Protonix Side Effects

Generic name: pantoprazole

Medically reviewed by Drugs.com. Last updated on Jan 27, 2025.

Note: This document provides detailed information about Protonix Side Effects associated with pantoprazole. Some dosage forms listed on this page may not apply specifically to the brand name Protonix.

Applies to pantoprazole: oral packet, oral powder for suspension, oral tablet delayed release, oral tablet enteric coated.

Other dosage forms:

• intravenous powder for solution

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 (the active ingredient contained in Protonix) 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 pantoprazole 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.

Serious side effects of Protonix

Along with its needed effects, pantoprazole 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 while taking pantoprazole:

Other side effects of Protonix

Some side effects of pantoprazole 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:

For healthcare professionals

Applies to pantoprazole: intravenous powder for injection, intravenous solution, oral delayed release tablet, oral granule enteric coated, oral suspension.

General adverse events

The most commonly reported side effects were headache, diarrhea, and injection site thrombophlebitis (in IV formulations).^[Ref]

Nervous system

• Very common (10% or more): Headache (Up to 26.4%), taste pervasion (Up to 18.2%)
• Common (1% to 10%): Dizziness, metallic/bitter taste, somnolence
• Rare (0.01% to 0.1%): Taste disorders
• Very rare (less than 0.01%): Change to the sense of taste, reduced movement, speech disorder
• Frequency not reported: Paresthesia, vertigo
• Postmarketing reports: Ageusia, dysgeusia^[Ref]

Headache was a very commonly reported side effect in pediatric patients 2 to 16 years of age. In adults, headache occurred most frequently in patients given quadruple therapy (pantoprazole, bismuth, metronidazole, tetracycline) for H pylori infections, but was also very common in triple therapy (pantoprazole, amoxicillin, clarithromycin).

Taste pervasion most frequently occurred in patients given triple therapy, but it was also very common in patients given quadruple therapy.^[Ref]

Respiratory

• Very common (10% or more): Nasopharyngitis (up to 13.6%), pharyngolaryngeal pain (up to 13.2%)
• Common (1% to 10%): Cough, nasal congestion, pharyngitis
• Very rare (less than 0.01%): Change to the sense of smell, dyspnea
• Frequency not reported: Upper respiratory tract infection^[Ref]

Nasopharyngitis and pharyngolaryngeal pain occurred in pediatric patients between the ages of 2 to 16 years.^[Ref]

Gastrointestinal

• Very common (10% or more): Diarrhea (Up to 11.6%)
• Common (1% to 10%): Abdominal pain, benign fundic gland polyps/fundic gland polyps, buccal inflammation, constipation, dry mouth, dyspepsia, fecal discoloration, flatulence, heartburn, nausea, oral moniliasis, pruritus ani, tongue discoloration, tongue pain, upper abdominal pain, vomiting
• Uncommon (0.1% to 1%): Abdominal discomfort/distention, bloating, loose stools
• Rare (0.01% to 0.1%): Colon polyp, rectal disorder
• Very rare (less than 0.01%): Increased saliva
• Frequency not reported: Clostridium difficile-associated diarrhea, severe eructation^[Ref]

Diarrhea occurred most frequently in patients given quadruple therapy (pantoprazole, bismuth, metronidazole, tetracycline) for Helicobacter pylori infections, but was also very common in triple therapy (pantoprazole, amoxicillin, clarithromycin).

Nausea, vomiting, abdominal pain, dry mouth, and constipation were more commonly reported in patients given triple therapy, compared to patients given quadruple therapy.

Fecal and/or tongue discoloration occurred more commonly in patients given quadruple therapy versus patients given triple therapy.^[Ref]

Other

• Common (1% to 10%): Tiredness
• Uncommon (0.1% to 1%): Asthenia, fatigue, malaise
• Rare (0.01% to 0.1%): Body temperature increased, fever
• Very rare (less than 0.01%): Pain, tinnitus
• Frequency not reported: Facial edema^[Ref]

Psychiatric

• Common (1% to 10%): Depression (and all aggravations)
• Uncommon (0.1% to 1%): Sleep disorders
• Rare (0.01% to 0.1%): Confusion (and all aggravations), disorientation (and all aggravations), hallucination (and all aggravations)
• Very rare (less than 0.01%): Anxiety
• Postmarketing reports: Insomnia^[Ref]

Confusion, depression, hallucinations, and disorientation, especially in predisposed patients, occurred with use, and was aggravated in patients with preexisting conditions.^[Ref]

Hepatic

• Common (1% to 10%): Increased liver enzymes (transaminases, GGT)
• Rare (0.01% to 0.1%): Increased bilirubin
• Very rare (less than 0.01%): Cholestatic hepatitis, hepatitis, hepatocellular failure, jaundice
• Frequency not reported: Hepatic effects, hepatocellular injury, liver function tests abnormal
• Postmarketing reports: Hepatocellular damage^[Ref]

Severe hepatocellular damage leading to jaundice/hepatic failure is predicted to have a frequency of 1 in 1,000,000 patients.^[Ref]

Dermatologic

• Common (1% to 10%): Exanthema/exanthemata, rash
• Uncommon (0.1% to 1%): Eruption, increased sweating, pruritus
• Rare (0.01% to 0.1%): Urticaria
• Very rare (less than 0.01%): Erythema multiforme, flushing, Lyell syndrome, photosensitivity/photosensitivity reaction, severe skin reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN)
• Frequency not reported: Cutaneous lupus erythematosus, facial edema, fatal skin reactions, fatal TEN, subacute cutaneous lupus erythematosus^[Ref]

Cardiovascular

• Common (1% to 10%): Chest pain
• Rare (0.01% to 0.1%): Hypertension, peripheral edema, thrombophlebitis
• Very rare (less than 0.01%): Circulatory collapse, flushing, hot flushes, substernal chest pain
• Frequency not reported: Generalized edema^[Ref]

Musculoskeletal

• Common (1% to 10%): Arthralgia
• Uncommon (0.1% to 1%): Fracture of the hip/wrist/spine
• Rare (0.01% to 0.1%): Myalgia
• Very rare (less than 0.01%): Skeletal pain
• Frequency not reported: Bone fracture, elevated creatine phosphokinase (CPK)/elevated creatine kinase (CK), muscle spasm, systemic lupus erythematosus
• Postmarketing reports: Rhabdomyolysis^[Ref]

Muscle spasm occurred as a consequence of electrolyte disturbances.^[Ref]

Metabolic

• Common (1% to 10%): Anorexia
• Rare (0.01% to 0.1%): Hyperlipidemia, increased cholesterol, increased triglycerides, lipid increases, weight changes
• Frequency not reported: Cyanocobalamin (vitamin B12) deficiency), electrolyte disturbances, hypocalcemia, hypokalemia, hypomagnesemia, hyponatremia, potential for exacerbation of zinc deficiency^[Ref]

Hypocalcemia occurred in association with hypomagnesemia.

Anorexia commonly occurred in patients with H pylori.^[Ref]

Local

• Common (1% to 10%): Injection site thrombophlebitis
• Frequency not reported: Injection site reactions^[Ref]

Immunologic

• Common (1% to 10%): Influenza-like symptoms, moniliasis
• Rare (0.01% to 0.1%): Sepsis^[Ref]

Hypersensitivity

• Rare (0.01% to 0.1%): Anaphylactic reactions, anaphylactic shock, angioedema/Quincke's edema, hypersensitivity, hypersensitivity reactions
• Frequency not reported: Allergic reactions
• Postmarketing reports: Anaphylaxis^[Ref]

Hematologic

• Rare (0.01% to 0.1%): Agranulocytosis, anemia
• Very rare (less than 0.01%): Increased coagulation time, leukopenia, pancytopenia, thrombocytopenia^[Ref]

Ocular

• Uncommon (0.1% to 1%): Blurred vision, visual disturbances
• Very rare (less than 0.01%): Conjunctivitis^[Ref]

Endocrine

• Rare (0.01% to 0.1%): Gynecomastia^[Ref]

Renal

• Very rare (less than 0.01%): Interstitial nephritis (with possible progression to renal failure)
• Frequency not reported: Acute interstitial nephritis^[Ref]

See also:

Frequently asked questions

• Pantoprazole vs. omeprazole: What's the difference between them?
• Can you take pantoprazole 40 mg twice a day?
• How long can I take pantoprazole?
• Does pantoprazole cause bloating?

Further information

Protonix side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer