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Protonix: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on April 5, 2022.

1. How it works

  • Protonix is a brand (trade) name for pantoprazole.
  • Pantoprazole works by reducing the production of stomach acid 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 which they are affected depends upon the dose of pantoprazole. This allows damaged tissue in the esophagus, stomach, and duodenum to heal.
  • Protonix 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 it may be used for up to 12 months to maintain the healing of erosive esophagitis.
  • No dosage adjustment is needed in people with kidney or liver disease or the elderly.
  • Available as oral tablets, an oral solution, and as an IV injection for infusion.
  • Protonix IV injection should only be given by intravenous infusion for a maximum of 7 to 10 days. Discontinue the IV infusion as soon as the patient can swallow the tablets or receive the oral suspension.
  • Protonix is available as a generic under the name pantoprazole.

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, fever, dizziness, nausea, diarrhea, cold-like symptoms (a sore throat, congested nose, sneezing), joint pain, and flatulence.
  • May also interfere with some laboratory tests.
  • May mask the symptoms of gastric malignancy. Further investigations should be carried out in people who have a suboptimal response to Nexium or an early symptomatic relapse once therapy has been discontinued. Endoscopy should be performed in seniors before administration of Protonix.
  • PPIs (including Protonix) 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 Protonix), 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 Protonix 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.
  • Will not provide instantaneous relief from heartburn symptoms. Antacids may be used to relieve these symptoms.
  • Long-term use in animal studies has been associated with stomach cancer; it is not certain if Protonix has this effect in humans.
  • Heartburn can cause similar symptoms to a heart attack. Seek urgent medical attention if you have chest pain, or pain that extends down your arm or up your neck, nausea, sweating and you feel unwell.
  • Protonix may not be suitable for some people including those with severe liver disease, osteoporosis or low bone mineral density, or low levels of magnesium in their blood. May increase the risk of osteoporosis-related fracture of the hip, wrist, or spine. Not suitable for children under five.
  • Protonix injection contains edetate disodium which can chelate metal ions, including zinc. Consider zinc supplementation in patients prone to zinc deficiency who are treated with Protonix IV.
  • May interact with some other medications including antivirals used to treat HIV, methotrexate, and sometimes warfarin. Protonix can also reduce the absorption of drugs that are dependent on a certain gastric pH for their absorption.
  • Data do not demonstrate an increased risk of major birth defects or adverse pregnancy outcomes with Protonix compared to the background risk present in pregnancies in general. Protonix has been detected in breast milk but its effects on a breastfeeding infant are unknown.

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

Protonix is used for the treatment of conditions associated with excessive acid production in the esophagus and stomach. Long-term use may be associated with magnesium and vitamin B12 deficiency and an increased risk of bone fracture. Use the lowest possible dose for the shortest possible time.

5. Tips

  • Protonix tablets can be taken with or without food. Do not crush, break or chew the tablet, or swallow it whole. Protonix oral granules should be taken 30 minutes before a meal; sprinkle directly onto one teaspoonful of applesauce or apple juice, stir and swallow straight away. Swallow delayed-release tablets whole; do not crush or chew.
  • Usually taken once a day. May be taken with or without food.
  • If using delayed-release granules, sprinkle intact granules on applesauce ONLY (do not use any other type of liquid including water). Swallow whole without chewing granules 30 minutes before a meal.
  • May cause a false positive result on a drug screening test.
  • Seek urgent medical advice if you have severe stomach pain, nausea, vomiting, diarrhea, seizures, blood in the urine, urinating more frequently, or symptoms of low magnesium (confusion, dizziness, tremors, muscle spasms, abnormal heart rate).
  • 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.

6. Response and effectiveness

  • Peak effects happen within two and a half hours and start to decline after 12 hours although may last for over 24 hours.

7. Interactions

Medicines that interact with Protonix may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Protonix. 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 Protonix 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, 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, Protonix 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 Protonix.

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


Further information

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

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

Copyright 1996-2023 Revision date: April 5, 2022.