Pantoprazole

1. About pantoprazole

Pantoprazole reduces the amount of acid your stomach makes.

It's used for heartburn, acid reflux and gastro-oesophageal reflux disease (GORD) - GORD is when you keep getting acid reflux. It's also taken to prevent and treat stomach ulcers.

Sometimes, pantoprazole is taken for a rare illness caused by a tumour in the pancreas or gut called Zollinger-Ellison syndrome.

Pantoprazole comes as tablets. It also comes as liquid that you swallow.

All types of pantoprazole are available on prescription. You can buy lower-strength 20mg tablets from pharmacies for heartburn or acid reflux.

2. Key facts

  • It's usual to take pantoprazole once a day in the morning.
  • Common side effects include headaches, constipation or diarrhoea, wind, stomach pain, feeling or being sick. These tend to be mild and go away when you stop taking the medicine.
  • If you've bought pantoprazole without a prescription and your symptoms don't improve after 2 weeks, see a doctor before taking any more.
  • Pantoprazole isn't usually recommended during pregnancy.
  • Pantoprazole is also called by the brand name Pantoloc Control.

3. Who can and can't take pantoprazole

Pantoprazole can be taken by adults and children aged 12 years and over. It is not generally recommended during pregnancy.

Pantoprazole isn't suitable for some people. To make sure that it is safe for you, tell your doctor if you:

  • have had an allergic reaction to pantoprazole or any other medicine in the past
  • have liver problems
  • are due to have an endoscopy

Ask your doctor if you should stop taking pantoprazole a few weeks before your endoscopy. This is because pantoprazole may hide some of the problems that would usually be spotted during an endoscopy.

4. How and when to take it

It's usual to take pantoprazole once a day, first thing in the morning.

If you take pantoprazole twice a day, take 1 dose in the morning and 1 dose in the evening.

It's best to take pantoprazole an hour before a meal. Swallow tablets whole with a drink of water.

How much will I take?

Each tablet contains 20mg or 40mg of pantoprazole. You can buy pantoprazole 20mg tablets from pharmacies. These are suitable for the short-term treatment of heartburn and acid reflux in adults.

Liquid pantoprazole can be prescribed for people who cannot swallow tablets. It will come with a syringe or spoon to help you take the right amount. If you don't have a syringe or spoon, ask your pharmacist for one.

The usual dose to treat:

  • heartburn and acid reflux is 20mg a day
  • gastro-oesophageal reflux disease is 20mg to 40mg a day
  • stomach ulcers is 20mg to 40mg a day
  • Zollinger-Ellison syndrome is 40mg to 80mg a day - this can increase to 160mg a day depending on how well it works for you

Will my dose go up or down?

Sometimes your doctor will increase your dose of pantoprazole if it isn't working well enough.

Depending on the reason you take pantoprazole, you may take a higher dose to begin with, usually for a month or two. After this, your doctor may recommend that you take a lower dose.

How long will I take it for?

If you buy pantoprazole from a pharmacy, you can usually take it for up to 2 weeks. After 2 weeks:

  • if your symptoms have improved - you can take it for another 2 weeks
  • if your symptoms haven't improved - or they are worse, speak to a doctor before taking any more pantoprazole

Do not take pantoprazole for more than 4 weeks without speaking to your doctor first. If your symptoms haven't improved, you may need some tests to find out what's causing them.

If you take it on prescription, you may only need to take it for a few weeks or months, depending on your illness. Sometimes your doctor may advise you to take it for longer, even for many years.

Your doctor may suggest taking pantoprazole only when you have symptoms. This means you won't have to take it every day. Once you feel better, you can stop taking it - often after a few days or weeks. Taking pantoprazole this way isn't suitable for everyone. Speak to your doctor about what's best for you.

What if I forget to take it?

If you usually take it:

  • once a day - take the missed dose as soon as you remember, unless your next dose is due in less than 12 hours in which case skip the missed dose. Take your next dose at the usual time, and then carry on as normal.
  • twice a day - take the missed dose as soon as you remember, unless your next dose is due in less than 4 hours in which case skip the missed dose. Take your next dose at the usual time, and then carry on as normal.

Never take a double dose to make up for a forgotten dose. If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicine.

What if I take too much?

It is very unlikely that taking one or two extra doses by accident will cause any problems. However, you should check with your doctor if you have taken too much and have any of these symptoms:

  • flushed skin
  • feeling sweaty
  • a fast heartbeat
  • feeling sleepy
  • blurred vision
  • feeling confused or agitated

5. Side effects

Most people who take pantoprazole do not have any side effects. If you do get a side effect, it is usually mild and will go away when you stop taking pantoprazole.

Talk to your pharmacist or doctor if these side effects bother you or don't go away:

  • headaches
  • diarrhoea
  • feeling sick or being sick (nausea or vomiting)
  • constipation
  • stomach pain or wind

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people.

Call a doctor straight away if you have:

  • joint pain and a red skin rash, especially in parts of your body exposed to the sun, such as your arms, cheeks and nose. These can be signs of a rare condition called subacute cutaneous lupus erythematosus. This can happen even if you've been taking pantoprazole for a long time.
  • stomach pain that gets worse, yellow skin (or the whites of your eyes turn yellow), dark pee. These can be signs of liver problems.
  • pain when you pee, peeing less, lower back pain, swollen ankles, and rash or fever. These could be signs of a kidney problem.

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to pantoprazole.

Contact a doctor straight away if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

These are warning signs of a serious allergic reaction. A serious allergic reaction is an emergency.

These are not all the side effects of pantoprazole. For a full list see the leaflet inside your medicine packet.

Information:

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

  • headaches - make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches usually go away after the first week of taking pantoprazole. Talk to your doctor if they last longer than a week or are severe.
  • diarrhoea - drink plenty of water by having small, frequent sips to avoid dehydration. Signs of dehydration include peeing less than usual or having strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
  • feeling sick or being sick (nausea or vomiting) - stick to simple meals and do not eat rich or spicy food. If you're vomiting, try small frequent sips of water. Do not take any other medicines to treat vomiting without speaking to a pharmacist or doctor.
  • constipation - get more fibre into your diet such as fresh fruit and vegetables and cereals, and drink plenty of water. Try to exercise, for example, by going for a daily walk or run. If this doesn't help, talk to your pharmacist or doctor.
  • stomach pain or wind - steer clear of foods that cause wind, such as lentils, beans and onions. It might also help to eat smaller and more frequent meals, eat and drink slowly, and exercise regularly. Some pharmacy remedies, such as simethicone, may relieve the symptoms of wind.

7. Pregnancy and breastfeeding

Pantoprazole isn't usually recommended during pregnancy as there's no firm evidence it's safe.

A medicine called omeprazole, which is similar to pantoprazole, is safe in pregnancy.

However, if you're pregnant, it's better to try to treat your symptoms without taking a medicine.

Your doctor or midwife may suggest eating smaller meals more often and avoiding fatty and spicy foods.

They may also suggest that you raise the head of your bed 10 to 20cm by putting something under your bed or mattress, so that your chest and head are above your waist. This helps stop stomach acid travelling up towards your throat.

If these lifestyle changes don't work, you may be recommended omeprazole, which is safe to take during pregnancy.

Pantoprazole and breastfeeding

Pantoprazole is safe to take while you're breastfeeding. It passes into breastmilk, but only in small amounts that aren't harmful to the baby.

If your baby is premature or has health problems, check with your doctor before taking pantoprazole.

Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

8. Cautions with other medicines

Some medicines can interfere with pantoprazole and make you more likely to have side effects.

Tell your doctor if you're taking these medicines before you start pantoprazole treatment:

  • digoxin (a heart medicine)
  • antifungal medicines such as itraconazole, ketoconazole, posaconazole and voriconazole
  • methotrexate (a medicine used to treat cancer, psoriasis and rheumatoid arthritis)
  • HIV medicines
  • rifampicin (an antibiotic)
  • blood-thinning medicines, such as clopidogrel and warfarin

Mixing pantoprazole with herbal remedies and supplements

Do not take St John's wort, the herbal remedy for depression, while you're taking pantoprazole. St John's wort may stop pantoprazole working as well as it should.

Important

Tell your pharmacist or doctor if you're taking other medicines including herbal remedies, vitamins and supplements.

9. Common questions

How does pantoprazole work?

Pantoprazole is a type of medicine called a proton pump inhibitor (PPI).

Proton pumps are tiny substances in the lining of the stomach that help it make acid to digest your food.

Pantoprazole prevents proton pumps from working properly. This reduces the amount of acid the stomach makes.

When will I feel better?

You should start to feel better within 2 to 3 days. It may take up to 4 weeks for pantoprazole to work properly so you may still have some symptoms during this time.

If you bought pantoprazole without a prescription, and feel no better after 2 weeks, tell your doctor. They may want to do tests or change you to a different medicine.

Is it safe to take pantoprazole for a long time?

If you take pantoprazole for more than 3 months, the levels of magnesium in your blood may fall. This can make you feel tired, confused and dizzy and cause muscle twitches, shakiness and an irregular heartbeat. If you get any of these symptoms, tell your doctor.

Taking pantoprazole for more than a year may increase your chances of certain side effects, including:

  • bone fractures
  • gut infections
  • vitamin B12 deficiency - symptoms include feeling very tired, a sore and red tongue, mouth ulcers, and pins and needles

If you take pantoprazole for longer than 1 year your doctor will regularly check your health to see if you should carry on taking it.

It's not known if pantoprazole works less well the longer you take it. If you feel like it isn't working any more, talk to your doctor.

Does taking pantoprazole for a long time cause stomach cancer?

A Hong Kong study published in 2017 suggested that people taking PPIs like pantoprazole for at least 3 years have a very small increased chance of developing stomach cancer. For every 10,000 people taking a PPI long term, it was thought an extra 4 people get stomach cancer.

However, the study didn't prove that PPIs were causing stomach cancer and the results may not apply in the UK.

People who take PPIs regularly shouldn't be particularly concerned by this study. However PPIs, like most medicines, have side effects, so it's best to take them for the shortest time possible.

Speak to your doctor or pharmacist if you are concerned.

How do I come off pantoprazole?

Usually, you can stop taking pantoprazole without reducing the dose first.

If you've taken pantoprazole for a long time speak to your doctor before you stop taking it. Stopping suddenly could make your stomach produce a lot more acid, and make your symptoms come back. Reducing the dose gradually before stopping completely will prevent this happening.

Are there similar medicines?

There are 4 other medicines that are similar to pantoprazole. They are:

Like pantoprazole, these medicines are proton pump inhibitors. They work in the same way to reduce acid in your stomach. They generally work as well and have similar side effects. However, they may be given in different doses.

Sometimes, if pantoprazole isn't working or doesn't agree with you, your doctor may suggest that you try taking another proton pump inhibitor.

Are there other indigestion medicines?

There are other pharmacy and prescription medicines for indigestion and heartburn.

Antacids, like calcium carbonate (Tums), sodium bicarbonate, Maalox and Milk of Magnesia, relieve indigestion and heartburn by neutralising the acid in your stomach. They give quick relief that lasts for a few hours. They're ideal for occasional stomach acid symptoms.

Some antacids, such as Gaviscon, have an extra ingredient called alginic acid. They work by lining your stomach so that juices from it don't splash up into your food pipe. They're especially good for relieving acid reflux.

Antacids are available from pharmacies and supermarkets.

Histamine antagonists (commonly called H2 blockers) reduce the amount of acid made in your stomach, but they do this in a different way to PPIs.

They include famotidine (Pepcid), ranitidine (Zantac), cimetidine (Tagamet) and nizatidine (Axid). In general, proton pump inhibitors like pantoprazole are used first because they are better than H2 blockers at reducing stomach acid.

However, if you don't get on with a proton pump inhibitor (for example, because of side effects), your doctor may prescribe an H2 blocker.

You can buy famotidine and ranitidine from pharmacies.

Can I take pantoprazole with an antacid?

You can take pantoprazole with an antacid, for example Gaviscon. Take it 2 hours before or after your dose of pantoprazole.

Can I take painkillers with it?

Yes, it's safe to take painkillers such as paracetamol or ibuprofen at the same time as pantoprazole.

It's best to take ibuprofen with, or just after, a meal so it doesn't upset your stomach.

Will it affect my fertility?

There's no firm evidence to suggest that taking pantoprazole will reduce fertility in either men or women.

However, speak to a pharmacist or your doctor if you're trying to get pregnant. They may want to review your treatment.

Will it affect my contraception?

Pantoprazole doesn't affect any type of regular contraception, including the combined pill. It may reduce the effectiveness of one type of emergency contraception called ellaOne (ulipristal) and a different form of emergency contraceptive may be recommended instead.

Can I drive or ride a bike?

Pantoprazole can make you feel dizzy, sleepy, or affect your vision. If this happens to you, do not drive, cycle or use machinery or tools until you feel better.

Is there any food or drink I need to avoid?

You can eat and drink normally while taking pantoprazole, but it's best to take it an hour before a meal.

It's best to avoid foods that seem to make your symptoms worse, such as rich, spicy and fatty foods. It also helps to cut down on caffeinated drinks, such as tea, coffee and cola, as well as alcohol.

Can I drink alcohol with it?

Alcohol does not interfere with the way pantoprazole works. However, drinking alcohol makes your stomach produce more acid than normal. This can irritate your stomach lining and make your symptoms worse.

Can lifestyle changes help?

It may be possible to ease symptoms caused by too much stomach acid by making a few changes to your diet and lifestyle:

  • maintain a healthy weight by eating healthily
  • avoid foods that can make your symptoms worse, such as rich, spicy and fatty foods, and acidic foods like tomatoes, citrus fruits, salad dressings and fizzy drinks
  • cut down on caffeinated drinks, such as tea, coffee and cola, as well as alcohol and smoking
  • if you have symptoms at night, try not to eat for at least 3 hours before you go to bed
  • raise the head of your bed 10 to 20cm by putting something under your bed or mattress so that your chest and head are above your waist

Page last reviewed: 12/11/2018
Next review due: 12/11/2021