Protonix (Pantoprazole) - Oral

What Is Protonix?

Protonix (pantoprazole) is a pill taken by mouth to treat disorders of the digestive system involving stomach acid.

Also known as a proton pump inhibitor (PPI), Protonix works by attaching to the gastric parietal cells on the outer lining of your stomach and decreasing the amount of gastric acid, or stomach acid, that these cells produce. Decreased acid results in decreased symptoms of disorders like gastroesophageal reflux disease (GERD), more commonly called heartburn.

Protonix is a prescription product, so you can’t purchase it over-the-counter (OTC). You’ll receive a prescription from your healthcare provider and get the medication from a pharmacy. This medication comes in tablet and oral granule forms.

Drug Facts

Generic Name: Pantoprazole

Brand Name: Protonix

Drug Availability: Prescription

Therapeutic Classification: Proton pump inhibitor

Available Generically: Yes

Controlled Substance: N/A

Administration Route: Oral

Active Ingredient: Pantoprazole

Dosage Form: Tablet, granules for suspension (liquid)

What Is Protonix Used For?

Protonix is most commonly used for treating damage done to the esophagus by gastroesophageal reflux disease (GERD).

GERD occurs when stomach acid rises from your stomach back up into your esophagus, the tube that carries food from your mouth to your stomach. When this happens often, it causes inflammation and heartburn symptoms, like throat or chest pain. These symptoms characterize erosive esophagitis.

Protonix decreases the amount of stomach acid your body produces to prevent an excess that can flow back up to your throat and cause heartburn.

It can also be used to treat hypersecretory conditions, such as Zollinger-Ellison syndrome. Zollinger-Ellison Syndrome is a rare disease that causes tumors to form in different places along the gastrointestinal tract, such as the stomach, pancreas, or intestine. These tumors secrete a high amount of a hormone called gastrin, leading to excessive stomach acid. Excess acid causes peptic ulcers, which are sores in the lining of your stomach, intestine, or esophagus.

How to Take Protonix

Protonix tablets can be taken with or without food. They must be swallowed whole, never crushed, cut, or chewed.

Protonix is also available as granules for oral suspension. This dosage form must be mixed with either applesauce or apple juice, not water or other food or drink. Once prepared, the oral suspension must also be taken about 30 minutes before a meal.

If using applesauce, empty the granules onto a teaspoonful of applesauce and consume within 10 minutes. Follow with sips of water to ensure the medicine makes it to your stomach.

If using apple juice, empty the granules into a small cup containing a teaspoonful of applesauce. Stir the mixture for a few seconds and swallow immediately. The granules will not dissolve.

Storage

Store Protonix tablets and granules at room temperature (between 68 F and 77 F) in the original container, out of reach of children and pets. Avoid storing in areas with a lot of heat and moisture, like the bathroom.

If you’re traveling by plane, you’ll want to keep Protonix in your carry-on luggage so that you aren’t separated from it in case your checked baggage goes missing. Do not leave your medicine in especially hot or cold temperatures for long periods, like overnight in the car.

Off-Label Uses

In addition to its FDA-approved indications, Protonix can be used off-label to treat other health conditions.

It may be used to treat H.pylori infection, where a bacteria called Helicobacter pylori can sometimes cause abdominal pain, nausea, and stomach lining inflammation.

Protonix may also be used for stress ulcer prophylaxis in hospitalized and critically ill people. These people undergoing major stress and strain on the body can develop ulcers, or open sores, along certain points of the digestive tract. Protonix may be used to prevent these issues.

How Long Does Protonix Take to Work?

It takes about two and a half hours for Protonix to begin decreasing stomach acid production. You may start to feel some relief that quickly, but it may also take up to four weeks for noticeable symptom improvement.

If you’re taking Protonix for the first time, you will likely start by taking it for a relatively short period–around eight weeks. Your healthcare provider will want to check on your symptoms and decide whether to extend your treatment.

What Are the Side Effects of Protonix?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

Some more common side effects that you may experience while taking Protonix include the following. Note that “common” in this case means they were experienced by greater than or equal to 2% of people in clinical trials. None were experienced by more than 13% in trials.

These common side effects include:

Severe Side Effects

Potential side effects of Protonix that may be more serious include:

  • Vitamin B12 deficiency: Stomach acid is needed to absorb vitamin B12 properly, so having less stomach acid can cause low levels, particularly if you have been on Protonix for more than three years.
  • Hypomagnesemia, or low magnesium levels: This can often happen after a year of treatment. You may or may not have symptoms, including dizziness, abnormal heartbeat, shakiness or jitters, muscle weakness, cramps, or aches.
  • C. Diff infection: The risk for this infection may be increased, particularly in hospitalized people who are also taking antibiotics and PPIs. Hallmark symptoms are watery diarrhea and abdominal cramping.

Call your healthcare provider right away if you feel like you are experiencing serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Long-Term Side Effects

In addition to the possible side effects of low vitamin B12 and low magnesium levels, it’s possible that using PPIs for a long time may increase the risk for bone fractures, such as in areas like the hip, wrist, or spine. This risk is mostly increased in people who take PPIs multiple times a day for a year or longer.

You may want to ask your healthcare provider about getting your levels checked for vitamin B12 and magnesium and how you can ensure your bones are staying strong, such as perhaps taking a bone density test.

Report Side Effects

Protonix may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Protonix Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage forms (delayed-release tablets or suspension):
    • For erosive esophagitis:
      • Adults—40 milligrams (mg) once a day for up to 8 weeks. Your doctor may want you to take pantoprazole for more than 8 weeks for certain conditions.
      • Children 5 years of age and older weighing 40 kilograms (kg) or more—40 mg once a day for up to 8 weeks.
      • Children 5 years of age and older weighing 15 to 39 kg—20 mg once a day for up to 8 weeks.
      • Children younger than 5 years of age—Use and dose must be determined by your doctor.
    • For Zollinger-Ellison syndrome:
      • Adults—At first, 40 milligrams (mg) 2 times a day. Your doctor may increase your dose as needed.
      • Children—Use and dose must be determined by your doctor.

Modifications

The following factors may affect your treatment with Protonix. Talk to your healthcare provider about whether changes (modifications) are needed.

Pregnancy

It is unknown whether taking Protonix while pregnant increases the risk of birth defects or miscarriage. There haven’t been many studies that include pregnant people exposed to PPIs. Still, one was done in 2005 that included 295 pregnancies exposed to different PPIs, including Protonix, Prilosec (omeprazole), and Prevacid (lansoprazole). The rate of birth defects was not significantly higher than in the group that did not take PPIs.

Speak with your healthcare provider about whether the benefit of PPIs may be worth any risk they may pose to a pregnancy. They could be a decent option if lifestyle modification and other treatment options aren’t sufficient to control symptoms.

Breastfeeding

Pantoprazole is present in human breast milk. But the significance of this and whether it negatively affects infants is poorly understood. Again, you will want to discuss with your healthcare provider and decide if Protonix's benefit is worth any potential risk.

Children

Protonix has been established as safe for children ages 1 year to 16 years, but there is no dosage form that’s appropriate for kids younger than 5. For that reason, it’s only indicated for children 5 and older for the short-term (eight weeks) treatment of erosive esophagitis associated with GERD.

Missed Dose

If you forget to take a dose of Protonix, take it as soon as you remember. However, if it is closer to your next dose than the one you missed, skip it and wait for your next scheduled one. For example, if you usually take pantoprazole at 8 a.m. and 8 p.m. and remember at 5 p.m. that you forgot your morning dose, wait and take your next dose that night at 8 p.m. Do not double up doses to make up for missed ones.

Overdose: What Happens If I Take Too Much Protonix?

As long as you take Protonix as prescribed, you don’t need to worry about overdosing. There is little data available regarding the toxicity of pantoprazole at very high doses.

The medicine cannot be removed by dialysis, a process that can remove some drugs from the body faster than they would work themselves out of your system, so any treatment for overdosage would most likely be in response to symptoms you are experiencing and keep you generally well.

If you take too much Protonix and experience side effects that may be related to this, contact your healthcare provider as soon as possible or go to the nearest emergency department.

What Happens If I Overdose on Protonix?

If you think you or someone else may have overdosed on Protonix, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Protonix, call 911 immediately.

Precautions

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It is very important that your doctor check your and your child's progress at regular visits to make sure this medicine is working properly. Blood, urine, and other laboratory tests may be needed to check for unwanted effects.

Do not use pantoprazole together with medicines containing rilpivirine (eg, Complera®, Edurant®, Odefsey®). Using these medicines together may cause unwanted side effects.

Check with your doctor right away if you have a change in frequency of urination or amount of urine, blood in the urine, fever, joint pain, loss of appetite, nausea, skin rash, swelling of the body, feet, or ankles, unusual tiredness or weakness, or unusual weight gain after receiving this medicine. These could be symptoms of a serious kidney problem called acute tubulointerstitial nephritis.

Cutaneous or systemic lupus erythematosus may occur or get worse in patients receiving a PPI. Call your doctor right away if you have joint pain or a skin rash on your cheeks or arms that gets worse when exposed to the sun.

Taking this medicine for a long time may make it harder for your and your child's body to absorb vitamin B12. Tell your doctor if you have concerns about this.

Serious stomach conditions may occur while taking this medicine. Check with your doctor immediately if you or your child has stomach cramps, bloated feeling, watery and severe diarrhea which may also be bloody sometimes, fever, nausea or vomiting, or unusual tiredness or weakness.

Pantoprazole may increase your risk of having fractures of the hip, wrist, and spine. This is more likely if you are 50 years of age and older, if you receive high doses of this medicine, or use it for one year or more. Call your doctor right away if you have severe bone pain or are unable to walk or sit normally.

This medicine may cause hypomagnesemia (low magnesium in the blood). This is more likely to occur if you are taking this medicine for more than one year, or if you are taking this medicine together with digoxin (Lanoxin®) or certain diuretics or "water pills". Check with your doctor right away if you have convulsions (seizures), fast, racing, or uneven heartbeat, muscle spasms (tetany), tremors, or unusual tiredness or weakness.

This medicine may cause serious skin reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, and drug reaction with eosinophilia and systemic symptoms (DRESS). Check with your doctor right away if you have black, tarry stools, blistering, peeling, or loosening of the skin, chest pain, chills, cough, diarrhea, itching, joint or muscle pain, painful or difficult urination, red irritated eyes, red skin lesions, often with a purple center, sore throat, sores, ulcers, or white spots in the mouth or on the lips, swollen glands, unusual bleeding or bruising, or unusual tiredness or weakness.

This medicine may increase your risk for fundic gland polyps (abnormal tissue growth in the upper part of your stomach). This is more likely if you are receiving this medicine for more than 1 year. Talk ti your doctor if you have concerns.

Do not stop taking this medicine without first checking with your doctor, or unless told to do so by your doctor.

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before you have medical tests.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription (eg, atazanavir, nelfinavir, Reyataz®, Viracept®) or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn't Take Protonix?

Protonix is not or may not be the best choice for you if you:

  • Have hypomagnesemia or low magnesium levels in your blood since Protonix can lower magnesium levels. Consider asking your healthcare provider about getting this level tested before taking pantoprazole.
  • Have vitamin B12 deficiency since Protonix can further lower the levels of vitamin B12, also called cyanocobalamin.
  • Are taking a medicine that contains rilpivirine such as Edurant (rilpivirine), Complera (​​emtricitabine/rilpivirine/tenofovir), or Odefsey (emtricitabine/rilpivirine/tenofovir alafenamide) to treat HIV, since pantoprazole can lessen how effective these drugs are at treating the virus.
  • Have a history of an allergy or serious reaction to Protonix, such as anaphylaxis, angioedema, or exfoliative skin conditions.

What Other Medications Interact With Protonix?

Some drugs can interact with Protonix and should be monitored by your healthcare provider. Before starting treatment, tell your healthcare provider about any other medicines you take or plan to take, including over-the-counter (OTC) nonprescription products, vitamins, herbs, supplements, and plant-based medicines.

Protonix may interact with:

  • Antiretrovirals: Protonix may lower the effectiveness of these drugs used to treat HIV, which could result in treatment failure. Let your healthcare provider know if you take any medicines containing the drugs rilpivirine, atazanavir, nelfinavir, or saquinavir.
  • Jantoven (warfarin): Protonix may strengthen the effects of this blood thinner that is used to prevent blood clots. This may result in a longer INR than desired and an increased risk of bleeding.
  • Methotrexate: Protonix may elevate the concentration of methotrexate in your body, which can lead to toxicity from this drug used to treat autoimmune diseases such as rheumatoid arthritis and some cancers.
  • Acid-dependent drugs: Some drugs, such as iron products, CellCept (mycophenolate mofetil), and ketoconazole, rely on acidity in the stomach for absorption. Since Protonix lowers the amount of acid, the effectiveness of these drugs may be lowered.

This is not a complete list of drug interactions that can occur. Talk with your pharmacist or healthcare provider for more detailed information about medication interactions with Protonix.

What Medications Are Similar to Protonix?

There are a few other PPI drugs in the same class as pantoprazole.

PPIs that are available OTC include:

PPIs that require a prescription, like Protonix, include Aciphex (rabeprazole) and Dexilant (dexlansoprazole).

Another class of drugs that is frequently used to treat heartburn symptoms is called H2 blockers, which include:

This is not a list of drugs recommended to take with Protonix; however, sometimes different drug classes may be combined when treatment with one is insufficient to relieve symptoms. Talk to your pharmacist or a healthcare provider if you have questions.

Frequently Asked Questions

  • What is Protonix used for?

    Protonix is used to treat digestive disorders or peptic disorders. The most common use is treating and maintaining gastroesophageal reflux disease (GERD) and the erosive esophagitis associated with it, which is damage to the esophagus. It can also be used for a rare disease called Zollinger-Ellison Syndrome, which causes tumors to form in the gastrointestinal tract that leads to peptic ulcers.

  • How does Protonix work?

    Protonix is a proton pump inhibitor or PPI. It works by attaching to the outer lining of your stomach and decreasing the amount of stomach acid that cells there produce. Decreased acid results in fewer symptoms of disorders like GERD, more commonly called heartburn.

  • What medicines interact with Protonix?

    Some drugs may have their effects increased or decreased by Protonix when you take both together. A few drugs that you should be sure to let your healthcare provider know that you’re taking include methotrexate, antiretroviral drugs to treat HIV, warfarin, iron products, and CellCept (mycophenolate mofetil).

How Can I Stay Healthy While Taking Protonix?

Heartburn is an extraordinarily common condition. Almost everyone experiences it from time to time, but feeling symptoms too often can become a burden. Luckily, there are many changes you can make that can improve symptoms in addition to using medicines to treat GERD.

You may have noticed worse heartburn symptoms after a particularly large meal. Overeating causes your stomach to expand, which increases the upward pressure on the lower esophageal sphincter. There is also more acid that gets produced after a larger meal to help digest everything. These two things together can worsen heartburn. Instead, try eating smaller, more frequent meals.

Also, avoid lying down flat soon after eating. Allow two or three hours after your meal before going to bed or lying down to watch TV. Lying down, especially flat, puts pressure on the lower esophageal sphincter, and the acid can get pushed up more easily. Using a wedge-shaped GERD pillow also takes advantage of gravity to keep acid down in your stomach where it belongs.

Quitting smoking, limiting alcohol intake, and reducing stress are all behaviors that will put you on the right track to conquering heartburn. Implementing one or two changes at a time will help you control symptoms and live a more comfortable life.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Sara Hoffman, PharmD
Sara is a clinical pharmacist that believes everyone should understand their medications, and aims to achieve this through her writing.