Protonix (Pantoprazole)
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Pantoprazole (Pantoprazole Sodium)
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Protonix (Pantoprazole)

What is Protonix (Pantoprazole)?

Protonix (pantoprazole) is a prescription proton pump inhibitor (PPI) medication that decreases the amount of acid produced by a patient’s stomach to aid in the treatment of certain medical conditions, such as gastroesophageal reflux disease (GERD) and Zollinger-Ellison syndrome. Its primary function is to suppress acid production and allow a patient’s esophagus to heal from any damage attributed to excess stomach acid production.

How is Protonix Used?

Protonix is available in the form of delayed-release tablets as well as delayed-release granules that are used for preparing an oral suspension version of this medication.

The strength of the medication necessary for treatment will be determined by your prescribing physician, and most patients will take this medication orally, once or twice per day. Protonix should be taken exactly as prescribed by the patient’s doctor regarding the specific condition it has been prescribed to treat.

For patients requiring treatment with the delayed-release granules, the dosage packets should never be split into smaller doses, and this form of Protonix should only be mixed with apple juice or applesauce to reconstitute the suspension due to the pH levels needing to be balanced by this specific combination of medication and acidic juices. Do not use water, other foods, or other liquids to mix the granules to create the oral suspension.

The delayed-release granules may be used for patients unable to swallow the tablets or for those with a nasogastric or gastrostomy tube in place. Patients with either of these tubes in place should only be given the Protonix suspension if their tube size is 16 French or any size larger.

Protonix typically begins to reduce the symptoms of excessive acid production within just a few hours after it has been administered.

Storage

Protonix should be stored at temperatures between 68°F (20°C) and 77°F (25°C). Temporary exposure to temperatures at a low point of 59°F (15°C) and a high point of 86°F (30°C) are permitted, but exposures to such temperatures should not be prolonged.

Keep this medication out of the reach of children and pets at all times.

Do not dispose of this medication in your household trash nor by flushing it or pouring it down the sink within your home. Please contact your local pharmacy or waste disposal company for advice regarding safe and proper disposal practices if your medication has expired or is no longer needed.

Uses

Protonix is prescribed for the treatment of erosive esophagitis attributed to the production of excess amounts of stomach acid, primarily caused by gastroesophageal reflux disease (GERD). It is generally prescribed for a treatment period of up to eight weeks in patients five years and older, including both children and adults.

If symptoms of erosive esophagitis in adults do not improve after the first eight weeks of treatment with Protonix, they may be recommended an additional eight weeks of treatment with the medication. The safety of this additional eight weeks of treatment has not been studied in pediatric patients.

Protonix may also be used long-term for the treatment of Zollinger-Ellison syndrome, a pathological hypersecretory condition resulting in the production of too much gastric acid that can cause serious symptoms and complications if left untreated.

Some physicians may prescribe Protonix as part of a treatment plan for patients who have duodenal or peptic (stomach) ulcers as well.

How Does Protonix Work?

Proton-pump inhibitors (PPIs), such as Protonix, work to decrease the amount of acid in one’s stomach by blocking the enzyme within the wall of the stomach that contributes to acid production. Patients taking this medication will experience a reduction of stomach acid and alleviation of symptoms such as heartburn, indigestion, nausea, chest pain, and regurgitation of food or acid.

Reducing the amount of acid within the stomach allows a patient’s esophagus to heal during the treatment period in which Protonix is being used. This same method of treatment applies to those with peptic or duodenal ulcers that may be prescribed this medication.

Dosage

The most commonly prescribed form of this medication is the delayed-released tablet form which comes in two strengths:

  • 20 mg
  • 40 mg

Protonix is also available in delayed-release granules for the purposes of reconstitution into an oral suspension, and this form of the medication contains 40 mg of pantoprazole per packet of granules.

There is also a 40 mg injection of Protonix available as well.

The appropriate dosage size and frequency of taking this medication will be determined by the patient’s prescribing physician relating to the condition for which it has been prescribed.

Overdose

If a patient has overdosed or taken too much Protonix, they should contact their local Poison Control Center or seek emergency medical assistance right away. Overexposure to this medication can result in a significant increase in the risk of experiencing adverse side effects. Patients or other individuals who have taken too much of this medication should be aware that hemodialysis has no effect on removing Protonix from the body, so treatment for significant cases of overdosing primarily focuses on alleviating the symptoms of having too much of this medication being present within the body.

Side Effects

Although Protonix is generally well-tolerated, it is known to cause side effects in many individuals taking the medication.

The most common side effects of taking Protonix are as follows:

  • constipation
  • diarrhea
  • dizziness
  • flatulence (gas)
  • headache
  • joint pain
  • nausea
  • rash
  • sensitivity to sunlight
  • stomach discomfort
  • upper respiratory tract infection
  • vomiting

The following side effects are considered rare but may still occur. These should be discussed with your doctor if they arise:

  • abnormal heartbeat
  • leg cramps
  • muscle pain
  • muscle weakness
  • nervousness or anxiety
  • water retention

Please contact your doctor for further information if you experience any of the following additional serious side effects while taking Protonix:

  • liver damage
  • an increase in osteoporosis-related fractures
  • pancreatitis
  • reduced levels of blood cells
  • rhabdomyolysis (breakdown of muscle)

Long-term use of proton-pump inhibitors, such as Protonix, has also been linked to patients having an increased risk of myocardial infarctions (heart attacks). If a patient already has preexisting heart conditions or is at risk of heart-related health concerns due to a family history of such conditions or other relevant factors, this should be discussed with their prescribing physician before remaining on Protonix for long-term treatment purposes.

Long-term side effects of taking Protonix also include the following risks:

  • bacterial overgrowth of the small intestine
  • bone demineralization
  • calcium deficiency
  • diarrhea
  • diminished absorption of certain medications
  • interstitial nephritis
  • iron deficiency
  • magnesium deficiency
  • vitamin B12 deficiency

Warnings & Precautions

Individuals who are allergic to the medication known as rilpivirine or who are allergic to pantoprazole or any additional ingredients contained within Protonix should not take this medication. If a patient has shown symptoms of hypersensitivity to other similar proton-pump inhibitor medications, they are advised to avoid taking Protonix as well. Please consult your doctor for safer, alternative treatment options.

Elderly Patients

Due to the increased risk of fractures associated with osteoporosis (which may be worsened by taking Protonix), a decrease in the patient’s bone density, and an increased risk of Clostridium difficile infection, prolonged treatment with Protonix is not advised for those in this age group. Elderly patients are recommended to only receive the bare minimum number of weeks of treatment with Protonix to avoid these adverse side effects.

Lupus

Individuals with lupus may experience worsening of their symptoms when taking Protonix. If you have been diagnosed with this autoimmune disease, inform your doctor before beginning treatment with Protonix. Your doctor will be able to determine the safety and efficacy of Protonix for use alongside your preexisting diagnosis of lupus, or your doctor may also determine that an alternative treatment besides Protonix may be more suitable.

Low Magnesium Levels

Protonix is capable of lowering the magnesium levels within the bodies of those who take this medication. If a patient already has low magnesium or has any other health conditions that may be impacted by changes to their magnesium levels, they should notify their doctor before beginning this medication. Patients with preexisting low levels of magnesium may be monitored during their treatment with Protonix to ensure they are able to balance the effects of this medication.

Osteoporosis

If a patient has been diagnosed with osteoporosis or struggles with brittle or weak bones, they should inform their doctor of this condition before beginning treatment with Protonix. This medication is capable of causing broken bones in the wrists, spine, or hips of patients who have osteoporosis and have been prescribed Protonix. In most cases of patients with osteoporosis, Protonix is only recommended for short-term use to avoid the risks associated with the side effect of increased instances of broken bones.

Neuroendocrine Tumors

Neuroendocrine tumors are a rare type of tumor that grows in the vicinity of the pancreas. If a patient has been diagnosed with such a tumor or is at risk, they should be aware that taking Protonix may interfere with the test results of the lab tests required to detect this particular condition. Protonix has been shown to flag false-positive results on these specific lab tests, and most doctors will require the patient to stop taking Protonix for at least two weeks before performing these tests to ensure accurate results.

Pregnancy and Breastfeeding

It has not been determined if Protonix is safe for use in pregnant individuals. For those currently pregnant or planning to become pregnant, discuss the risks and benefits of this medication with your doctor before beginning treatment.

Protonix has been confirmed to be present in breast milk for breastfeeding parents who are taking the medication, but there are no definitive studies confirming the potential effects of this medication on a breastfed child. Discuss any concerns or potential health risks of passing this medication to your child via breast milk with your doctor.

Drug Screening

Protonix has been found to occasionally result in false-positive test results for patients taking this medication who may be required to have a urine drug screen performed. It has been documented to flag a false positive result for marijuana (cannabis) when certain types of drug tests are being used for screening.

Drug Interactions

Speak to your doctor about any medications or herbal supplements you are currently taking before beginning treatment with Protonix. Discuss any concerns you may have with your doctor or a trusted pharmacist.

The following medications are known to interact with Protonix:

  • CellCept (mycophenolate mofetil)
  • Edurant (rilpivirine)*
  • Invirase (saquinavir)
  • Jantoven (warfarin)
  • Ketaconazole
  • Lanoxin (digoxin)
  • Microzide (hydrochlorothiazide)
  • Plavix (clopidogrel)
  • Reyataz (atazanavir)
  • Sporanox (itraconazole)
  • Sprycel (dasatinib)
  • Tarceva (erlotinib)
  • Tasigna (nilotinib)
  • Trexall (methotrexate)
  • Viracept (nelfinavir)

Although the above-listed medications are those indicated to interact with Protonix, be sure to discuss with your doctor if you are taking any of the following types of medications that are associated with the list above:

  • antifungal medications
  • antiplatelet medications
  • blood thinners
  • cancer medications
  • heart failure medications
  • HIV medications
  • immunosuppressant medications
  • thiazide diuretics

Drugs That Should Not Be Used with Protonix

*The non-nucleoside reverse transcriptase inhibitor rilpivirine used in the treatment of human immunodeficiency virus (HIV) should not be used in conjunction with Protonix. Protonix has been shown to decrease the absorption of rilpivirine due to its ability to reduce the amount of acid within the stomach, i.e., the stomach acid that rilpivirine needs in order to be absorbed properly.

Supplements That May Interact with Protonix

The following supplements are also indicated to potentially cause interactions when used while taking Protonix:

  • iron supplements

Alternative Medications

For patients who are unable to take Protonix or are experiencing significant adverse side effects, alternative medications may be used to treat some of the associated conditions for which this medication is commonly prescribed:

  • dexlansoprazole (Dexilant)
  • esomeprazole (Nexium)
  • famotidine
  • lansoprazole (Prevacid)
  • omeprazole (Prilosec)
  • rabeprazole (Aciphex)

Frequently Asked Questions

If your doctor has instructed you to take Protonix twice a day, it is perfectly safe for some patients to do so. Do not take additional doses of Protonix unless specifically directed to take additional doses by your doctor.

Both weight loss and weight gain were reported in the initial studies involving Protonix. Some individuals experience an increase in their weight after beginning this medication due to the side effects such as water retention and bloating.

Higher doses of medications such as Protonix can contribute to C. difficile infection and diarrhea, causing patients taking high doses of this medication to have loose and/or frequent bowel movements.

For patients taking an eight-week course of treatment with Protonix, quitting the medication cold turkey typically does not have any adverse side effects or other concerns. Patients who have taken Protonix for a significantly longer period of time should consult with their prescribing physician about tapering off of the medication to manage the symptoms associated with stopping Protonix, such as a significant increase in stomach acid.

Patients should not lie down immediately after taking Protonix due to the need for the medication to travel all the way down the esophagus and into the stomach to properly break down and function. Lying down may cause the medication to not travel all the way down into the stomach. Please allow 30 to 60 minutes to pass after having taken your daily dose of Protonix before lying down.

It is safe to take Tums while taking Protonix. No interactions have been reported between the two.

If you begin taking Protonix and experience a reduction in GERD-related symptoms, this is evidence of the medication working properly. Often, Protonix will take two to three days to become effective, but some individuals have not experienced the full benefits of Protonix until nearly four weeks after beginning the medication.

Protonix effectively controls symptoms for 24 hours. Once the 24-hour mark has been reached, the proton pumps within the stomach have been replaced, and another dose becomes necessary.

Protonix has been shown to be safe and effective for both short-term and long-term use, thanks to its minimal amount of drug interactions and side effects. Long-term use of Protonix is generally well-tolerated without any complications associated with prolonged use.

Proton-pump inhibitors, the same category of medications as Protonix, have been shown in studies to cause a 44% increased risk of developing dementia in patients who remain on these medications for the long term.

The proper dosage for treatment should be determined by your physician. If you feel that taking this medication only every other day is beneficial in the treatment of your symptoms, discuss these concerns with your doctor to ensure this frequency of taking Protonix will be both safe and effective.

Protonix may be taken at any time during the day, but it is typically recommended to take this medication in the morning before breakfast. Regardless, Protonix should be taken at least 30 minutes before a meal for optimum results.

No interactions between probiotics and Protonix have been reported. Taking a probiotic while taking this medication may reduce some of the adverse effects associated with Protonix, but further research is required to determine the exact benefits of such a combination.

The active ingredient in this medication is pantoprazole sodium. The delayed-release tablets contain inactive ingredients such as crospovidone, calcium stearate, iron oxide, hypromellose, methacrylic acid copolymer, mannitol, povidone, polysorbate 80, sodium carbonate, propylene glycol, titanium dioxide, triethyl citrate, and sodium lauryl sulfate. The delayed-release oral suspension includes inactive ingredients such as hypromellose, crospovidone, microcrystalline cellulose, methacrylic acid copolymer, povidone, polysorbate 80, sodium lauryl sulfate, sodium carbonate, yellow ferric oxide, titanium dioxide, and triethyl citrate.

Protonix and other proton-pump inhibitor medications have been linked to changes within the gut microbiome as well as a decrease in the bacterial richness of the gut when used in higher dosages or for longer periods of time. These changes to the gut microbiome are why C. difficile infection is a potential risk of taking Protonix for those who remain on the medication for an extended period of time.

It is not required that patients take a probiotic when taking Protonix, but there are no indications of adverse effects with combining the two. Probiotics may assist in alleviating certain side effects caused by long-term or higher dosage use of Protonix due to promoting improved gut health and decreasing changes to the gut microbiome that may result in adverse digestive effects.

Yes. Protonix and other PPIs affect the absorption of magnesium in the stomach and have been proven to cause magnesium deficiency (hypomagnesemia).

There have been no reports of interactions occurring between vitamins or multivitamins and Protonix. However, patients should be aware that Protonix may interfere with iron absorption. If a patient has anemia or is iron-deficient, they should discuss this with their doctor in relation to the impact that treatment with Protonix may have on the treatment of the iron-related conditions.

Although there have been no documented interactions between pantoprazole and alcohol consumption, patients should be aware that alcohol can worsen the symptoms of gastroesophageal reflux disease (GERD). Due to this, drinking alcohol while taking Protonix may result in the medication being less effective.