pantoprazole

Pronunciation

Generic Name: pantoprazole (pan TOE pra zole)
Brand Name: Protonix, Protonix IV

What is pantoprazole?

Pantoprazole is in a group of drugs called proton pump inhibitors. It decreases the amount of acid produced in the stomach.

Pantoprazole is used to treat erosive esophagitis (damage to the esophagus from stomach acid), and other conditions involving excess stomach acid such as Zollinger-Ellison syndrome.

Pantoprazole is not for immediate relief of heartburn symptoms.

Pantoprazole may also be used for purposes not listed in this medication guide.

What is the most important information I should know about pantoprazole?

Heartburn is often confused with the first symptoms of a heart attack. Seek emergency medical attention if you have chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, and a general ill feeling.

You should not use this medication if you are allergic to pantoprazole or to any other benzimidazole medication such as albendazole (Albenza), or mebendazole (Vermox).

Slideshow: 2014 Update - First Time Brand-to-Generic Switches

Pantoprazole is not for immediate relief of heartburn symptoms.

Take this medication for the full prescribed length of time. Your symptoms may improve before the condition is fully treated.

Pantoprazole should not be taken together with atazanavir (Reyataz) or nelfinavir (Viracept). Tell your doctor if you are taking either of these medications to treat HIV or AIDS.

Some conditions must be treated long-term with pantoprazole. The chronic use of pantoprazole has caused stomach cancer in animal studies, but it is not known if this medication would have the same effects in humans. Talk with your doctor about your specific risk of developing stomach cancer.

Long-term treatment with pantoprazole may also make it harder for your body to absorb vitamin B-12, resulting in a deficiency of this vitamin. Talk with your doctor if you need long-term pantoprazole treatment and you have concerns about vitamin B-12 deficiency.

What should I discuss with my healthcare provider before taking pantoprazole?

Heartburn is often confused with the first symptoms of a heart attack. Seek emergency medical attention if you have chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, and a general ill feeling.

You should not take this medication if you are allergic to pantoprazole or to any other benzimidazole medication such as albendazole (Albenza), or mebendazole (Vermox).

To make sure you can safely take pantoprazole, tell your doctor if you low levels of magnesium in your blood.

Some conditions must be treated long-term with pantoprazole. The chronic use of pantoprazole has caused stomach cancer in animal studies, but it is not known if this medication would have the same effects in humans. Talk with your doctor about your specific risk of developing stomach cancer.

Taking a proton pump inhibitor such as pantoprazole may increase your risk of bone fracture in the hip, wrist, or spine. This effect has occurred mostly in people who have taken the medication long term or at high doses, and in those who are age 50 and older. It is not clear whether pantoprazole is the actual cause of an increased risk of fracture. Before you take this medication, tell your doctor if you have osteoporosis or osteopenia (low bone mineral density).

Long-term treatment with pantoprazole may also make it harder for your body to absorb vitamin B-12, resulting in a deficiency of this vitamin. Symptoms of a vitamin B-12 deficiency may develop slowly and include pale skin, weakness, tired feeling, shortness of breath, and a fast heart rate. Talk with your doctor if you need long-term pantoprazole treatment and you have concerns about vitamin B-12 deficiency.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Pantoprazole can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take pantoprazole?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Pantoprazole tablets can be taken with or without food. Pantoprazole oral granules should be taken 30 minutes before a meal.

Do not crush, chew, or break the tablet. Swallow it whole. The enteric-coated pill has a special coating to protect your stomach. Breaking the pill will damage this coating.

The oral granules should be mixed only with applesauce or apple juice to make swallowing easy. Do not use any other type of liquid or soft food. Sprinkle the granules directly onto a teaspoon of applesauce and swallow this mixture right away without chewing. Or pour the granules into a cup with 1 teaspoon of apple juice, stir for 5 seconds and swallow right away. To make sure you get the entire dose, add a little more apple juice to the same glass, swirl gently and drink right away. Do not save the granule mixture for later use.

To give pantoprazole granules through a nasogastric (NG) feeding tube:

  • Attach a 60-milliliter syringe to the NG tube and remove the plunger. Hold the syringe high enough to prevent any bends in the tube.

  • Sprinkle the pantoprazole granules into the syringe barrel and mix in 2 teaspoons of apple juice. Gently tap or shake the syringe as it empties into the tube.

  • Add another 2 teaspoons of apple juice to the syringe to help rinse the granules through and to make sure the entire pantoprazole dose is given. Tap or shake the syringe as the juice empties into the tube.

  • Repeat the rinse with 2 teaspoons of apple juice at least twice more, gently shaking the syringe as it empties into the tube. Make sure there are no granules remaining in the syringe or NG tube.

This medication can cause you to have a false positive drug-screening test. If you provide a urine sample for drug-screening, tell the laboratory staff that you are taking pantoprazole.

Take this medication for the full prescribed length of time. Your symptoms may improve before the condition is fully treated.

Call your doctor if your symptoms do not improve or if they get worse while you are taking this medicine.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking pantoprazole?

This medication can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking pantoprazole and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Pantoprazole side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using pantoprazole and call your doctor at once if you have symptoms of low magnesium such as:

  • fast or uneven heart rate;

  • jerking muscle movements;

  • feeling jittery;

  • diarrhea that is watery or bloody;

  • muscle cramps, muscle weakness or limp feeling;

  • cough or choking feeling; or

  • headache, trouble concentrating, memory problems, weakness, loss of appetite, feeling unsteady, confusion, hallucinations, fainting, seizure, or shallow breathing.

Less serious side effects are more likely to occur, such as:

  • weight changes;

  • nausea, vomiting, mild diarrhea;

  • gas, stomach pain;

  • dizziness, drowsiness, tired feeling;

  • joint pain; or

  • sleep problems (insomnia).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Pantoprazole dosing information

Usual Adult Dose for Erosive Esophagitis:

Treatment of Erosive Esophagitis:
40 mg orally once a day for up to 8 weeks; however an additional 8 weeks may be considered for patients who have not healed after the initial treatment. Safety and efficacy beyond 16 weeks of therapy have not been established.

Maintenance of Healing of Erosive Esophagitis:
40 mg orally once a day. Controlled studies have been limited to 12 months of pantoprazole therapy.

Usual Adult Dose for Gastroesophageal Reflux Disease:

Parenteral: 40 mg once a day for 7 to 10 days, administered via intravenous infusion over a period of 15 minutes. Intravenous therapy should be discontinued as soon as the patient is able to resume oral therapy.

Oral: 40 mg orally once a day, for short-term administration (up to 8 weeks); however an additional 8 weeks may be considered for patients who have not healed after the initial treatment. Safety and efficacy beyond 16 weeks of therapy have not been established.

Usual Adult Dose for Duodenal Ulcer:

Study (n=54)
40 mg orally once a day, dose was increased every 12 weeks by 40 mg increments to a maximum of 120 mg per day, for 28 weeks. Data have revealed that monotherapy with daily doses of 40 mg have been associated with complete duodenal ulcer healing in up to 87% and 94% of patients after 4 weeks and 8 weeks respectively.

Usual Adult Dose for Gastric Ulcer:

40 mg orally once a day. Data have revealed that monotherapy with daily doses of 40 mg have been associated with complete gastric ulcer healing in up to 87% and 97% of patients after 4 weeks and 8 weeks respectively.

Usual Adult Dose for Helicobacter pylori Infection:

Study (n=242) - Triple therapy:
40 mg orally twice daily for 7 days, commonly in conjunction with clarithromycin and either amoxicillin or metronidazole to eradicate Helicobacter pylori, followed with 40 mg pantoprazole orally once daily until day 28. Triple therapy has resulted in eradication rates of greater than 95%.

The QUADRATE Study (n=405) - Quadruple therapy:
40 mg orally twice daily for 7 days, concomitantly with bismuth subcitrate and tetracycline, both four times daily, and metronidazole 200 mg three times daily and 400 mg at bedtime. Helicobacter Pylori eradication was achieved in 82% of patients.

Usual Adult Dose for Zollinger-Ellison Syndrome:

Parenteral: 80 mg every 12 hours, administered by 15-minute infusion. Daily doses higher than 240 mg administered in equally divided doses by 15-minute infusion, or administered for more than 6 days have not been studied.

Oral: 40 mg twice daily, to a maximum of 240 mg per day. Some patients have received treatment with pantoprazole for more than 2 years.

Usual Adult Dose for Stress Ulcer Prophylaxis:

Study (n=21) - Stress Ulcer bleeding prophylaxis in the Critical Care Setting:
80 mg twice daily, as a bolus infusion over a period of 15 minutes, to a maximum daily dose of 240 mg, divided into three equal doses.

Study (n=20 ) - Peptic Ulcer rebleeding prophylaxis after hemostasis in the Critical Care Setting:
80 mg IV bolus, followed by continuous infusion of 8 mg/hr for 3 days, after which therapy may be continued with an oral PPI.

Usual Adult Dose for Peptic Ulcer:

Study (n=21) - Stress Ulcer bleeding prophylaxis in the Critical Care Setting:
80 mg twice daily, as a bolus infusion over a period of 15 minutes, to a maximum daily dose of 240 mg, divided into three equal doses.

Study (n=20 ) - Peptic Ulcer rebleeding prophylaxis after hemostasis in the Critical Care Setting:
80 mg IV bolus, followed by continuous infusion of 8 mg/hr for 3 days, after which therapy may be continued with an oral PPI.

What other drugs will affect pantoprazole?

Pantoprazole should not be taken together with atazanavir (Reyataz) or nelfinavir (Viracept). Tell your doctor if you are taking either of these medications to treat HIV or AIDS.

Tell your doctor about all other medicines you use, especially:

  • ampicillin (Principen, Unasyn);

  • a blood thinner such as warfarin (Coumadin, Jantoven);

  • digoxin (Lanoxin, Lanoxicaps);

  • a diuretic (water pill);

  • ketoconazole (Nizoral);

  • iron (Feosol, Mol-Iron, Fergon, Femiron, others); or

  • methotrexate (Rheumatrex, Trexall).

This list is not complete and other drugs may interact with pantoprazole. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about pantoprazole.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 15.01. Revision Date: 2012-07-06, 4:57:05 PM.

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