Pantoprazole

Sounds like 'pan-TO-pra-zol'

Easy-to-read medicine information about pantoprazole – what it is, how to take it safely and possible side effects.

Type of medicine Also called
  • Medicine to reduce stomach acid
  • Belongs to a group of medicines known as proton pump inhibitors
  • Panzop Relief®
  • Pantoprazole (Dr Reddy's)®
  • Pantoprazole (Actavis)®

What is pantoprazole?

Pantoprazole reduces the amount of acid produced in your stomach. It belongs to a group of medicines known as proton pump inhibitors (PPIs). They are used to treat a number of conditions associated with high stomach acid affecting your stomach and gut, such as indigestion, reflux and ulcersPantoprazole can also prevent ulcers from forming, or help the healing process where damage has already occurred. Pantoprazole can may be given together with antibiotics to get rid of Helicobacter pylori, a bacteria found in the stomach that can cause ulcers. Pantoprazole may be used to prevent ulcers caused by medicines such as non-steroidal anti-inflammatory drugs (NSAIDs). Examples of NSAIDs are diclofenac, ibuprofen and naproxen. In New Zealand pantoprazole is available as tablets.

Dose

  • The usual dose of pantoprazole is 40 mg once a day.
  • For some people, 20 mg once a day is enough.
  • The pharmacy label on your medicine will tell you how much pantoprazole to take, how often to take it and any special instructions.
  • Your doctor will advise you how long to take pantoprazole for, which can range from a few weeks to months.

How to take pantoprazole

  • Take pantoprazole at the same time each day, usually in the morning.
  • Swallow your tablet whole with a glass of water. Do not crush or chew – the medicine doesn't work properly if the tablet is crushed or chewed.
  • Pantoprazole can be taken before or after food, although taking it before food is best.
  • If you forget to take your dose, take it as soon as you remember. But, if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.

Avoid long-term use – choose wisely

If you don’t need them, PPIs like pantoprazole should not be taken long term, because of the possible side effects. These include an increased risk of bone fractures, chest infections, kidney problems and nutrient deficiencies such as low magnesium. If you’ve been taking a PPI for reflux for longer than 4 to 8 weeks, and your symptoms seem to be well managed, it’s a good idea to talk to your healthcare provider about reviewing your medicine. They may recommend stepping down your treatment. This could include:

  • reducing your daily dose of pantoprazole
  • taking pantoprazole only when you experience the symptoms of heartburn and reflux (also known as on-demand therapy)
  • stopping treatment completely, as your symptoms may not return.

Read more about PPIs for heartburn and reflux Choosing Wisely, NZ

Precautions – before starting pantoprazole

  • Are you pregnant, planning a pregnancy or breastfeeding?
  • Do you have problems with your liver?
  • Are taking any other medicines? This includes any medicines you are taking which you can buy without a prescription, as well as herbal and complementary medicines.

If so, it’s important that you tell your doctor or pharmacist before you start pantoprazole. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Possible side effects

Like all medicines, pantoprazole can cause side effects, although not everyone gets them. Often side effects improve as your body adjusts to the new medicine.

Rebound acid secretion

When pantoprazole is stopped, a common side effect is rebound acid secretion, where the acid secretion in your stomach increases significantly. This should return to normal within 2 weeks. Because the symptoms of rebound acid secretion are the same as for reflux (such as indigestion, discomfort and pain in your upper stomach and chest, feeling sick and an acid taste in your mouth), it can form an ongoing loop where stopping pantoprazole treatment creates the need to start it again. Rather than restart pantoprazole, you can use medicines that contain both an antacid and an anti-foaming agent, such as Mylanta P oral liquid, Acidex oral liquid or Gaviscon Double Strength tablets. These can be effective for treating rebound acid secretion. You can use these medicines to relieve the symptoms when they occur. Talk to your doctor or pharmacist about how to manage rebound acid secretion.

Other side effects

Side effects What should I do?
  • Stomach upset, feeling sick
  • Feeling bloated, gas in your abdomen (tummy)
  • Diarrhoea
  • Constipation
  • These are quite common when you first start taking pantoprazole.
  • Tell your doctor if troublesome.
  • Signs of low magnesium, such as muscle cramps, weakness, tiredness, feeling irritable and changes in heartbeat
  • Increase your intake of magnesium-rich foods such as wholegrain cereals, green leafy vegetables (spinach, parsley, cabbage), peas, lean meats, nuts, seeds and bananas
  • Tell your doctor if troublesome – you may need a magnesium supplement.
  • Severe diarrhoea (loose, watery, frequent stools)  
  • Pantoprazole can increase the chance of getting severe diarrhoea (which may be caused by a bacteria called clostridium difficle).
  • Stop pantoprazole and tell your doctor immediately.
  • Signs of an allergic reaction, such as rash, fever, painful joints
  • Tell your doctor immediately or ring HealthLine 0800 611 116.
  • Worsening stomach problems, such as really bad stomach pain, blood in your stools or black stools, vomiting blood or dark-coloured vomit
  • Tell your doctor immediately or ring HealthLine 0800 611 116.

Interactions

Pantoprazole may interact with a few medications and herbal supplements, so check with your doctor or pharmacist before starting pantproazole or before starting any new medicines.

Learn more

New Zealand Formulary Patient Information: Pantoprazole

References

  1. Proton pump inhibitors – when is enough, enough? BPAC, NZ, 2014
  2. Proton pump inhibitors and the risk of acute kidney injury BPAC, NZ, 2016
  3. Pantoprazole New Zealand Formulary
Credits: Sandra Ponen, Pharmacist. Reviewed By: Dr Janine Bycroft, GP, Health Navigator NZ Last reviewed: 16 Jan 2019