Protonix (pantoprazole) is a proton pump inhibitor that decreases the amount of acid produced in the stomach.
Protonix is used to treat erosive esophagitis (damage to the esophagus from stomach acid), and other conditions involving excess stomach acid such as Zollinger-Ellison syndrome.
Protonix is not for immediate relief of heartburn symptoms.
Important information
You should not use Protonix if you are allergic to pantoprazole or to any other benzimidazole medication such as albendazole (Albenza), or mebendazole (Vermox).
Protonix is not for immediate relief of heartburn symptoms.
Heartburn is often confused with the first symptoms of a heart attack. Seek emergency medical attention if you have chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, and a general ill feeling.
Take Protonix for the full prescribed length of time. Your symptoms may improve before the condition is fully treated.
Protonix should not be taken together with atazanavir (Reyataz) or nelfinavir (Viracept). Tell your doctor if you are taking either of these medications to treat HIV or AIDS.
Some conditions must be treated long-term with Protonix. Chronic use has caused stomach cancer in animal studies, but it is not known if this medication would have the same effects in humans. Talk with your doctor about your specific risk of developing stomach cancer.
Long-term treatment with Protonix may also make it harder for your body to absorb vitamin B-12, resulting in a deficiency of this vitamin. Talk with your doctor if you need long-term Protonix treatment and you have concerns about vitamin B-12 deficiency.
Before taking this medicine
Heartburn is often confused with the first symptoms of a heart attack. Seek emergency medical attention if you have chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, and a general ill feeling.
You should not use Protonix if you are allergic to pantoprazole or to similar medicines such as lansoprazole (Prevacid), esomeprazole (Nexium), omeprazole (Prilosec, Zegerid), or rabeprazole (AcipHex).
To make sure Protonix is safe for you, tell your doctor if you have:
Taking a proton pump inhibitor such as pantoprazole may increase your risk of bone fracture in the hip, wrist, or spine. This effect has occurred mostly in people who have taken the medicine long term or at high doses, and in those who are age 50 and older. It is not clear whether Protonix is the actual cause of an increased risk of fracture.
Protonix is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
Pantoprazole can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.
Protonix is not approved for use by anyone younger than 5 years old.
How should I take Protonix?
Take Protonix exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.
Protonix tablets can be taken with or without food. Protonix oral granules should be taken 30 minutes before a meal.
Do not crush, chew, or break the tablet. Swallow it whole.
The oral granules should be mixed with applesauce or apple juice. Do not use any other type of liquid or soft food. Sprinkle the granules directly onto 1 teaspoon of applesauce or apple juice. Stir for 5 seconds and swallow this mixture right away without chewing. Do not save the mixture for later use.
To give Protonix granules through a nasogastric (NG) feeding tube:
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Attach a 60-milliliter syringe to the NG tube and remove the plunger. Hold the syringe high enough to prevent any bends in the tube.
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Empty the Protonix granules into the syringe barrel and mix in 2 teaspoons of apple juice.
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Add 2 more teaspoons of apple juice to the syringe to rinse the granules through. Tap or shake the syringe as the juice empties into the tube.
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Rinse with 2 teaspoons of apple juice at least twice more to make sure there are no granules remaining in the syringe or NG tube.
Take Protonix for the full prescribed length of time. Your symptoms may improve before the condition is fully treated.
If you use Protonix for longer than 3 years, you could develop a vitamin B-12 deficiency. Talk to your doctor about how to manage this condition if you develop it.
Call your doctor if your symptoms do not improve or if they get worse while you are taking this medicine.
If you use Protonix for longer than 3 years, you could develop a vitamin B-12 deficiency. Talk to your doctor about how to manage this condition if you develop it.
This medicine can cause you to have a false positive drug screening test. If you provide a urine sample for drug screening, tell the laboratory staff that you are taking Protonix.
Store Protonix at room temperature away from moisture and heat.
Protonix dosing information
Usual Adult Dose for Erosive Esophagitis:
Treatment of Erosive Esophagitis:
40 mg orally once a day for up to 8 weeks; however an additional 8 weeks may be considered for patients who have not healed after the initial treatment. Safety and efficacy beyond 16 weeks of therapy have not been established.
Maintenance of Healing of Erosive Esophagitis:
40 mg orally once a day. Controlled studies have been limited to 12 months of Protonix therapy.
Usual Adult Dose for Gastroesophageal Reflux Disease:
Parenteral: 40 mg once a day for 7 to 10 days, administered via intravenous infusion over a period of 15 minutes. Intravenous therapy should be discontinued as soon as the patient is able to resume oral therapy.
Oral: 40 mg orally once a day, for short-term administration (up to 8 weeks); however an additional 8 weeks may be considered for patients who have not healed after the initial treatment. Safety and efficacy beyond 16 weeks of therapy have not been established.
Usual Adult Dose for Duodenal Ulcer:
Study (n=54)
40 mg orally once a day, dose was increased every 12 weeks by 40 mg increments to a maximum of 120 mg per day, for 28 weeks. Data have revealed that monotherapy with daily doses of 40 mg have been associated with complete duodenal ulcer healing in up to 87% and 94% of patients after 4 weeks and 8 weeks respectively.
Usual Adult Dose for Gastric Ulcer:
40 mg orally once a day. Data have revealed that monotherapy with daily doses of 40 mg have been associated with complete gastric ulcer healing in up to 87% and 97% of patients after 4 weeks and 8 weeks respectively.
Usual Adult Dose for Helicobacter pylori Infection:
Study (n=242) - Triple therapy:
40 mg orally twice daily for 7 days, commonly in conjunction with clarithromycin and either amoxicillin or metronidazole to eradicate Helicobacter pylori, followed with 40 mg Protonix orally once daily until day 28. Triple therapy has resulted in eradication rates of greater than 95%.
The QUADRATE Study (n=405) - Quadruple therapy:
40 mg orally twice daily for 7 days, concomitantly with bismuth subcitrate and tetracycline, both four times daily, and metronidazole 200 mg three times daily and 400 mg at bedtime. Helicobacter Pylori eradication was achieved in 82% of patients.
Usual Adult Dose for Zollinger-Ellison Syndrome:
Parenteral: 80 mg every 12 hours, administered by 15-minute infusion. Daily doses higher than 240 mg administered in equally divided doses by 15-minute infusion, or administered for more than 6 days have not been studied.
Oral: 40 mg twice daily, to a maximum of 240 mg per day. Some patients have received treatment with Protonix for more than 2 years.
Usual Adult Dose for Stress Ulcer Prophylaxis:
Study (n=21) - Stress Ulcer bleeding prophylaxis in the Critical Care Setting:
80 mg twice daily, as a bolus infusion over a period of 15 minutes, to a maximum daily dose of 240 mg, divided into three equal doses.
Study (n=20 ) - Peptic Ulcer rebleeding prophylaxis after hemostasis in the Critical Care Setting:
80 mg IV bolus, followed by continuous infusion of 8 mg/hr for 3 days, after which therapy may be continued with an oral PPI.
Usual Adult Dose for Peptic Ulcer:
Study (n=21) - Stress Ulcer bleeding prophylaxis in the Critical Care Setting:
80 mg twice daily, as a bolus infusion over a period of 15 minutes, to a maximum daily dose of 240 mg, divided into three equal doses.
Study (n=20 ) - Peptic Ulcer rebleeding prophylaxis after hemostasis in the Critical Care Setting:
80 mg IV bolus, followed by continuous infusion of 8 mg/hr for 3 days, after which therapy may be continued with an oral PPI.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking Protonix?
This medicine can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.
Protonix side effects
Get emergency medical help if you have signs of an allergic reaction to Protonix: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
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severe stomach pain, nausea, vomiting, and weight loss;
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diarrhea that is watery or bloody;
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seizure (convulsions);
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kidney problems - urinating more or less than usual, blood in your urine, swelling, rapid weight gain; or
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symptoms of low magnesium - dizziness, confusion; fast or uneven heart rate; tremors (shaking) or jerking muscle movements; feeling jittery;muscle cramps, muscle spasms in your hands and feet; cough or choking feeling.
Common Protonix side effects may include:
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headache;
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fever;
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cold symptoms such as stuffy nose, sneezing, sore throat;
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stomach pain, gas, nausea, vomiting;
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mild diarrhea; or
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joint pain.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
See also: Side effects (in more detail)
What other drugs will affect Protonix?
Tell your doctor about all medicines you use, and those you start or stop using during your treatment with Protonix, especially:
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ampicillin;
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ketoconazole;
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methotrexate;
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mycophenolate mofetil;
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warfarin (Coumadin, Jantoven);
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HIV or AIDS medicine - atazanavir, nelfinavir; or
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iron-containing medicines - ferrous fumarate, ferrous gluconate, ferrous sulfate, and others.
This list is not complete. Other drugs may interact with pantoprazole, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
