Pantoprazole (Oral)

Pantoprazole is a medication that is used to treat certain conditions where excess stomach acid is present, including heartburn'.

Overview

In the US, pantoprazole is more commonly known as Protonix. It is a prescription-only medication that will be given to you by your GP and comes in the form of tablets or powder.

Pantoprazole is used to treat conditions that are caused when there is too much stomach acid present. One such condition is erosive esophagitis, more commonly called heartburn', which is caused by gastroesophageal reflux disease (GERD). This problem causes the stomach acid to flow back up on to the patient's esophagus. Pantoprazole can also be used to treat a condition called Zollinger-Ellison syndrome, where the person's stomach produces excessive amounts of acid.

Pantoprazole is one of a family of medicines called proton pump inhibitors (PPI). The medicine works by effectively reducing the quantity of stomach acid that is produced by the patient's body.

This medication will not provide a complete cure for your condition, but it can be very effective at controlling the symptoms.

Conditions treated

  • Erosive esophagitis (heartburn')
  • Zollinger-Ellison syndrome
  • Excessive production of stomach acid

Type of medicine

  • Proton pump inhibitors (PPI)
  • Tablet
  • Enteric coated tablet
  • Packet

Side effects

In addition to the effects it is intended to have, some drugs can cause a few unwanted side effects or bad reactions. Not everyone using pantoprazole will notice anything untoward, but if you do experience any effects, you may need to see your GP for further medical treatment.

If you notice any of the effects noted below, you should check with your GP right away:

  • Yellow skin or eyes
  • Vomiting blood
  • Vomiting
  • Feeling unusually tired or weak
  • Unpleasant odor on the breath
  • Unexplained weight loss
  • Unexplained bleeding or bruising
  • Breathing problems
  • Trembling
  • Tightness in the chest
  • Swollen glands
  • Swelling of the lower legs or feet
  • Sweating
  • Persisting stomach pain
  • Ulcers, sores, or white spots in the mouth or on the lips
  • Sore throat
  • Sensation of spinning
  • Seizures
  • Irritated, red eyes
  • Red skin lesions, sometimes with purple centers
  • Swelling or puffiness around the eyes, the eyelids, face, tongue, or lips
  • Pale skin
  • Pains in the abdomen, side, and stomach, often radiating around to the back
  • Nausea
  • Muscle spasms (tetany) or twitching
  • Muscle stiffness or pain
  • Muscle cramps
  • Mental or mood changes
  • Poor appetite
  • Light-colored stools
  • Large swellings on the eyelids, face, lips, throat, tongue, legs, hands, feet, or genitals
  • Joint pains
  • Indigestion
  • Increased urination
  • Increased thirst
  • Increased hunger
  • Skin rash, hives, or itching
  • High fever
  • Loss of hearing
  • Headache
  • Greatly decreased amount of urine or frequency of urination
  • General feelings of weakness or tiredness
  • Fruity breath odor
  • Dry, flushed skin
  • Feeling of constant movement of surroundings or self
  • Rapid heartbeat
  • Dry mouth
  • Drowsiness
  • Feelings of dizziness or lightheadedness
  • Difficulty swallowing
  • Difficulty speaking
  • Diarrhea
  • Failing vision
  • Dark-colored urine
  • Cough
  • Continuous tinnitus
  • Constipation
  • Clay-colored stools
  • Chills
  • Blurred vision
  • Black, bloody, or tarry stools
  • Cloudy or bloody urine
  • Bloating
  • Peeling, blistering, or loosening of the skin
  • Blindness
  • Decrease in or absence of body movement
  • Stomach or abdominal pains

Some people taking pantoprazole experience side effects that resolve by themselves without requiring further treatment. The effects usually disappear as your body gets used to the new medicine. Your GP may also be able to suggest ways in which you can reduce or prevent the side effects.

Ask your GP for advice if any of the following effects prove to be persistent of especially annoying, or if you have anything you would like to ask about them:

  • Belching
  • Bloated or full feeling
  • Excess air or gas in the stomach or intestines
  • Passing gas
  • Trouble sleeping
  • Increased watering of the mouth

There may be other effects experienced by people taking pantoprazole that are not mentioned here. If you notice any other effects, always check with your GP.

Dosage

This medication should only be used as per your GP's instructions. Do not exceed the dose that you have been prescribed, take it more frequently, or use it for a longer period than you have been directed to by your GP.

When you collect your prescription for pantoprazole, you will also be given a patient guide. Be sure to read and follow the directions contained in the guide. If you do not understand anything about your new medication, ask your GP for clarification.

When taking the delayed-release tablet version of pantoprazole, do not chew, split, or crush the tablets; swallow them whole.

If you are using pantoprazole delayed-release oral suspension granules, there are several methods of administration:

Apple sauce:

  • Open the packet.
  • Take one teaspoonful of apple sauce and mix the packet contents into it.
  • Be sure to eat the mixture at least half an hour before you have a meal, and use the concoction within ten minutes of mixing it.
  • After you have eaten the mixture, take a small drink of water to wash the medicine right through to your stomach.
  • You must not split the packet contents into lesser doses. Do not eat the granules alone or try to squash them to a powder.

Apple juice:

  • Open the packet.
  • Take one teaspoonful of apple juice and mix the granules into it, using a cup.
  • Stir the mixture for a few seconds and drink it right away, at least half an hour before you have a meal.
  • Rinse any residual granules around the cup with more apple juice and swallow right away to wash the medicine right through to your stomach.
  • You must not split the packet contents into lesser doses. Do not eat the granules alone or try to squash them to a powder.

Feeding tube:

  • Empty the granules into a 2 oz catheter tipped syringe.
  • Ensure that the feeding tube is clear of obstructions before placing the product into it.
  • Pour 10 ml of apple juice into the dispenser. Tap or gently shake the syringe to rinse it out.
  • Repeat if necessary so that there is no residual product in the syringe or the tube.
  • Use the medication at least half an hour before having a meal.

It should be noted by patients that their dose of pantoprazole will possibly be at variance from that given to other people with similar conditions. You should keep to your GP's instructions or follow the dispensary label's instructions. The information contained in this guide is based on the recommended average. Do not change your dose if it is different from this, unless you are told to do so by your GP.

The size of your dose of pantoprazole will depend on the strength of the preparation that you are given. In addition, the number of daily doses you take, the time you leave between them, and the duration of your course of treatment will be dependent on the health condition you are taking pantoprazole in order to treat.

Delayed-release suspension or tablets for erosive esophagitis:

  • Adults: Take 40 mg once daily for up to eight weeks. Your GP may instruct you to extend your course of treatment if applicable to your condition.
  • Children aged over five years, over 40 kg in weight: Take 40 mg once daily for up to eight weeks.
  • Children aged over five years, 15 kg to 39 kg in weight: Take 20 mg once daily for up to eight weeks.
  • Children under five years of age: Your GP will determine the dose and use of the medicine.

Delayed-release suspension or tablets for Zollinger-Ellison syndrome:

  • Adults: Initially, take 40 mg twice daily. Your GP may alter your dose if necessary.
  • Children: Your GP will determine the dose and use of the medicine.

If you miss out a dose of pantoprazole, you should try to take it right away. However, if your next dose is due, leave out the one that you forget and revert to your original dosing regimen. Do not take a double dose.

Interactions

Drug interactions

There are some medications that you should never use together, as this can cause a dangerous interaction. In other instances, it may be applicable to use both drugs together, despite the interactions. In this case, your GP might change the dose of one or both of the drugs that you take, or offer advice on precautions that you can take to avoid interactions.

When taking pantoprazole, you must tell your GP if you are using any of the drugs that are listed below:

  • Vismodegib
  • Velpatasvir
  • Saquinavir
  • Rilpivirine
  • Pazopanib
  • Nilotinib
  • Nelfinavir
  • Mycophenolate Mofetil
  • Methotrexate
  • Ledipasvir
  • Ketoconazole
  • Gefitinib
  • Eslicarbazepine Acetate
  • Erlotinib
  • Dasatinib
  • Citalopram
  • Cilostazol
  • Bosutinib
  • Atazanavir

It should be noted by patients using pantoprazole that using it with any of the following drugs can present a high risk of side effects. However, using both of these drugs may be the most appropriate treatment for you. In this case, your GP may change the frequency of use or dose of one or both of the drugs:

  • Warfarin
  • Levothyroxine

Other interactions

You must not use some drugs with certain foodstuffs or when eating a meal. In addition, some medicines should not be used with alcohol or tobacco, as this could cause an interaction to take place. The interactions mentioned here are not necessary an exhaustive list and have been chosen on the basis of their significance.

Be sure to discuss this aspect of your treatment with your treating physician.

While you are taking pantoprazole, you should avoid eating cranberries or drinking cranberry juice, as it can cause an interaction with this drug. If you have any questions about this, you should ask your doctor for advice.

Medical interactions

If you have any existing or historical health conditions, you must tell your treating physician as these could affect your use of pantoprazole, especially those conditions mentioned below.

You must inform your treating physician if you have every suffered from any of the following health problems. Using pantoprazole with any of these conditions could make them worse:

  • Systemic lupus erythematosus (SLE)
  • Osteoporosis or other bone problems
  • Low magnesium levels in your bloodstream (hypomagnesemia)
  • History of seizures
  • Diarrhea

Warnings

When deciding whether or not to undergo treatment with a particular drug, you should have a discussion with your GP. This will give you the chance to address any concerns that you have about using the medicine and will allow you to weigh up the pros and cons of using it.

Before you begin taking pantoprazole, be sure to tell your GP if you have ever noticed any bad reactions to this drug or to any other prescription or over the counter medicines. You should also mention if you have any known allergies to particular food groups, food colors, preservatives, or to animal by-products. Before you begin taking the medicine, check the label to make sure that you are not allergic to any of the ingredients.

There have not been any definitive studies into the effect of pantoprazole on children under the age of five years. If you have any concerns or questions about the use of this medicine in your child, have a chat with your GP.

Studies have not been carried out into the use of pantoprazole in geriatric patients, so it is not clear if there are any issues with using this drug in elderly people. If you have any concerns in this regard, you should mention them to your GP.

Although the use of pantoprazole in pregnant women has been studied, there is no evidence to suggest that using this medicine can cause any harm to the unborn baby. Pregnant women should discuss the use of this drug with their GP before they begin using it.

Similarly, it is not known whether pantoprazole can be ingested by a nursing infant via the mother's breast milk. You should discuss this with your midwife or GP if you are breastfeeding and have concerns in this regard. You may wish to consider using an alternative feeding option for your infant while you are using pantoprazole.

While you are taking pantoprazole, you must attend your GP for regular checks and monitoring, including blood and urine testing. This will ensure that the medicine is working as desired and is not causing any unmanageable side effects.

You must speak with your GP right away if you notice any of the following signs:

  • Joint pain
  • Fever
  • Skin rashes
  • Swelling of the feet, body, or ankles
  • Unexpected weight gain

These could all be symptomatic of a condition called interstitial nephritis.

If you suffer from systemic or cutaneous lupus erythematosus, your condition may become worse if you are taking a PPI such as pantoprazole. If you develop joint pains, or a rash on your arms or cheeks that gets worse when you are exposed to the sun, you must check with your GP.

Pantoprazole can affect the body's ability to absorb vitamin B12, especially if you are a long-term user. If you suffer from or are worried that you may develop vitamin B12 deficiency, check with your GP.

If you have stomach pains, fever, or watery stool that does not resolve, speak to your GP right away.

Pantoprazole can cause an increased risk of bone problems in patients over the age of 50 years, especially if the dosage rate is high. Be aware that you could suffer from fractures of the spine, wrist, and hips, and moderate your activities accordingly.

Pantoprazole can cause low magnesium levels in the blood (hypomagnesemia) in some patients, especially if you have been using the drug for over a year, or if you use digoxin, or certain diuretics at the same time. If you notice seizures, irregular or rapid heartbeat, muscle spasms, tremors, or feelings of unexplained weakness or tiredness, check with your treating physician right away.

You must not stop using pantoprazole without asking your GP first, or unless another medical professional tells you to stop taking it.

If you are due to attend for any medical tests, you must tell the doctor in charge that you are using pantoprazole. This medicine can affect the results of some tests.

You must not take any other forms of medicine unless their use has been approved by your GP, including herbal or vitamin products and those medicines listed below:

  • Viracept
  • Reyataz
  • Nelfinavir
  • Atazanavir

Storage

Keep this medication in a sealed container, away from direct sunlight and other heat sources. Keep pantoprazole at room temperature. Do not freeze the medicine. Do not allow the medicine to get damp.

Be sure to put your prescription of pantoprazole well away from children and pets. If a pet does consume any of your medication, contact your vet right away.

Do not keep and use medication that is out of date or no longer required.

Ask your GP or pharmacist for guidance on how to dispose of unwanted drugs safely.

Summary

Pantoprazole is one of a class of drugs called proton pump inhibitors (PPI). These medicines are used to treat conditions caused by gastroesophageal reflux disease (GERD), where the body makes too much gastric acid. One condition that is treated with pantoprazole is erosive esophagitis, or heartburn'.

Although pantoprazole cannot provide a complete cure for your GERD, it can be very effective at controlling the symptoms.

Pantoprazole can cause a wide range of side effects, and there are a number of drugs that it should not be used in conjunction with. For this reason, you should be sure to discuss your medical history with your GP before you start using this medicine. Throughout the course of your treatment you will need to attend your doctor for check-ups and routine urine and blood tests. These visits are designed to make sure that the medication is working correctly and that any side effects are identified and treated appropriately.