Description and Brand Names

Drug information provided by: IBM Micromedex

US Brand Name

  1. Protonix

Descriptions


Pantoprazole is used to treat certain conditions in which there is too much acid in the stomach. It is used to treat erosive esophagitis or "heartburn" caused by gastroesophageal reflux disease (GERD), a condition where the acid in the stomach washes back up into the esophagus. This medicine may also be used to treat Zollinger-Ellison syndrome, a condition where the stomach produces too much acid.

Pantoprazole is a proton pump inhibitor (PPI). It works by decreasing the amount of acid produced by the stomach.

This medicine is available only with your doctor's prescription.

This product is available in the following dosage forms:

  • Packet
  • Tablet, Enteric Coated
  • Tablet, Delayed Release

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of pantoprazole to treat erosive esophagitis in children younger than 5 years of age. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of pantoprazole in the elderly.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Rilpivirine

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acalabrutinib
  • Amphetamine
  • Atazanavir
  • Belumosudil
  • Benzphetamine
  • Bosutinib
  • Capecitabine
  • Cilostazol
  • Citalopram
  • Dacomitinib
  • Dasatinib
  • Dextroamphetamine
  • Erlotinib
  • Eslicarbazepine Acetate
  • Fedratinib
  • Gefitinib
  • Infigratinib
  • Ketoconazole
  • Ledipasvir
  • Lisdexamfetamine
  • Methamphetamine
  • Methotrexate
  • Mycophenolate Mofetil
  • Nelfinavir
  • Neratinib
  • Nilotinib
  • Octreotide
  • Palbociclib
  • Pazopanib
  • Pexidartinib
  • Saquinavir
  • Secretin Human
  • Selpercatinib
  • Sotorasib
  • Sunitinib
  • Velpatasvir
  • Vismodegib

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Levothyroxine
  • Warfarin

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Cranberry

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Diarrhea or
  • Hypomagnesemia (low magnesium in the blood), history of or
  • Osteoporosis (bone problem) or
  • Seizures, history of or
  • Systemic lupus erythematosus (SLE)—Use with caution. May make these conditions worse.
  • Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

This medicine comes with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.

Swallow the delayed-release tablet whole. Do not split, crush, or chew it. You may take the tablet with or without food.

For delayed-release oral suspension granules:

  • Applesauce method:
    • 1. Open packet.
    • 2. Mix the packet contents with 1 teaspoonful of applesauce. Do not mix with water, other liquids, or food.
    • 3. Swallow the mixture at least 30 minutes before a meal. Take it within 10 minutes after you mix it.
    • 4. Sip some water after you swallow the mixture. This will make sure all of the granules get all the way to your stomach.
    • 5. Do not chew or crush the granules. Do not divide the packet contents to make smaller doses.
  • Apple juice method:
    • 1. Open packet.
    • 2. Mix the packet contents with 1 teaspoon of apple juice in a small cup or container.
    • 3. Stir for 5 seconds (granules will not dissolve) and swallow it immediately or take it at least 30 minutes before a meal.
    • 4. Rinse the container with apple juice to make sure you get all of the medicine. Swallow it immediately.
    • 5. Do not chew or crush the granules. Do not divide the packet contents to make smaller doses.
  • Feeding tube:
    • 1. Pour the packet contents in a 2-ounce (60 mL) catheter-tip syringe.
    • 2. Clear any clogs from the feeding tube before you put this medicine mixture into the tube.
    • 3. Add 10 mL of apple juice into the syringe. Gently tap or shake the barrel of the syringe to help rinse the syringe and tube.
    • 4. Repeat with an additional 10 mL of apple juice. No granules should remain in the syringe.
    • 5. Take this medicine at least 30 minutes before a meal.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage forms (delayed-release tablets or suspension):
    • For erosive esophagitis:
      • Adults—40 milligrams (mg) once a day for up to 8 weeks. Your doctor may want you to take pantoprazole for more than 8 weeks for certain conditions.
      • Children 5 years of age and older weighing 40 kilograms (kg) or more—40 mg once a day for up to 8 weeks.
      • Children 5 years of age and older weighing 15 to 39 kg—20 mg once a day for up to 8 weeks.
      • Children younger than 5 years of age—Use and dose must be determined by your doctor.
    • For Zollinger-Ellison syndrome:
      • Adults—At first, 40 milligrams (mg) 2 times a day. Your doctor may increase your dose as needed.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions

It is very important that your doctor check your and your child's progress at regular visits to make sure this medicine is working properly. Blood, urine, and other laboratory tests may be needed to check for unwanted effects.

Do not use pantoprazole together with medicines containing rilpivirine (eg, Complera®, Edurant®, Odefsey®). Using these medicines together may cause unwanted side effects.

Check with your doctor right away if you have a change in frequency of urination or amount of urine, blood in the urine, fever, joint pain, loss of appetite, nausea, skin rash, swelling of the body, feet, or ankles, unusual tiredness or weakness, or unusual weight gain after receiving this medicine. These could be symptoms of a serious kidney problem called acute tubulointerstitial nephritis.

Cutaneous or systemic lupus erythematosus may occur or get worse in patients receiving a PPI. Call your doctor right away if you have joint pain or a skin rash on your cheeks or arms that gets worse when exposed to the sun.

Taking this medicine for a long time may make it harder for your and your child's body to absorb vitamin B12. Tell your doctor if you have concerns about this.

Serious stomach conditions may occur while taking this medicine. Check with your doctor immediately if you or your child has stomach cramps, bloated feeling, watery and severe diarrhea which may also be bloody sometimes, fever, nausea or vomiting, or unusual tiredness or weakness.

Pantoprazole may increase your risk of having fractures of the hip, wrist, and spine. This is more likely if you are 50 years of age and older, if you receive high doses of this medicine, or use it for one year or more. Call your doctor right away if you have severe bone pain or are unable to walk or sit normally.

This medicine may cause hypomagnesemia (low magnesium in the blood). This is more likely to occur if you are taking this medicine for more than one year, or if you are taking this medicine together with digoxin (Lanoxin®) or certain diuretics or "water pills". Check with your doctor right away if you have convulsions (seizures), fast, racing, or uneven heartbeat, muscle spasms (tetany), tremors, or unusual tiredness or weakness.

This medicine may cause serious skin reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, and drug reaction with eosinophilia and systemic symptoms (DRESS). Check with your doctor right away if you have black, tarry stools, blistering, peeling, or loosening of the skin, chest pain, chills, cough, diarrhea, itching, joint or muscle pain, painful or difficult urination, red irritated eyes, red skin lesions, often with a purple center, sore throat, sores, ulcers, or white spots in the mouth or on the lips, swollen glands, unusual bleeding or bruising, or unusual tiredness or weakness.

This medicine may increase your risk for fundic gland polyps (abnormal tissue growth in the upper part of your stomach). This is more likely if you are receiving this medicine for more than 1 year. Talk ti your doctor if you have concerns.

Do not stop taking this medicine without first checking with your doctor, or unless told to do so by your doctor.

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before you have medical tests.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription (eg, atazanavir, nelfinavir, Reyataz®, Viracept®) or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

  1. Blurred vision
  2. dry mouth
  3. flushed, dry skin
  4. fruit-like breath odor
  5. increased hunger
  6. increased thirst
  7. increased urination
  8. nausea
  9. stomach pain
  10. sweating
  11. trouble breathing
  12. unexplained weight loss
  13. vomiting

Incidence not known

  1. Absence of or decrease in body movements
  2. black, tarry stools
  3. blindness
  4. blistering, peeling, or loosening of the skin
  5. bloating
  6. bloody or cloudy urine
  7. bloody, black, or tarry stools
  8. blurred vision
  9. chest pain or tightness
  10. chills
  11. clay-colored stools
  12. confusion
  13. constipation
  14. continuous ringing or buzzing or other unexplained noise in the ears
  15. cough
  16. dark urine
  17. decreased vision
  18. diarrhea
  19. difficulty with speaking
  20. difficulty with swallowing
  21. dizziness or lightheadedness
  22. drowsiness
  23. fast heartbeat
  24. feeling of constant movement of self or surroundings
  25. fever
  26. greatly decreased frequency of urination or amount of urine
  27. headache
  28. hearing loss
  29. high fever
  30. hives, itching, or skin rash
  31. indigestion
  32. joint pain
  33. large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
  34. light-colored stools
  35. loss of appetite
  36. mood or mental changes
  37. muscle cramp, pain, stiffness, spasms, or twitching
  38. muscle cramps in the hands, arms, feet, legs, or face
  39. numbness and tingling around the mouth, fingertips, or feet
  40. painful or difficult urination
  41. pains in the stomach, side, or abdomen, possibly radiating to the back
  42. pale skin
  43. puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  44. red skin lesions, often with a purple center
  45. red, irritated eyes
  46. seizures
  47. sensation of spinning
  48. sore throat
  49. sores, ulcers, or white spots on the lips or in the mouth
  50. stomach pain, continuing
  51. swelling of the feet or lower legs
  52. swollen glands
  53. trembling
  54. unexplained bleeding or bruising
  55. unpleasant breath odor
  56. unusual tiredness or weakness
  57. vomiting of blood
  58. yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

  1. Belching
  2. bloated or full feeling
  3. excess air or gas in the stomach or bowels
  4. passing gas
  5. trouble sleeping

Incidence not known

  1. Increased watering of the mouth

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.