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 condition caused by a tumour in the pancreas or gut called Zollinger-Ellison syndrome.
Pantoprazole comes as tablets.
All types of pantoprazole are available on prescription. You can also buy lower-strength 20mg tablets from pharmacies for heartburn or acid reflux.
2. Key facts
- You'll usually take pantoprazole once a day in the morning.
- The most common side effects are headaches and diarrhoea. These tend to be mild and go away when you stop taking the medicine.
- You should start to feel better in 2 to 3 days, but it may take up to 4 weeks for pantoprazole to fully control your symptoms.
- If you've bought pantoprazole without a prescription and your symptoms do not improve after 2 weeks, see a doctor before taking any more.
- Pantoprazole is not usually recommended during pregnancy.
3. Who can and cannot take pantoprazole
Adults and children aged 12 years and over can take pantoprazole.
Pantoprazole is not suitable for some people. To make sure it's safe for you, tell your doctor if you:
- have ever had an allergic reaction to pantoprazole or any other medicine
- have liver problems
- are pregnant, trying to get pregnant or breastfeeding
- are due to have an endoscopy
If you're going to have an endoscopy, ask your doctor if you should stop taking pantoprazole a few weeks before your procedure. This is because pantoprazole may hide some of the problems that would usually be spotted during an endoscopy.
4. How and when to take pantoprazole
You'll usually 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.
Dosage and strength
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.
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
Doses are usually lower for people with liver problems.
How to take it
It's best to take pantoprazole an hour before a meal. Swallow tablets whole with a drink of water.
Changes to your dose
Sometimes your doctor will increase your dose of pantoprazole if it's not working well enough.
Depending on the reason you take pantoprazole, you may take a higher dose to begin with, usually for a month or 2. After this, your doctor may recommend that you take a lower dose.
How long to 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 have not 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 have not improved, you may need some tests to find out what's causing them.
If you take pantoprazole on prescription, you may only need to take it for a few weeks or months, depending on your condition. Sometimes your doctor may advise you to take it for longer, even for many years.
Some people do not need to take pantoprazole every day and take it only when they have symptoms. Once you feel better (often after a few days or weeks), you can stop taking it.
Taking pantoprazole just on days when you have symptoms is not suitable for everyone. Speak to your doctor about what's best for you.
If you forget to take it
If you usually take pantoprazole:
- 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 and take the next one at the usual time
- 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 and take the next one at the usual time
Never take a double dose to make up for a forgotten one.
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 to take your medicine.
If you take too much
It is very unlikely that taking extra doses of pantoprazole will cause any problems. But if you're concerned, contact your doctor.
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.
These side effects happen in 1 in 100 people. Talk to your pharmacist or doctor if these side effects bother you or do not go away:
Serious side effects
Serious side effects are rare and happen in less than 1 in 1,000 people.
Call a doctor or contact 111 straight away if you have:
- joint pain along with a red skin rash, especially on parts of your body exposed to the sun, such as your arms, cheeks and nose (this may be less noticeable on brown or black skin) – 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, the whites of your eyes turn yellow or your skin turns yellow (this may be less obvious on brown or black skin), or dark pee – these can be signs of liver problems
- pain when you pee, peeing less than usual, lower back pain, swollen ankles, and rash or a high temperature – these can be signs of a kidney problem
- severe or persistent diarrhoea – this can be a sign of an inflamed bowel
Go to 111.nhs.uk or call 111.
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to pantoprazole.
Immediate action required: Call 999 or go to A&E now 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
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of pantoprazole. For a full list see the leaflet inside your medicine packet.
You can report any suspected side effect using the Yellow Card safety scheme.
6. How to cope with side effects of pantoprazole
What to do about:
- headaches – make sure you rest and drink plenty of fluids. It's best not to 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 or squash by having small, frequent sips to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor. If diarrhoea does not get better, talk to your doctor.
7. Pregnancy and breastfeeding
Pantoprazole and pregnancy
Pantoprazole is not usually recommended if you're pregnant because there is little information about its use during pregnancy. Your doctor may recommend a similar medicine called omeprazole instead as there is more safety information available.
You may wish to try to treat your symptoms without taking medicine. You can try eating smaller meals more often, and avoiding fatty and spicy foods. Sit up straight when you eat, as this will take the pressure off your stomach.
If you get symptoms at night, you could prop your head and shoulders up when you go to bed. This helps to stop stomach acid coming up while you sleep.
Pantoprazole and breastfeeding
If your doctor or health visitor says your baby is healthy, it's OK to take pantoprazole while you're breastfeeding.
There is a little information available which shows that pantoprazole passes into breast milk in tiny amounts and your baby will not absorb a lot into their body from the breast milk.
It is unlikely that pantoprazole will cause any side effects in your baby.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
8. Cautions with other medicines
Some medicines and pantoprazole can affect each other and make you more likely to have side effects or stop one of the medicines working as well.
Tell your doctor if you're taking any of these medicines before you start pantoprazole treatment:
- antifungal medicines such as itraconazole, ketoconazole, posaconazole and voriconazole
- fluvoxamine, an antidepressant
- methotrexate, a medicine used to treat cancer, psoriasis and rheumatoid arthritis
- HIV medicines
- rifampicin, an antibiotic
- medicines that hep to prevent blood clots, such as 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.
There's not enough information to say that other complementary medicines and herbal remedies are safe to take with pantoprazole. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about pantoprazole
How does pantoprazole work?
Pantoprazole is a type of medicine called a proton pump inhibitor (PPI).
Proton pumps are enzymes in the lining of your 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.
Can I take pantoprazole for a long time?
If you've bought pantoprazole from a pharmacy without a prescription, do not take it for more than 4 weeks without speaking to your doctor.
If you take pantoprazole for more than 3 months, the levels of magnesium in your blood may fall.
Low magnesium 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 that it's not working any more, talk to your doctor.
Does taking pantoprazole for a long time cause stomach cancer?
There is some information to suggest people taking medicines that reduce stomach acid, like proton pump inhibitors (PPIs) such as pantoprazole and H2 blockers, might have a very small increased chance of developing stomach cancer. It could be more likely in people taking them for longer than 3 years.
But studies involving more people need to be done to be sure that PPIs and H2 blockers cause stomach cancer, rather than something else causing it.
PPIs, like most medicines, can have side effects so it's best to take them for the shortest time possible.
And it's important to speak to your doctor if you notice any of these symptoms which can be signs of stomach cancer:
- having problems swallowing (dysphagia)
- feeling or being sick
- feeling full very quickly when eating
- losing weight without trying to
Speak to your doctor or pharmacist if you're concerned.
How do I stop taking pantoprazole?
Usually, you can stop taking pantoprazole without reducing the dose first.
But 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:
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 as pantoprazole and have similar side effects. However, they may be given in different doses to pantoprazole.
Sometimes, if pantoprazole is not working for you or you get side effects, your doctor may suggest that you try taking another proton pump inhibitor.
Are there other indigestion medicines?
There are other prescription medicines and ones you can buy that treat indigestion and heartburn.
Antacids, like calcium carbonate (Tums), sodium bicarbonate, Maalox and Milk of Magnesia, relieve indigestion and heartburn by reducing the damage of 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 do not 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 proton pump inhibitors.
They include famotidine (Pepcid), cimetidine (Tagamet) and nizatidine.
In general, proton pump inhibitors like pantoprazole are used first because they are better than H2 blockers at reducing stomach acid.
However, if a proton pump inhibitor does not suit you (for example, because of side effects), your doctor may prescribe an H2 blocker.
You can buy famotidine and nizatidine without a prescription from pharmacies.
Can I take pantoprazole with an antacid?
You can take pantoprazole with an antacid like Gaviscon.
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 does not upset your stomach.
Will it affect my fertility?
There's no 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 as they may want to review your treatment.
Will it affect my contraception?
Pantoprazole does not affect any type of regular contraception, including the combined pill. But it may reduce the effectiveness of one type of emergency contraception called ellaOne (ulipristal), so a different form of emergency contraceptive may be recommended instead.
If pantoprazole gives you severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Check the pill packet to find out what to do.
Find out what to do if you're on the pill and have diarrhoea.
Can I drive or ride a bike?
Pantoprazole can make you feel dizzy or sleepy, or affect your vision. If this happens to you, do not drive, cycle or use machinery or tools until you feel better.
It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.
Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking pantoprazole. GOV.UK has more information on the law on drugs and driving.
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 affect the way pantoprazole works. However, it's best not to drink too much alcohol because 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.
- Cut down on alcohol.
- Quit smoking if you can.
- Sit up straight when you eat. This will take the pressure off your stomach.
- If you have symptoms at night, try not to eat for at least 3 hours before you go to bed.
- Prop your head and shoulders up when you go to bed. This can stop stomach acid coming up while you sleep.