Pantoprazole is a generic prescription drug, also known as pantoprazole sodium, available as delayed-release oral tablets. These tablets have a special coating that allows them to pass through your stomach without dissolving, helping them release the drug into your body at the right time. Pantoprazole is a proton pump inhibitor (PPI) used to treat conditions related to excess stomach acid. It is prescribed for short-term and long-term treatment of erosive esophagitis (esophagus damage from too much stomach acid) due to gastroesophageal reflux disease (GERD) in adults and children ages 5 years and older and to treat certain conditions that cause too much stomach acid, such as Zollinger-Ellison syndrome, in adults.
As with any medication, pantoprazole can cause side effects. Understanding these potential side effects is crucial for patients and healthcare providers. This article provides a detailed overview of the side effects associated with pantoprazole, including common, mild, and serious side effects, as well as its potential impact on weight. It also addresses frequently asked questions and important considerations before starting pantoprazole treatment.
Common and Mild Side Effects of Pantoprazole
Pantoprazole can cause certain side effects, with some being more common than others. Many of these side effects are temporary, lasting from a few days to a few weeks. In studies of pantoprazole, the side effects that people reported were unrelated to the strength they took. Examples of common and mild side effects reported in studies include:
- Abdominal (stomach) pain
- Diarrhea
- Headache
- Nausea
- Vomiting
- Flatulence (gas)
- Dizziness
- Constipation
- Joint pain
These side effects are usually mild and manageable. However, if any of these symptoms persist, worsen, or become bothersome, it is important to consult a doctor or pharmacist.
Serious Side Effects of Pantoprazole
While serious side effects are not common, they can occur with pantoprazole use. It's important to be aware of these potential risks and seek immediate medical attention if they develop. Serious side effects that have been reported include:
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Acute nephritis: This is a sudden inflammation of the kidneys. Symptoms may include a change in the frequency or amount of urine, blood in the urine, fever, nausea, and swelling in the body.
Increased risk of osteoporosis-related broken bones: Long-term use of pantoprazole may increase the risk of fractures in the hip, spine, or wrist, especially in older adults or those with existing osteoporosis.
Low levels of magnesium: Pantoprazole can cause hypomagnesemia (low magnesium in the blood), especially with long-term use or when taken with certain medications like digoxin or diuretics. Symptoms may include convulsions, muscle spasms, tremors, and an irregular heartbeat.
Low levels of vitamin B12: Long-term use of pantoprazole may interfere with the absorption of vitamin B12.
Lupus: Pantoprazole may cause or worsen lupus, an autoimmune condition. Symptoms may include joint pain or a skin rash on the cheeks or arms that worsens with sun exposure.
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Polyps in the lining of the upper part of the stomach: Long-term use of pantoprazole may increase the risk of fundic gland polyps.
Severe diarrhea caused by Clostridium difficile (C. difficile): This is a severe diarrhea caused by an infection called Clostridioides difficile.
Severe skin reactions: These may include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis, and drug reaction with eosinophilia and systemic symptoms (DRESS). Symptoms can include blistering, peeling skin, fever, and swollen glands.
Allergic reaction: Although not common, pantoprazole can cause an allergic reaction. Symptoms of a severe allergic reaction can include swelling or trouble breathing, call 911 or your local emergency number right away.
Pantoprazole and Weight Changes
Weight gain and weight loss are not commonly reported side effects of pantoprazole in clinical trials. However, some people have reported weight changes after the drug was approved for use.
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A study evaluated 52 adult patients with GERD and 58 healthy controls. Patients with GERD were treated with PPI for a mean of 2.2 years (range, 0.8-5.7 years), and also advised on lifestyle modifications (e.g. selective diet, weight management). The study demonstrated for the first time that long-term PPI treatment is associated with undesirable body weight gain in patients with GERD, despite lifestyle modification recommendations by their physicians.
It's important to note that conditions pantoprazole treats, such as GERD, can also influence weight. Untreated patients suffering from reflux symptoms find it difficult to have large meals, because this generally aggravates their symptoms. Untreated patients may therefore reduce their meal sizes and intake of fats intentionally or unintentionally.
If you experience bothersome weight changes while taking pantoprazole, talk with your doctor. They can help determine what’s causing the weight change and how to manage it.
Managing Common Side Effects
Several strategies can help manage the common side effects associated with pantoprazole:
Nausea: Taking the medication with food may decrease nausea. Your doctor may also be able to recommend other ways to ease nausea. Call your doctor right away if nausea prevents you from being able to drink liquids. This can be a sign of dehydration. Severe dehydration can lead to serious conditions such as kidney failure.
Headache: Steps you can take to manage symptoms associated with this side effect include: drink plenty of water to stay hydrated, try a ‘headache diet‘, apply a cold or warm compress (whichever feels better to you) and take a pain reliever, such as acetaminophen (Tylenol).
Abdominal (stomach) pain: If you have stomach pain during your pantoprazole treatment, tell your doctor. They can help determine the cause and suggest how to manage it. But if you have stomach pain that’s severe or doesn’t go away, seek medical care right away.
Joint pain: If you have joint pain while you’re taking pantoprazole, talk with your doctor. They may offer ways to help treat your joint pain. For example, they may recommend using a heating pad or taking an OTC medication, such as acetaminophen.
Other Considerations Before Taking Pantoprazole
Before starting pantoprazole, it is essential to discuss your health history with your doctor. Pantoprazole may not be right for you if you have certain medical conditions or other factors affecting your health. Be sure to talk with your doctor if any of the following apply to you:
Low magnesium levels: Pantoprazole can cause low levels of magnesium. If you already have this condition, taking pantoprazole could worsen it. Your doctor may want to check your levels and treat your condition before starting pantoprazole.
Lupus: Pantoprazole may cause lupus in some people. If you already have this condition, pantoprazole could make it worse.
Neuroendocrine tumors: If you have a neuroendocrine tumor, talk with your doctor before taking pantoprazole. This medication can cause inaccurate results on tests for neuroendocrine tumors.
Osteoporosis: Pantoprazole can increase the risk of osteoporosis-related broken bones in the hips, spine, or wrists if used long term. If you have osteoporosis, your risk of broken bones is already higher.
Stomach cancer: Stomach cancer can cause symptoms similar to GERD and other conditions that pantoprazole treats. Your doctor may order testing for stomach cancer even if pantoprazole seems to help your symptoms.
Allergic reaction: If you’ve had an allergic reaction to pantoprazole or any of its ingredients, your doctor will likely not prescribe it.
Pregnancy and breastfeeding: It is unknown if pantoprazole is safe to take during pregnancy. Pantoprazole can pass into human breast milk. But it is unknown whether the drug may affect a child who is breastfed.
Interactions with Other Medications
Pantoprazole can interact with several types of drugs, including:
- Medicines containing rilpivirine (eg, Complera®, Edurant®, Odefsey®).
- Iron supplements
- Thiazide diuretics
- Certain HIV drugs
- Certain cancer drugs
- Certain immunosuppressant drugs
- Certain antifungal drugs
- The blood thinner drug warfarin
- The antiplatelet drug clopidogrel
- The heart failure drug digoxin
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.
Pantoprazole Dosage and Administration
Pantoprazole comes as oral tablets that you’ll take by mouth. They come in the following strengths: 20 milligrams (mg) and 40 mg. The usual dosage of pantoprazole varies, depending on the reason you’re taking the drug. You’ll take pantoprazole oral tablets either once or twice per day.
You can take pantoprazole with food or without it. You should swallow the tablets whole and should not chew, crush, or split pantoprazole tablets.
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