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Protonix (oral/injection)

Generic name: pantoprazole (oral/injection) [ pan-TOE-pra-zole ]
Brand name: Protonix
Drug class: Proton pump inhibitors

Medically reviewed by on Dec 26, 2022. Written by Cerner Multum.

What is pantoprazole?

Pantoprazole is used to treat erosive esophagitis (damage to the esophagus from stomach acid caused by gastroesophageal reflux disease, or GERD) in adults and children who are at least 5 years old. Pantoprazole is usually given for up to 8 weeks at a time while your esophagus heals.

Pantoprazole is also used to treat Zollinger-Ellison syndrome and other conditions involving excess stomach acid.

Pantoprazole is not for immediate relief of heartburn.

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

Pantoprazole side effects

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

Protonix may cause serious side effects. Call your doctor at once if you have:

  • severe stomach pain, diarrhea that is watery or bloody;

  • sudden pain or trouble moving your hip, wrist, or back;

  • bruising or swelling where intravenous pantoprazole was injected;

  • kidney problems-- fever, rash, nausea, loss of appetite, joint pain, urinating less than usual, blood in your urine, weight gain;

  • low magnesium--dizziness, fast or irregular heart rate, tremors (shaking) or jerking muscle movements, feeling jittery, muscle cramps, muscle spasms in your hands and feet, cough or choking feeling; or

  • new or worsening symptoms of lupus--joint pain, and a skin rash on your cheeks or arms that worsens in sunlight.

Taking pantoprazole long-term may cause you to develop stomach growths called fundic gland polyps. Talk with your doctor about this risk.

If you use pantoprazole for longer than 3 years, you could develop a vitamin B-12 deficiency. Talk to your doctor about how to manage this condition if you develop it.

Common side effects of Protonix may include:

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.


Pantoprazole can cause kidney problems. Tell your doctor if you are urinating less than usual, or if you have blood in your urine.

Diarrhea may be a sign of a new infection. Call your doctor if you have diarrhea that is watery or has blood in it.

Pantoprazole may cause new or worsening symptoms of lupus. Tell your doctor if you have joint pain and a skin rash on your cheeks or arms that worsens in sunlight.

You may be more likely to have a broken bone while taking this medicine long term or more than once per day.

Before taking this medicine

Heartburn can mimic early symptoms of a heart attack. Get emergency medical help if you have chest pain that spreads to your jaw or shoulder and you feel anxious or light-headed.

You should not use this medicine if:

Tell your doctor if you have ever had:

  • low levels of magnesium in your blood;

  • lupus; or

  • osteoporosis or low bone mineral density.

You may be more likely to have a broken bone in your hip, wrist, or spine while taking a proton pump inhibitor long-term or more than once per day. Talk with your doctor about ways to keep your bones healthy.

Tell your doctor if you are pregnant or breastfeeding.

Pantoprazole is not approved for use by anyone younger than 5 years old.

How should I use pantoprazole?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Use the lowest dose for the shortest amount of time needed to treat your condition.

Pantoprazole is taken by mouth (oral) or given as an infusion into a vein (injection). A healthcare provider may teach you how to properly use pantoprazole injection by yourself.

Pantoprazole tablets are taken by mouth, 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 oral granules should be mixed with applesauce or apple juice and given either by mouth or through a nasogastric (NG) tube.

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.

Use this medicine for the full prescribed length of time, even if your symptoms quickly improve.

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

This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using pantoprazole.

Pantoprazole may also affect a drug-screening urine test and you may have false results. Tell the laboratory staff that you use this medicine.

Store this medicine at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

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 using pantoprazole?

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

What other drugs will affect pantoprazole?

Tell your doctor about all your other medicines, especially:

This list is not complete. Other drugs may affect pantoprazole, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Popular FAQ

Take pantoprazole tablets immediately before a meal, preferably in the morning. Pantoprazole tablets may be taken with food or on an empty stomach. Swallow the tablet whole. Do not crush, break, or chew the tablet.

Pantoprazole may cause side effects, but it does not seem to cause anxiety. Some people in clinical trials reported headaches while taking pantoprazole. Less than 2% of people in clinical trials also reported depression and vertigo (dizziness). There is some clinical evidence that shows that people with gastroesophageal reflux disease (GERD) sometimes also have anxiety and depression. In one clinical study, pantoprazole and the antidepressant drug amitriptyline were found to be safe and effective in treating people with both GERD and anxiety.

Pantoprazole starts to work within 2 and a half (2.5) hours – this is the time it takes for it to block the secretion of acid in the stomach - and lasts for 24 hours. Pantoprazole does not provide fast-acting relief from indigestion, acid reflux, or dyspepsia symptoms like antacids such as Tums or Maalox do, and will not treat current symptoms. It may take up to 4 weeks for pantoprazole to work properly so you may still have some symptoms during this time.

Pantoprazole and omeprazole are both medicines from the class of medications called proton pump inhibitors (PPIs). The approved uses for pantoprazole and omeprazole differ slightly, but they are all disorders related to too much stomach acid. Continue reading

The usual dosage for pantoprazole 40mg is 40mg once a day if you are buying it without a prescription or a physician's evaluation of your symptoms. The only conditions that pantoprazole 40mg twice a day is recommended for are those characterized by excessively high gastric acid secretion such as Zollinger Ellison syndrome, and if you have these conditions then you should be under the care of a physician. Studies have shown that for reflux, dyspepsia, or GERD, dosages higher than 40mg did not offer any further significant lowering of stomach acid than 40mg dosages. Continue reading

You should only take pantoprazole for up to 8 weeks if you are buying it without a prescription or a physician evaluation of your symptoms. This is because certain stomach symptoms that persist for more than 4 to 8 weeks should be investigated by a doctor, as they may be a sign of something more serious, such as cancer. Pantoprazole is very good at relieving and hiding serious stomach symptoms, which may make you think you don’t need to see a physician. Long-term use of pantoprazole has also been associated with vitamin B12 deficiency; low magnesium, calcium, iron, or vitamin C levels; and an increased risk of fractures of the hip, wrist, or spine. Elderly, the malnourished, or those on dialysis are more at risk. Continue reading

Bloating has been reported as a side effect of regular pantoprazole use. One study reported bloating in 43% of patients taking a similar proton pump inhibitor to pantoprazole (called esomeprazole) after 8 weeks. By 6 months, over 50% reporting bloating. Other similar side effects reported with pantoprazole that also can have bloating as a side effect include flatulence, abdominal pain, and diarrhea. Symptoms of bloating include tightness, fullness, or swelling of your stomach area. Continue reading

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Further information

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.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.