole is a prescription medication used for:

• erosive esophagitis (damage to the esophagus caused by stomach acid) caused by gastroesophageal reflux disease (GERD)
• Zollinger-Ellison Syndrome (a condition in which the stomach makes too much acid)

​This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Pantoprazole may be found in some form under the following brand names:

• Protonix

Pantoprazole can cause serious side effects including:

• Stomach lining weakening with long-term use
• Vitamin B-12 deficiency
• Serious allergic reactions. Tell your doctor if you get any of the following symptoms with pantoprazole
  • rash
  • face swelling
  • throat tightness
  • difficult breathing

Your doctor may stop pantoprazole if these symptoms happen.

The most common side effects with pantoprazole in adults include:

• Headache
• Diarrhea
• Nausea
• Stomach pain
• Vomiting
• Gas
• Dizziness
• Pain in your joints

The most common side effects with pantoprazole in children include:

• Upper respiratory infection
• Headache
• Fever
• Diarrhea
• Vomiting
• Rash
• Stomach pain

People who are taking multiple daily doses of proton pump inhibitor medicines for a long period of time may have an increased risk of fractures of the hip, wrist or spine.

Tell your doctor about any side effects that bother you or that do not go away.

These are not all the possible side effects with pantoprazole. Talk with your doctor or pharmacist if you have any questions about side effects. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all of the medicines you take, including prescription and non-prescription drugs, vitamins and herbal supplements. Pantoprazole may affect how other medicines work, and other medicines may affect how pantoprazole works. Especially tell your doctor if you take:

• Warfarin (Coumadin, Athrombin-K, Jantoven, Panwarfin)
• Ketoconazole (Nizoral)
• Atazanavir (Reyataz), Nelfinavir (Viracept)
• Iron supplements
• Ampicillin antibiotics

Ask your doctor if you are not sure if any of your medicines are the kind listed above.

Do not take pantoprazole if you are:

• allergic to any of the ingredients in pantoprazole delayed-release tablets. 
• allergic to any proton pump inhibitor (PPI). If you do not know if your medicines are PPIs, please ask your doctor.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of Pantoprazole there are no specific foods that you must exclude from your diet when receiving Pantoprazole.

Before taking pantoprazole, tell your doctor about all your medical conditions, including if you are:

• pregnant, think you may be pregnant, or are planning to become pregnant. 
• breastfeeding or planning to breastfeed. 

Tell your doctor about all of the medicines you take, including prescription and non-prescription drugs, vitamins and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Pantoprazole falls into category B. There are no well-done studies that have been done in humans with pantoprazole. But in animal studies, pregnant animals were given this medication, and the babies did not show any medical issues related to this medication.

Tell your doctor if you are breastfeeding or plan to breastfeed.

Pantoprazole has been detected in human breast milk. Because of the possibility for adverse reactions in nursing infants from pantoprazole, a choice should be made whether to stop nursing or to stop use of this medication. The importance of the drug to the mother should be considered.

• Take pantoprazole exactly as prescribed by your doctor.
• Do not change your dose or stop pantoprazole without talking to your doctor.
• If you forget to take a dose of pantoprazole, take it as soon as you remember. If it is almost time for your next dose, do not take the missed dose. Take the next dose at your regular time. Do not take two doses to try to make up for a missed dose.

Tablets:

• You can take pantoprazole tablets with food or on an empty stomach.
• Swallow pantoprazole tablets whole.
• If you have trouble swallowing a pantoprazole 40 mg tablet, you can take two 20 mg tablets instead.
• Do not split, chew, or crush pantoprazole sodium tablets.

Oral Suspension:

• Pantoprazole oral suspension should only be taken with applesauce or apple juice 30 minutes before a meal.
• Pantoprazole should not be taken in or with water or other liquids, or with other foods other than those described below.
• Pantoprazole oral suspension should not be chewed or crushed.
• Pantoprazole oral suspension packet should not be divided to make a smaller dose.

Directions for use with applesauce:

• Open packet.
• Sprinkle granules on one teaspoonful of applesauce. Do not use any other foods. Do not crush or chew the granules.
• Take within 10 minutes of putting the granules into the teaspoon of applesauce.
• Take sips of water to make sure the granules are washed down into the stomach. Repeat water sips as necessary.

Directions for use with apple juice:

• Open packet.
• Empty granules into a small cup or teaspoon with one teaspoonful of apple juice.
• Stir the mix for 5 seconds (granules will not break up) and swallow it right away.
• To make sure that the entire dose is taken, rinse the container once or twice with apple juice to get out any leftover granules. Swallow the apple juice right away.

Nasogastric Tube or Gastrostomy Tube Administration

For people who have a nasogastric (NG) tube or gastrostomy tube in place, pantoprazole oral suspension can be given as follows:

• Remove the plunger from the barrel of a 2 ounce (60 mL) catheter-tip syringe. Throw away the plunger.
• Connect the catheter tip of the syringe to a 16 French (or larger) tube.
• Hold the syringe attached to the tubing as high as possible while giving pantoprazole oral suspension to prevent any bending of the tubing.
• Empty the contents of the packet into the barrel of the syringe.
• Add 10 mL (2 teaspoonfuls) of apple juice and gently tap or shake the barrel of the syringe to help empty the syringe.
• Do this again at least two more times using the same amount of apple juice (10 mL or 2 teaspoonfuls) each time. No granules should be left in the syringe.

Injection:

• This medication is also available in an injectable form to be given directly into a vein (IV) by a healthcare professional.

Take pantoprazole exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

• For short-term treatment of erosive esophagitis linked with GERD, the adult dose is 40 mg once daily for up to 8 weeks.
• For maintenance of healing of erosive esophagitis, the adult 40 mg once daily.
• For hypersecretory conditions such as Zollinger-Ellison Syndrome, the adult dose is 40 mg twice daily.

If you take too much pantoprazole sodium, call your doctor right away.

• Store pantoprazole at room temperature between 59° to 86°F (15° to 30°C).
• Keep pantoprazole and all medicines out of the reach of children.