Pantoprazole, sold under the brand name Protonix, among others, is a proton pump inhibitor medication used for the treatment of stomach ulcers, short-term treatment of erosive esophagitis due to gastroesophageal reflux disease (GERD), maintenance of healing of erosive esophagitis, and pathological hypersecretory conditions including Zollinger–Ellison syndrome. It may also be used along with other medications to eliminate Helicobacter pylori. Pantoprazole is a proton-pump inhibitor (PPI) and its effectiveness is similar to that of other PPIs. It is available by mouth and by injection into a vein. Common side effects include headaches, diarrhea, abdominal pain, and joint pain. More serious side effects may include severe allergic reactions, a type of chronic inflammation known as atrophic gastritis, Clostridioides difficile colitis, low magnesium, and vitamin B12 deficiency. Use in pregnancy appears to be safe. Pantoprazole is a proton pump inhibitor that decreases gastric acid secretion. It works by inactivating (H+/K+)-ATPase function in the stomach. The study of pantoprazole began in 1985, and it came into medical use in Germany in 1994. It is available as a generic medication. In 2023, it was the thirteenth most commonly prescribed medication in the United States, with more than 37 million prescriptions. In Australia, it was one of the top 10 most prescribed medications between 2017 and 2023.
Medical uses Pantoprazole is used for short-term treatment of erosion and ulceration of the esophagus for adults and children five years of age and older caused by gastroesophageal reflux disease. It can be used as a maintenance therapy for long-term use after initial response is obtained, but there have not been any controlled studies about the use of pantoprazole past a duration of 12 months. Pantoprazole may also be used in combination with antibiotics to treat ulcers caused by Helicobacter pylori. It can also be used for long-term treatment of Zollinger-Ellison syndrome. It may be used to prevent gastric ulcers in those taking NSAIDs. For improved efficacy of pantoprazole, the oral tablet formulation is taken half an hour prior to ingestion of food. In the hospital, intravenous administration is indicated when patients are unable to take the medication by mouth.
Children Pantoprazole is only indicated for the short-term treatment of erosive esophagitis in children ages seven and older; and the safety and effectiveness of pantoprazole have only been established in the treatment of erosive esophagitis in children.
Adverse effects
Infection Stomach acid plays a role in killing ingested bacteria. Use of pantoprazole may increase the chance of developing infections such as pneumonia, particularly in hospitalized patients.
Elderly The incidence of adverse effects occurring in people aged 65 years and older was similar to that in people aged 65 years and less.
Pregnancy In reproductive studies using doses largely greater than the recommended doses performed on rats and rabbits, there was no evident harm on the development of the baby.
Breast feeding Pantoprazole has been found to pass through the breast milk. Additionally, in rodent cancer studies, pantoprazole has been shown to potentially cause tumor growth. The clinical relevance of the finding is unknown, but risks and benefits are recommended for consideration in determining the use of therapy for the mother and child.
Common Gastrointestinal: abdominal pain (6%), diarrhea (9%), flatulence (4%), nausea (7%), vomiting (4%) Neurologic: headache (12%), dizziness (3%) Neuromuscular and skeletal: arthralgia (3%)
Rare Gastrointestinal: constipation, dry mouth, hepatitis Blood problems: low white blood cell count, thrombocytopenia Immunologic: Stevens–Johnson syndrome, toxic epidermal necrolysis Metabolic: elevated creatine kinase, elevated cholesterol levels, elevated liver enzymes (AST/ALT), swelling Musculoskeletal: Muscle disorders, bone fracture and infection, Clostridioides difficile infection, osteoporosis-related hip fracture, rhabdomyolysis Kidneys: interstitial nephritis Nutrition: may reduce the absorption of important nutrients, vitamins, and minerals, including certain medications, leaving users at increased risk for pneumonia.
Long-term use Osteoporosis and bone fracture have been observed in people on high-dose and/or long-term (over one year) prescription proton pump inhibitors. Hypomagnesia has been observed in people on medications like pantoprazole when taken for longer periods of time (generally one year or more, although cases have been reported with regimens as short as three months). Deficiencies such as vitamin B12 deficiency, iron deficiency, and calcium deficiency may be seen with long term use. Vitamin B12 deficiency is due to the change in the acidic environment within the stomach with the use of pantoprazole which prevents peptidases from being activated. This prevents the cleaving of R-factor from vitamin B12 and prevents its absorption. Rebound hypergastrinemia may be seen when stopping the medication after long term use.
Discontinuation In people taking PPIs for longer than six months, a dose taper is recommended prior to discontinuation.
Interactions Due to its effect of reducing stomach acidity, use of pantoprazole can affect absorption of drugs that are pH-sensitive, such as ampicillin esters, ketoconazole, atazanavir, iron salts, amphetamine and mycophenolate mofetil. Additional medications that are affected include bisphosphonate derivatives, fluconazole, clopidogrel, and methotrexate.
Pharmacology
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