Formulary
Pantoprazole: Indications, Dosing, Side Effects and Interactions
For all proton pump inhibitors Proton pump inhibitors inhibit gastric acid secretion by blocking the hydrogen-potassium adenosine triphosphatase enzyme system...
MedNext Academy | 5 min read
Pantoprazole: Indications, Dosing, Side Effects and Interactions
For all proton pump inhibitors Proton pump inhibitors inhibit gastric acid secretion by blocking the hydrogen-potassium adenosine triphosphatase enzyme system...
Drug action
For all proton pump inhibitors Proton pump inhibitors inhibit gastric acid secretion by blocking the hydrogen-potassium adenosine triphosphatase enzyme system (the 'proton pump') of the gastric parietal cell.
Indications and dose
**Helicobacter pylorieradication [in combination with other drugs]**
- **Adult** (By Mouth): Helicobacter pylori eradication [in combination with other drugs] 40 mg twice daily for 7 days for first- and second-line eradication therapy; 10 days for third-line eradication therapy.
**Benign gastric ulcer**
- **Adult** (By Mouth): 40 mg once daily for 8 weeks, dose can be increased if necessary up to 80 mg per day in severe cases.
**Gastric ulcer**
- **Adult** (By Intravenous Injection, Or By Intravenous Infusion): 40 mg once daily until oral administration can be resumed.
**Duodenal ulcer**
- **Adult** (By Mouth): 40 mg once daily for 4 weeks, dose can be increased if necessary up to 80 mg per day in severe cases.
- **Adult** (By Intravenous Injection, Or By Intravenous Infusion): 40 mg once daily until oral administration can be resumed.
**NSAID-associated peptic ulcer disease**
- **Adult** (By Mouth): 40 mg once daily for 8 weeks.
**Prophylaxis of NSAID-associated gastric ulcer in patients with an increased risk of gastroduodenal complications who require continued NSAID treatment,Prophylaxis of NSAID-associated duodenal ulcer in patients with an increased risk of gastroduodenal complications who require continued NSAID treatment**
- **Adult** (By Mouth): 20 mg once daily.
**Gastro-oesophageal reflux disease**
- **Adult** (By Mouth): 40 mg once daily for 4 or 8 weeks.
- **Adult** (By Intravenous Injection, Or By Intravenous Infusion): 40 mg once daily until oral administration can be resumed.
**Severe oesophagitis**
- **Adult** (By Mouth): 40 mg once daily for 8 weeks, continue as maintenance treatment if appropriate.
**Severe oesophagitis, refractory to initial treatment**
- **Adult** (By Mouth): 40 mg twice daily.
**Functional dyspepsia**
- **Adult** (By Mouth): 20 mg once daily for 4 weeks.
**Uninvestigated dyspepsia**
- **Adult** (By Mouth): 40 mg once daily for 4 weeks.
**Zollinger-Ellison syndrome (and other hypersecretory conditions)**
- **Adult** (By Mouth): Initially 80 mg once daily, dose to be adjusted according to response, doses above 80 mg per day should be given in 2 divided doses.
- **Adult** (By Intravenous Injection, Or By Intravenous Infusion): Initially 80 mg for 1 dose, alternatively initially 160 mg for 1 dose, to be used if rapid acid control required, then 80 mg once daily, dose to be adjusted according to response, doses above 80 mg per day should be given in 2 divided doses.
Cautions
For all proton pump inhibitors Can increase the risk of fractures (particularly when used at high doses for over a year in the elderly); may increase the risk of gastro-intestinal infections (including Clostridioides difficile infection); may mask the symptoms of gastric cancer; may reduce absorption of vitamin B 12 with long-term treatment; patients at risk of osteoporosis Cautions, further information Risk of osteoporosis Patients at risk of osteoporosis should maintain an adequate intake of calcium and vitamin D, and if necessary, receive other preventative therapy. Gastric cancer Particular care is required in those presenting with 'alarm features', in such cases gastric malignancy should be ruled out before treatment. Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate for uncomplicated peptic ulcer disease or erosive peptic oesophagitis at full therapeutic dosage for longer than 8 weeks (dose reduction or earlier discontinuation indicated).
Side effects
For all proton pump inhibitors Common or very common Abdominal pain; constipation; diarrhoea; dizziness; dry mouth; gastrointestinal disorders; headache; insomnia; nausea; skin reactions; vomiting Uncommon Arthralgia; bone fractures; confusion; depression; drowsiness; leucopenia; malaise; myalgia; paraesthesia; peripheral oedema; thrombocytopenia; vertigo; vision disorders Rare or very rare Agranulocytosis; alopecia; gynaecomastia; hallucination; hepatic disorders; hyperhidrosis; hyponatraemia; nephritis tubulointerstitial; pancytopenia; photosensitivity reaction; severe cutaneous adverse reactions (SCARs); stomatitis; taste altered Frequency not known Gastrointestinal infection; hypomagnesaemia (more common after 1 year of treatment, but sometimes after 3 months of treatment); subacute cutaneous lupus erythematosus Side-effects For pantoprazole General side-effects: Uncommon Asthenia; gastrointestinal discomfort; sleep disorder Rare or very rare Angioedema; hyperlipidaemia; weight change Specific side-effects: Frequency not known With intravenous use Electrolyte imbalance; muscle spasms
Interactions
**Severe interactions:**
- HIV protease inhibitors Co-administration of pantoprazole is not recommended with HIV protease inhibitors for which absorption is dependent on acidic intragastric pH such as atazanavir due to...
- Interaction studies with medicinal products also metabolized with these pathways, like carbamazepine, diazepam, glibenclamide, nifedipine, and an oral contraceptive containing levonorgestrel and...
**Other interactions (14):**
- Medicinal products with pH-Dependent Absorption Pharmacokinetics Because of profound and long lasting inhibition of gastric acid secretion, pantoprazole may interfere with the absorption of...
- A pantoprazole dose of 20 mg per day should not be exceeded.
- Dosage of the HIV protease inhibitor may need to be adjusted Coumarin anticoagulants (phenprocoumon or warfarin) Co-administration of pantoprazole with warfarin or phenprocoumon did not affect the...
- However, there have been reports of increased INR and prothrombin time in patients receiving PPIs and warfarin or phenprocoumon concomitantly.
- Patients treated with pantoprazole and warfarin or phenprocoumon may need to be monitored for increase in INR and prothrombin time.
- Methotrexate Concomitant use of high dose methotrexate (e.g.
Pregnancy
Manufacturer advises avoid unless potential benefit outweighs risk-fetotoxic in animals .
Breast feeding
Specialist sources indicate amount in milk is small and not known to be harmful.
Hepatic impairment
Manufacturer advises caution in severe impairment (increased half-life)-monitor liver function and discontinue if deterioration. Dose adjustments Manufacturer advises maximum dose of 20 mg daily in severe impairment.
Renal impairment
Avoid in combination therapy for Helicobacter pylori eradication (no information available). M
Medicinal forms
Suspension,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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