PantoprazolePantoprazole Sodium

About Pantoprazole

Pantoprazole blocks the proton pump, the enzyme that acid-producing cells in the stomach lining use to release acid. The label approves it for short-term treatment (up to eight weeks) of erosive esophagitis from reflux disease in adults and children 5 and older, for maintaining healing of erosive esophagitis in adults, and for long-term treatment of conditions with too much acid, including Zollinger-Ellison syndrome. Adults take 40 mg once a day, and a second eight-week course may be considered if healing is incomplete; Zollinger-Ellison syndrome starts at 40 mg twice a day. Children 5 and older take 20 mg (15 to under 40 kg) or 40 mg (40 kg or more). Effectiveness for erosive esophagitis has not been shown under age 1, and because a trial in infants found it ineffective for reflux symptoms, it is not indicated for that use.

There is no boxed warning. Pantoprazole must not be taken by anyone allergic to it or to other substituted benzimidazoles, or with rilpivirine, an HIV medicine. Relief of symptoms does not rule out stomach cancer. The label warns of acute kidney inflammation (tubulointerstitial nephritis); C. difficile diarrhea, especially in hospitalized patients; hip, wrist and spine fractures with high doses (several a day) and long-term use (a year or longer); severe skin reactions; new or worsening lupus; vitamin B12 deficiency after daily acid suppression over a long time (for example, longer than three years); low magnesium, reported rarely, which can cause muscle spasms, abnormal heart rhythms and seizures; and fundic gland polyps with long-term use. Headache, diarrhea, nausea, abdominal pain, vomiting, gas, dizziness and joint pain are the most common side effects in adults.

The label notes false-positive urine screens for THC (the active ingredient in marijuana) in people taking proton pump inhibitors, so a positive result may need a confirmatory test, and says to stop pantoprazole at least 14 days before a chromogranin A blood test. In healthy volunteers it had no clinically important effect on clopidogrel’s activity, and the label says no clopidogrel dose change is needed. Observational studies have not linked it to major birth defects. The granules come only as a 40 mg packet, which is not divided. An intravenous form (Protonix I.V. and generics) is given in hospitals.

Taking Pantoprazole

How to take it

Swallow tablets whole, with or without food, without splitting, chewing or crushing them; someone who cannot swallow a 40 mg tablet may take two 20 mg tablets. Take granules about 30 minutes before a meal, never chewed and never mixed with any other food or liquid: sprinkle them on one teaspoon of applesauce and swallow within 10 minutes, followed by sips of water, or stir them into one teaspoon of apple juice and swallow at once.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose. Never take two doses at once.

Storage

At room temperature in the original, tightly closed container, away from excess heat and moisture (not in the bathroom), out of reach of children.

Interactions to know about

Never with rilpivirine, and avoid nelfinavir; it lowers levels of atazanavir and of other drugs that need stomach acid, such as iron salts, erlotinib, dasatinib, nilotinib, ketoconazole, itraconazole and mycophenolate. Warfarin users need INR checks, and with high-dose methotrexate the prescriber may pause pantoprazole.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Pantoprazole differs from pharmacy to pharmacy

Generic pantoprazole tablets come from many makers and are rated equivalent to Protonix, so quotes for the same strength differ mainly by each pharmacy’s fee and markup and by whether pantoprazole is on its flat-price generic list. A prescription that names Protonix and blocks substitution must be filled with the brand and is priced as a brand.

The granules have fewer makers and are quoted per 40 mg packet, separately from the tablets; a pharmacist fills the form written.

Ways to pay less for Pantoprazole without insurance

• Ask for generic pantoprazole tablets, and check that the prescription does not block substitution.
• Once your dose is settled, ask for a ninety-day supply, and ask the prescriber at each review whether you still need it.
• If granules were prescribed and you can swallow tablets whole, ask the prescriber whether tablets would suit you.
• Ask whether pantoprazole is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Pantoprazole

1. 1.Can my prescription be filled with a generic, and is it written to allow that?
2. 2.Is it safe with my HIV medicine, warfarin or methotrexate?
3. 3.How long should I take it, and when should my need for it be reviewed?
4. 4.Should my magnesium or vitamin B12 be checked while I take it?

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