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Pantoprazole: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on Dec 28, 2019.

1. How it works

  • Pantoprazole reduces the production of acid by the stomach by irreversibly blocking the actions of an enzyme responsible for acid production, called H+/K+ ATPase (also known as the gastric proton pump). The proton pump is located in the parietal cells of the stomach wall. Both baseline gastric acid secretion and stimulated gastric acid secretion are affected; the degree that they are affected to depends upon the dose of pantoprazole.
  • This allows damaged tissue in the esophagus, stomach, and duodenum to heal.
  • Pantoprazole belongs to the class of medicines known as proton pump inhibitors (PPIs).

2. Upsides

  • Effective at healing erosive esophagitis (a severe inflammation of the lining of the esophagus- the tube that carries food from the mouth to the stomach), and relieving symptoms of gastro-esophageal reflux disease (also known as heartburn).
  • Useful in the treatment of hypersecretory conditions such as Zollinger-Ellison syndrome.
  • Usually, only up to 8 weeks of treatment is required; although may be used for up to 12 months to maintain healing of erosive esophagitis.
  • No dosage adjustment is needed in people with kidney or liver disease or the elderly.
  • Generic pantoprazole is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • A headache, dizziness, nausea or vomiting, abdominal pain, diarrhea, joint pain, and flatulence.
  • May also interfere with some laboratory tests.
  • May mask the symptoms of gastric cancer. An endoscopy may be necessary for some people (especially seniors) before pantoprazole treatment to rule out malignancy, or in those who don't respond to treatment or relapse soon after pantoprazole is discontinued.
  • PPIs (including pantoprazole) have been associated with an increased risk of osteoporosis-related fractures of the hip, wrist, or spine. People on high-dose or long-term therapy are more at risk.
  • Has also been associated with other conditions such as lupus erythematosus and magnesium deficiency.
  • Prolonged treatment (greater than 24-36 months) may cause vitamin B12 deficiency. The risk is greater in women, people aged less than 30, and with higher dosages.
  • Administration of PPIs (such as pantoprazole), has been associated with acute interstitial nephritis, a severe inflammation of the kidneys. May occur on medication initiation or at any point of therapy. Symptoms include fever, rash, and generalized aches and pains. Discontinue pantoprazole and seek medical advice.
  • Has been associated with a greater risk of Clostridium difficile-associated diarrhea. See your doctor if you develop diarrhea that does not improve.
  • May interact with some other medications including methotrexate and sometimes warfarin. Pantoprazole can also reduce the absorption of drugs that are dependant on a certain gastric pH for their absorption.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Pantoprazole effectively heals inflamed tissue in the gastrointestinal tract and relieves symptoms of heartburn. Pantoprazole tablets should not be split, crushed, or chewed.

5. Tips

  • Usually taken once daily.
  • May be taken with or without food.
  • Swallow delayed-release tablets whole; do not split, crush or chew.
  • See your doctor if you develop any unexplained fever, rash (particularly one that gets worse after you have been in the sun), new or worsening joint pain, persistent diarrhea or generalized aches and pains.
  • Also see your doctor if you develop any muscle cramps, spasms, or weakness; jitteriness; abnormal heartbeat; dizziness; seizures; or any other symptoms of concern.

6. Response and Effectiveness

  • Peak effects happen within two and a half hours and effects can last for over 24 hours.

7. Interactions

Medicines that interact with pantoprazole may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with pantoprazole. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with pantoprazole include:

  • aminophylline or theophylline
  • ampicillin
  • astemizole
  • bisphosphonates, such as alendronate, etidronate, or risedronate
  • clopidogrel
  • delavirdine
  • digoxin
  • diuretics
  • HIV medications (eg, atazanavir, indinavir, ritonavir, or saquinavir)
  • iron supplements
  • methotrexate
  • medications that rely on a certain gastric pH for absorption, such as ampicillin, bisacodyl, dasatinib, erlotinib, iron salts, ketoconazole/itraconazole, mycophenolate mofetil, or nilotinib
  • medications that affect either CYP3A4 or CYP2C19 hepatic enzymes, such as erythromycin, fluconazole, fluvoxamine, itraconazole, ketoconazole, or voriconazole
  • sucralfate
  • tacrolimus
  • warfarin.

In addition, pantoprazole may affect some diagnostic tests, for example, those for neuroendocrine tumors or the secretin stimulation test. There have also been reports of false-positive urine screening tests for tetrahydrocannabinol (THC) in patients receiving PPIs, such as pantoprazole.

Note that this list is not all-inclusive and includes only common medications that may interact with pantoprazole. You should refer to the prescribing information for pantoprazole for a complete list of interactions.


Pantoprazole [Package Insert]. Revised 06/2019.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use pantoprazole only for the indication prescribed.

Copyright 1996-2021 Revision date: December 28, 2019.

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