Pantoprazole vs. omeprazole: how do they compare?

Omeprazole and pantoprazole are both generic medications used to treat heartburn and digestive conditions like gastroesophageal reflux disease (GERD) and erosive esophagitis. Both work in similar ways, but is one better than the other?

Omeprazole and pantoprazole are considered safe and equally effective. Both fall into a class of drugs called proton pump inhibitors (PPIs), which work by blocking acid production in the stomach (Strand, 2017). While they function in the same way, there are some differences between the two generic drugs. Here's what you need to know about omeprazole and pantoprazole, and how the drugs compare. 

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As we mentioned, both omeprazole and pantoprazole are PPIs. Compared to other drugs such as H2 antagonists, which also work by restricting acid production in the stomach, PPIs are considered the first line of treatment for GERD (Zhang, 2017). 

So, how do these particular PPIs differ? Omeprazole is the generic version of Prilosec, a popular brand name drug approved by the U.S. Food and Administration (FDA) to treat a number of gastro-related conditions, the main ones being GERD, peptic ulcers, erosive esophagitis, and Zollinger-Ellison syndrome (FDA, 2015). Pantoprazole, also known under the brand name Protonix, is prescribed for managing and healing erosive esophagitis associated with GERD, as well as the long-term treatment of Zollinger-Ellison syndrome (FDA, 2016). 

Both medications are intended for short-term use only (up to 8 weeks), but only omeprazole is available both over-the-counter (OTC) and by prescription — you can only get pantoprazole with a prescription. Either drug can be taken by adults and children, with some restrictions: omeprazole can be taken by kids one year and up, while pantoprazole is only prescribed for children five years of age and up (FDA, 2016). Both medications are reported to be safe and effective, although omeprazole carries a higher potential for drug interactions (Wedemeyer, 2014).  

Another difference between the two drugs is cost. Omeprazole can range from around $9 to $60 for a 30-day supply, and pantoprazole is slightly cheaper, costing from $9 to $50. Both drugs are typically covered by Medicare and most health insurance plans, although costs vary depending on your insurance provider. Now that we know the basics let's take a look at each of these drugs individually.

Approved in 1989, omeprazole was one of the first PPIs developed to treat conditions caused or made worse by high levels of stomach acid (FDA, 2018). It was a major breakthrough at the time, and even 30 years later, research has found that PPIs are much better at suppressing acid formation in the stomach compared to H2 blockers like brand names Pepcid AC or Zantac (Strand, 2017). 

Previously only available with a prescription, the FDA approved an OTC version of omeprazole in 2015 (FDA, 2015). Omeprazole is available as a delayed-release capsule or dissolvable powder and comes in amounts of 10 mg, 20 mg, 40 mg, and 60 mg. Taken once daily, the effects of omeprazole kick in within an hour and can take up to four days to reach full effect (Covis, 2018). 

Omeprazole treats a variety of conditions, but here are some of its main uses (FDA, 2018): 

• Gastroesophageal reflux disease (GERD) Omeprazole treats and improves frequent heartburn and other symptoms of GERD.

• Erosive esophagitis: PPIs help control symptoms and encourage rapid healing of erosive esophagitis.

• Gastric and duodenal ulcers:  By neutralizing acid levels in the stomach, omeprazole helps prevent gastric and duodenal ulcers, as well as heal existing ulcers.

• Zollinger-Ellison syndrome: Omeprazole helps manage this rare condition characterized by tumors in the pancreas and small intestine.

• Helicobacter pylori When used alongside antibiotics, PPIs may help heal damage caused by H. pylori bacteria in the inner layers of the stomach. 

• Upper gastrointestinal bleeding: Upper GI bleeding can be a symptom among patients with peptic ulcer disease. PPIs have been shown to be an important therapy in preventing GI bleeds, especially in high-risk patients (Khan, 2018). 

Side effects of omeprazole

Generally, omeprazole is safe and well-tolerated by patients. Side effects vary, but the most common ones include headache, abdominal pain, nausea, vomiting, diarrhea, and gas (DailyMed, n.d.). Less common side effects that have been reported by patients include back pain, change in sense of taste, and dizziness (DailyMed, n.d.).

While rare, omeprazole may cause serious side effects like chronic kidney disease, pancreatitis, and liver damage (Kinoshita, 2018). Serious or less common side effects — like bone fractures or chronic stomach inflammation — may be triggered in patients living with other underlying health conditions (Thong, 2019). 

Drug interactions with omeprazole

There is a long list of medications omeprazole may interact with, but listed here are the most serious ones (FDA, 2018):

• Antiretrovirals, including rilpivirine, atazanavir, nelfinavir, and saquinavir

• Blood thinners, including clopidogrel, citalopram, cilostazol, phenytoin, diazepam, and digoxin

• Warfarin (blood thinner)

• Tacrolimus (organ transplant medication)

• Methotrexate (a medication used to treat arthritis and cancer)

This list doesn't include all the potential drug interactions with omeprazole. Consult with your healthcare provider first before taking this drug — especially if you have other health conditions or are taking multiple medications. 

Pantoprazole, also known under the brand name Protonix, was approved by the FDA in 2000 (FDA, 2016). It works just like omeprazole, effectively treating GERD and complications that can arise from it (such as erosive esophagitis or another serious condition called Barrett's esophagus) by reducing acid levels in the stomach. One 2018 study found that 45% of participants living with GERD had relief from their symptoms after taking 40 mg of pantoprazole each day for four weeks; after eight weeks, close to 70% of patients had significant improvement in symptoms (Dabrowski, 2018). 

Pantoprazole comes in time-released capsules or an oral suspension for those with difficulty swallowing pills. Dosages vary depending on age, weight, and the condition it's being used for. For adults, a typical dosage is 40 mg once daily for up to 8 weeks (FDA, 2016).

Here are the main conditions pantoprazole has been FDA-approved to treat (FDA, 2016): 

• Gastroesophageal reflux disease (GERD): Pantoprazole helps manage and relieve symptoms of GERD.

• Erosive esophagitis: Maintains healing of ulcers in the esophagus (the tube leading from your mouth to your stomach) and prevents it from recurring.

• Zollinger-Ellison syndrome: This extremely rare condition can result in the development of gastric ulcers, among other things. Pantoprazole is used for the long-term treatment of this condition.

Pantoprazole is also sometimes used off-label (meaning used for indications not specifically approved by the FDA) to treat H. pylori bacterial infections and prevent NSAID-induced ulcers as well as any peptic ulcers from rebleeding (Bernshteyn, 2020).

Side effects of pantoprazole

The side effects of pantoprazole are similar to other PPIs, such as omeprazole. The most common side effects include nausea, diarrhea, vomiting, gas, and joint pain (Makunts, 2019). Serious side effects are rare and may result from an allergy or drug sensitivity — contact a health provider right away if you experience a rash, swelling in your face, difficulty breathing, or throat tightness (Casciaro, 2019). 

Long-term use of pantoprazole may also be linked to a higher risk of kidney problems. One 2016 study found that over the course of a decade, people who took PPIs had a 20 to 50% higher risk of developing chronic kidney disease compared to those who did not (Lazarus, 2016). While rare, other adverse reactions like bone fractures and memory loss have also been linked to long-term use of PPIs (Makunts, 2019). 

Drug interactions with pantoprazole

So far, studies have found pantoprazole to have fewer drug interactions compared to omeprazole (Wedemeyer, 2014). While the number of serious drug interactions with pantoprazole is low, they're still important to consider — especially for patients taking more than one medication at a time.

This doesn't include the whole list of drugs pantoprazole could react with, but here are the top ones to avoid while taking pantoprazole (FDA, 2016):

• Certain antiretrovirals which are medications used to treat HIV infection.

• Warfarin, a blood thinner. When combined with warfarin, pantoprazole may significantly increase a person's risk of bleeding. 

• Methotrexate. The use of pantoprazole, in combination with methotrexate, can increase the chance of methotrexate toxicity.

Omeprazole and pantoprazole are safe for most people to use, with a few exceptions. There are no adequate studies yet on either drug about the risks for women who are nursing or pregnant. While omeprazole is considered to be safe for children over the age of one year, pantoprazole can be prescribed by a healthcare provider in very specific circumstances for children five years of age and up (FDA, 2016).

While more research is still needed, studies have found that PPIs may be more dangerous for those living with or at risk of migraines, visual impairment, and memory problems (Makunts, 2019). Since PPIs are intended for short-term use, any prolonged use of either drug could increase the risks for adverse effects or even death. A large 2017 study found that PPI users had a greater risk of death compared to patients taking H2 blockers or no stomach acid-reducing medications at all (Xie, 2017).   

Talk to a healthcare provider before taking either omeprazole or pantoprazole. Do not take these drugs together as it could increase the risk of side effects. For more information about side effects and safety, you can check out the medication pamphlets for Prilosec (omeprazole) and Protonix (pantoprazole).

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Current version

October 06, 2020

Written by

Anna Brooks

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.