What can pantoprazole and PPIs be used for?

If you’ve ever had heartburn, you’re not alone. Research shows that as many as one in every five people in the Western world experiences symptoms of acid reflux on a weekly basis (Dent, 2005). While acid production in the stomach is a normal part of the digestive process, when some of that acid escapes the stomach and comes back up the esophagus (the tube that connects your throat to your stomach), it can be painful and even dangerous.

When it happens once in a while, heartburn is usually nothing more than a nuisance. It’s typically described as pain behind the sternum (the bone in the middle of your chest). But if it happens frequently or your symptoms are severe, you may have a condition known as GERD (gastroesophageal reflux disease) (Vakil, 2006). 

While the stomach is built to hold acid with a special protective lining, the esophagus isn’t, so the persistent presence of acid there can cause damage known as esophagitis. Pantoprazole is used to relieve symptoms of this condition (Wolfe, 2020). 

Pantoprazole can also be used as a treatment for a rare condition called Zollinger Ellison syndrome and as part of the treatment for H. Pylori--a common bacterial infection that can cause stomach ulcers (Wolfe, 2020). 

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Pantoprazole is part of a group of medications called proton pump inhibitors (PPIs). These drugs work by blocking the production of acid in the stomach (Shin, 2013). 

Other PPIs include omeprazole (brand name Prilosec), lansoprazole (brand name Prevacid), and rabeprazole (Aciphex) (Wolfe, 2020).

Acid reflux is a common medical condition that occurs when your stomach contents flow back into your esophagus, causing inflammation. If you’ve ever had it, you know how it feels. If you haven’t, it’s typically described as a burning sensation in the chest behind the breastbone that travels up through the neck and throat. The feeling usually occurs after a big meal, and it may even feel like your food is rising back up into your throat, leaving a bitter or sour taste in your mouth.

You might be surprised to learn that many people with acid reflux are actually entirely asymptomatic. In fact, one study in Sweden showed that nearly four out of every ten people they evaluated who were found to have damage to their esophagus from acid reflux reported no symptoms at all (Ronkainen, 2004). Acid reflux can range from mild to severe and is pretty common in the United States. 

According to the American College of Gastroenterology, more than 60 million Americans experience heartburn at least once per month, with 15 million Americans experiencing heartburn symptoms each day (ACG, n.d.) 

Gastroesophageal reflux disease (GERD) is a chronic, more severe form of acid reflux and is diagnosed when acid reflux occurs more than twice a week.

GERD can cause the development of a condition called Barrett’s esophagus, which results from repeated exposure of the esophagus to stomach acid resulting in damage to the cells there. This condition is quite common, affecting between 10–20% of people in the Western world (Dent, 2005). 

Common symptoms of GERD can include (Vakil, 2006):

• Heartburn

• Regurgitation (when the food rises back up into your throat)

• A sour taste in your mouth, especially after lying down or when you wake up in the morning

Less commonly, if the damage to the esophagus is severe, GERD can cause bleeding there, which might result in bloody coughs, bloody stool, iron-deficiency anemia, weight loss, or difficulty swallowing. If you experience any of these symptoms, schedule some time with your healthcare provider for a more thorough investigation (Vakil, 2006).

Medication

As explained earlier, heartburn is pretty common, and occasional episodes after meals aren’t usually anything to be concerned about. 

Simple occasional heartburn often results due to diet and lifestyle choices and can be managed by losing weight and cutting out smoking. When the heartburn is a symptom of a more severe problem like acid reflux or GERD, your healthcare provider may suggest treatment involving a PPI like pantoprazole. If your heartburn becomes frequent or uncomfortable, speak with your healthcare provider to discuss an evaluation using an upper endoscopy and a barium swallow test. 

Peptic ulcer disease (PUD) is when painful sores develop in the lining of the stomach, bowels, or the start of the small intestine (duodenum) (AGA, n.d.). Stomach ulcers develop the inside of the stomach, while duodenal ulcers grow on the inside of the upper portion of your small intestine.

PUD typically occurs for one of two reasons (AGA, n.d.):

• An infection in the stomach lining caused by bacteria called Helicobacter pylori (H. pylori). This common condition can cause damage to the lining of the digestive tract.

• Overuse of nonsteroidal anti-inflammatory drugs (NSAIDs)—such as ibuprofen (brand names Advil and Motrin) and aspirin. NSAIDs are used to alleviate aches, pains, and swelling. NSAIDs disrupt the stomach defenses against damage by stomach acid, and continuous use can result in damage to the stomach lining. 

Stress and spicy foods won’t actually cause peptic ulcers, but they can make your symptoms worse (AGA, n.d.).

Serious stomach pain is the most common symptom of an ulcer. The burning sensation can be unpredictable, happening at any time of the day or night and lasting from a few minutes to several hours. Other, less frequent, side effects include an upset stomach, vomiting, and loss of appetite (AGA, n.d.).

Some people may have peptic ulcer disease but no symptoms. In this case, your healthcare provider might only suspect PUD if you have low iron levels in your blood (iron-deficiency anemia) or black or bloody stool (Vakil, 2020).

Treatment for peptic ulcer disease

Treatment for PUD depends on the root of the condition. If you’re experiencing any of the symptoms mentioned above, meet with your healthcare provider for a proper evaluation

To understand if H. pylori infection is the cause of your PUD, your healthcare provider might conduct a simple breath test called the urea breath test or check your stool for the bacteria. If you’ve been taking PPIs like pantoprazole, you will have to stop taking them for the test (Crowe, 2020). 

Treatment for H. pylori typically lasts 10–14 days and involves the use of two types of antibiotics and a PPI like pantoprazole. This combination will help alleviate the discomfort and clear the infection (Chiba, 2013). Your symptoms may improve before you finish the full course of treatment, but it’s very important to follow your healthcare provider’s instructions and complete your treatment course to ensure that the infection is treated completely and to reduce the likelihood that it will return (Crowe, 2020).

If your peptic ulcers are due to NSAIDs, your healthcare provider will advise you to stop the medication and find an alternative option if possible. This treatment will also likely include the use of PPIs to alleviate the symptoms and allow the ulcers to heal (Vakil, 2020). 

Pantoprazol is the generic version of Protonix, and it entered the market in December 2007. It’s identical to the brand name drug in usage and dosage.

Protonix (pantoprazole sodium) received FDA approval in 2000 for the short-term treatment of the following conditions (FDA, 2012):

• Erosive esophagitis (esophagus inflammation) associated with GERD

• The maintenance of healing of erosive esophagitis

• Conditions like Zollinger Ellison syndrome

The medication is available in delayed-release tablets at 20 mg or 40 mg. Liquid pantoprazole, 40 mg, can also be prescribed for people who have difficulty swallowing tablets. The tablets can be swallowed whole with or without food, and the oral medicine is usually administered with applesauce or apple juice approximately 30 minutes prior to a meal (FDA, 2012).

The most frequently reported side effect of pantoprazole is headache. Other common side effects include (DailyMed, n.d):

• Diarrhea

• Nausea

• Abdominal pain

• Gas

• Dizziness

• Muscle pain

Although pantoprazole is usually well tolerated, long-term use (one year or longer) can increase the risk of an adverse event or drug interaction.  

High doses and long-term use of pantoprazole may increase the risk of osteoporosis and bone fractures of the hip, wrist, or spine. Long-term use of PPIs can also lead to Clostridium difficile (C. diff), an infection in the digestive system that causes severe diarrhea (FDA, 2017). If you develop persistent diarrhea, the FDA recommends being evaluated by a healthcare professional to rule out C. diff. immediate care if they use PPIs and develop diarrhea that does not improve.

Pantoprazole can make it difficult for your body to absorb certain nutrients—most frequently, magnesium. Magnesium deficiency typically only occurs in people taking PPIs for more than three months and can result in muscle spasms and weakness.

Less frequently, people can develop a vitamin B12 deficiency, but this usually only occurs in people taking pantoprazole for more than two years. Your healthcare provider can check your B12 levels with a simple blood test and, if necessary, recommend supplements (UpToDate, n.d.).

Pantoprazole is safe for most adults but may not be suitable for everyone. To check if this is the right medication for you, let your healthcare provider know if you (NHS, 2018):

• Have ever experienced an allergic reaction to pantoprazole 

• Have liver problems

• Are due for an endoscopy

• Are pregnant 

If you do experience adverse effects from the medication, always seek medical advice from your healthcare provider before stopping a prescription PPI drug.

Pantoprazole and alcohol

Unlike many medications, alcohol does not interfere with the way pantoprazole works. However, it’s important to call out that drinking alcohol causes your stomach to generate more acid than normal. This excess acid can irritate your stomach lining and exacerbate existing symptoms. If you’re taking pantoprazole for any of the conditions mentioned in this article, it might be best to abstain or drink in moderation (NHS, 2018).

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Current version

August 30, 2020

Written by

Alexandria Bachert

Fact checked by

Yael Cooperman, MD

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About the medical reviewer

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.