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Pantoprazole Side Effects & Adverse Reactions (List)

Pantoprazole is a medication prescribed to treat: erosive esophagitis associated with GERD (gastroesophageal reflux disease); gastric acid hypersecretory conditions like Zollinger-Ellison syndrome; and gastric ulceration induced by Helicobacter pylori infection.  The medication was originally synthesized in 1985 and received FDA approval in 2000 throughout the United States under the brand name “Protonix.”

Research indicates that, when pantoprazole is ingested, it interacts with parietal cells located inside of gastric glands to inhibit activation of H+/K+ (hydrogen/potassium) ATPase, an enzyme implicated in acidifying the stomach.  More specifically, pantoprazole covalently binds to the H+/K+ ATP pump whereby it suppresses secretion of gastric and basal acid for 24 hours (or more) following administration – hence its classification as a “proton pump inhibitor.”

Although many individuals with gastrointestinal dysfunction derive therapeutic benefit from the ability of pantoprazole to inhibit acid secretion, the medication can cause side effects, some of which may be unpleasant.  If you’re using pantoprazole, it is important to be informed of potential side effects and adverse reactions that could occur.

Pantoprazole Side Effects (Most Common)

Included below is a list of side effects associated with pantoprazole that you might experience throughout treatment.  It is important to underscore the fact that, although certain side effects of pantoprazole may be more common than others, the specific side effects experienced – as well as the severities of those side effects – will be subject to significant interindividual variation among users.  In other words, the side effects that you end up with from pantoprazole treatment might be much different than those reported by other users.

Although side effects will vary among pantoprazole users, research suggests that certain side effects are more common than others.  According to clinical research, the most common side effects of pantoprazole include: headache, diarrhea, nausea, abdominal pain, flatulence, vomiting dizziness, and joint pain.  If, at any point throughout pantoprazole treatment you have a question or concern regarding a side effect, it is recommended to consult a medical doctor.

Headache: The most common of all side effects associated with pantoprazole is headache.  Clinical trial data indicate that approximately 12.2% of all users will experience headache during treatment.  In most cases, the headache will not be severe enough to warrant discontinuation of the medication.  If you experience headache, verify that you’re drinking enough water (and aren’t dehydrated) and eating a balanced, nutritious diet.

Because long-term pantoprazole therapy can sometimes interfere with the absorption of vitamins and minerals, it’s possible that the side effect of headache is explained by a vitamin deficiency – particularly in vitamin B12, vitamin C, calcium, iron, and magnesium.  Correcting vitamin and mineral deficiencies might help alleviate headaches as a side effect.

Diarrhea: The second most common side effect associated with pantoprazole is diarrhea.  Because the medication decreases acidification of the stomach, the absorption and digestion of food changes.  As a result of altered absorption and digestion of food, it is estimated that 8.8% of pantoprazole users will experience diarrhea – or frequent discharge of bowels, possibly in a loose or liquid form.

Because pantoprazole increases risk of the bacterial infection Clostridium difficile (C. diff), and this particular infection induces diarrhea, it is recommended to get tested for Clostridium difficile associated diarrhea (CDAD) throughout treatment.  If you become infected with Clostridium difficile while taking pantoprazole, then treating the infection may help reverse your diarrhea.

If you don’t have Clostridium difficile, yet are experiencing frequent diarrhea, discuss this reaction with your doctor.  Getting diarrhea under control during treatment is advisable due to the fact that diarrhea can interfere with vitamin and mineral absorption, as well as cause dehydration.

Nausea: Nausea, or feeling as though you’re on the verge of vomiting, is a side effect that occurs in around 7% of pantoprazole users.  Nausea generally occurs as a side effect of pantoprazole due to the fact that the medication suppresses acid production within the gastrointestinal tract.  Decreased acidification of the gastrointestinal tract alters gastric function and corresponding digestion of food, possibly leading to nausea.

For a subset of pantoprazole users, nausea may be a transient side effect that emerges in the early stages of treatment, but subsides with longer-term use – as the body adapts to the medication.  That said, other individuals may experience frequent bouts of nausea as a long-term complication of pantoprazole administration.  If the nausea becomes severe enough to induce vomiting and/or interferes with your ability to function – report this to a medical doctor.

Stomach pain: In clinical trials of adults diagnosed with gastroesophageal reflux disease (GERD), stomach pain was reported in approximately 6.2% of pantoprazole users as a side effect.  Stomach pain among pantoprazole users is most frequently documented as occurring within the abdominal region.  If you’re experiencing stomach aches or abdominal pain while using pantoprazole, understand that this is the fourth most common side effect of the medication.

In some cases, stomach pain may be accompanied by other side effects such as diarrhea, nausea, vomiting, and/or burping.  That said, if you develop intense stomach pain accompanied by diarrhea and/or fever while using pantoprazole, it could be a sign of Clostridium difficile infection.  Because pantoprazole increases risk of Clostridium difficile infection, it is recommended to have your doctor rule out infection if you experience abdominal pain or intense stomach aches.

Vomiting: Although nausea is a common side effect of pantoprazole, vomiting is less common.  In clinical trials of pantoprazole (20 mg or 40 mg), vomiting occurred in 4.3% of recipients.  In the event that you experience vomiting at any point during treatment, report it to your doctor as soon as possible – vomiting could be the sign of a serious adverse reaction.

For certain individuals, vomiting may be a transient side effect that occurs intermittently in the first couple weeks of pantoprazole use and subsides thereafter.  Moreover, vomiting is generally preceded by nausea and may be accompanied by stomach pain.  If you end up vomiting while taking pantoprazole, understand that this could cause dehydration and/or interfere with food absorption (possibly leading to vitamin and mineral deficiencies).

Gas (flatulence): Yet another side effect associated with pantoprazole is increased gassiness or flatulence.  If you notice frequent urges to pass gas, or gas buildup throughout your stomach – know that this might be attributable to pantoprazole.  Reports from pantoprazole trials indicate that around 3.9% of users experienced flatulence as a side effect.

Some individuals may experience bloating, stomach pain, and possibly even diarrhea along with flatulence.  Staying adequately hydrated and adjusting your diet, specifically avoiding foods that cause you to pass gas might prove helpful in reducing gassiness while undergoing treatment.

Dizziness:  Reports suggest that around 3% of individuals using pantoprazole will experience dizziness as a side effect.  It is unknown as to whether the reaction of dizziness is directly caused by the medication – or an indirect downstream reaction stemming from another more common side effect like diarrhea or vomiting.

If you experience diarrhea or vomiting as side effects, this could cause dehydration, electrolyte imbalances, and/or vitamin deficiencies – each of which might result in dizziness.  If you end up losing weight while taking pantoprazole, dizziness could be due to rapid weight loss or malnourishment.

Joint pain: Around 2.8% of persons taking pantoprazole will end up with arthralgia or joint pain as a side effect.  If you have a history of joint pain or a medical condition that causes joint pain (e.g. arthritis), your preexisting joint pain may worsen from pantoprazole.  For some individuals, things like: gentle massage and/or a warm bath may help alleviate some of the pantoprazole-induced joint pain.

In most cases, joint pain as a side effect of pantoprazole will be of mild intensity and/or intermittent (such that it won’t occur nonstop).  If joint pain becomes severe and natural interventions such as massage and warm baths don’t seem to help, you may need to ask your doctor for a medication that can be used with pantoprazole to counteract the increased joint pain.

Fatigue & drowsiness: Pantoprazole may cause fatigue and/or drowsiness as side effects in a subset of users.  If you’re a new pantoprazole user and are experiencing fatigue or drowsiness, understand that this could be a transient reaction that dissipates with continued longer-term pantoprazole administration.  Fatigue and drowsiness might impair motor function such that you may exhibit delayed reaction, compromised mental acuity, and/or suboptimal coordination – all of which could increase your risk of accidents.

For the sake of safety, it is recommended to abstain from operating heavy machinery and/or motor vehicles if you experience fatigue and/or drowsiness as side effects.  In the event that fatigue and/or drowsiness become severe and/or interfere with your occupational performance, productivity, and/or lifestyle – discuss them with a doctor.  There may be adjunct interventions that could help increase your alertness and energy.

Weight change: Although weight change wasn’t documented in clinical trials of pantoprazole, many users claim that ongoing treatment causes weight loss or weight gain.  Weight loss as a side effect may be a downstream byproduct of other relatively common side effects such as: diarrhea, nausea, and vomiting.  If you’re experiencing diarrhea or vomiting, your body may not be absorbing as many calories as it was prior to taking pantoprazole – ultimately causing reduced body weight.

Furthermore, both diarrhea and vomiting can dehydrate the body, leading to loss of water weight.  The side effects of diarrhea, nausea, and/or vomiting can also impair appetite, which may result in a pantoprazole user consuming less food and losing weight from reduced caloric intake.  On the other hand, weight gain from pantoprazole might occur as a result of a severe adverse reaction (e.g. acute interstitial nephritis) or less common side effects such as bloating, edema, and constipation.

Burping: A fairly common symptom of GERD (gastroesophageal reflux disease) is frequent burping or belching, along with heartburn.  It is thought that frequent burping among persons with GERD is due to stomach acid rising in the gastrointestinal tract, as well as increased gas production.  In most cases, treating GERD with a medication like pantoprazole should decrease the frequency of burping and/or belching.

However, some individuals report that burping can occur as a side effect of the medication.  If you’re taking pantoprazole and notice that you’re burping more than you were before taking it, discuss this with your doctor – it could be a sign that the medication is not fully managing your symptoms.  That said, burping might also occur as a side effect due to pantoprazole-mediated changes in the digestion of food and/or increased gas production.

Bloating: Pantoprazole treatment may cause bloating as a side effect such that some users may report feeling swollen with fluid and/or gas.  If you experience severe bloating such that various parts of your body (e.g. face) become noticeably swollen while using pantoprazole, understand that this could be the sign of a serious adverse reaction.  That said, most bloating from the medication won’t be associated with a severe reaction – and will probably be caused by altered gastrointestinal activity, leading to gas and fluid accumulation.

For some individuals, bloating may account for a modest amount of water weight gain during treatment.  To counteract the bloating, it is recommended to drink plenty of water and avoid consuming excessive calories.  In any regard, most persons using pantoprazole are probably willing to put up with bloating as long as the medication is alleviating their gastric symptoms.

Insomnia: A small percentage of pantoprazole users may report experiencing insomnia as a side effect of treatment.  Individuals with preexisting neuropsychiatric disorders such as: anxiety and/or depression may be at increased risk of developing insomnia as a side effect compared to those without neuropsychiatric disorders.  In some cases, insomnia while using pantoprazole could be due to: changes in gut bacteria or the occurrence of late-night gastrointestinal side effects (e.g. rumbling stomach, diarrhea, etc.).

If you develop insomnia along with other neuropsychiatric symptoms such as anxiety, agitation, and restlessness while using pantoprazole – report this reaction to a medical doctor as soon as possible.  Psychiatric reactions to pantoprazole are considered rare but can occur.  Most individuals who develop insomnia specifically from pantoprazole will probably want to discontinue pantoprazole and transition to another medication.

Injection site reactions: If you receive an injectable format of pantoprazole such as “Protonix IV,” you might end up with injection site reactions.  Common injection site reactions include: redness, pain, swelling, itchiness, and/or discoloration around the specific site of injection.  In most cases, skin reactions resulting from a pantoprazole injection will gradually transition back to pre-injection appearance within several days or weeks (depending on the severity).

If an injection site reaction continues to worsen in appearance, seek emergency medical attention to rule out an infection.  Assuming the site at which you administer pantoprazole isn’t infected, you may want to ask your doctor for tips as to how you can prevent future injection site reactions – or at least minimize the severities of those reactions.  Moreover, if you dislike the injectable format of pantoprazole, ask your doctor about the oral version.

Pantoprazole Adverse Effects & Reactions (List)

Included below is a list of relatively uncommon or rare adverse reactions to pantoprazole treatment.  These are reactions that occur in a very small subset of pantoprazole users (less than 2%).  Because many of these adverse effects are considered serious and/or potentially life-threatening, anyone who experiences these reactions should seek emergency medical attention.

Before using pantoprazole, it’s probably a good idea to have a general understanding of adverse reactions that might occur.  This way if an adverse reaction occurs, you may be able to quickly identify it and report it to a medical professional.

  • Allergic reaction: A very small percentage of individuals may be allergic to pantoprazole. Signs of an allergic reaction to pantoprazole might include: difficulty breathing; confusion; dizziness; swelling (e.g. face, tongue, throat); skin rash; itchiness; and/or kidney dysfunction.  In the event that you suspect an allergic reaction to pantoprazole, do not hesitate to contact emergency medical services.
  • Blood problems: Pantoprazole may induce hematologic abnormalities in a subset of users. For this reason, it is recommended to receive regular blood tests to ensure that no bloodwork abnormalities arise during treatment.  Examples of blood problems that can occur while taking pantoprazole include: thrombocytopenia (low thrombocytes or platelet count); leukopenia (low white blood cell count); pancytopenia (deficiency in red cells, white cells, and platelets); and/or agranulocytosis (low white blood cell count, usually of neutrophils).
  • Constipation: It is far more common to experience diarrhea than constipation while using pantoprazole. Nevertheless, constipation has been reported as an adverse reaction to pantoprazole treatment.  If you find yourself experiencing severe constipation such that bowel movements become infrequent – or difficult to pass, be sure to inform your doctor.  Constipation may lead to indigestion, heartburn, stomach pain, and/or flatulence.
  • Dry mouth: Though odds of developing dry mouth from pantoprazole are extremely low, this is an adverse reaction that has been reported. Dry mouth generally stems from the medication interfering with activation of the salivary glands to reduce saliva production.  If you experience dry mouth while using pantoprazole, beware of the fact that ongoing dry mouth may increase risk of cavities and tooth decay.
  • Edema: Pantoprazole can cause some individuals to develop edema, or excessive collection of water within certain regions of the body. According to data, edema in the facial region is most common among pantoprazole users compared to edema in other regions of the body.  Because severe edema might be the sign of a severe adverse reaction to pantoprazole, it is recommended to inform a doctor as soon as edema is observed.
  • Fever: Anyone who develops a fever while using pantoprazole should seek immediate medical attention. Developing a fever during treatment might be the sign of a life-threatening adverse reaction to pantoprazole like: Stevens-Johnson syndrome or toxic epidermal necrosis.  Fever may also be the sign that you’ve developed an infection (e.g. Clostridium difficile) while using pantoprazole – or a nutrient deficiency.
  • Hair loss: Hair loss is regarded as yet another extremely rare adverse reaction to pantoprazole. If you’re middle-aged or older and are taking pantoprazole, understand that the hair loss may simply be attributable to your age.  That said, hair loss could occur from a pantoprazole-induced vitamin deficiency throughout treatment.  If you experience hair loss during treatment, have your vitamin levels evaluated and consider pantoprazole alternatives.
  • Hepatic dysfunction: Cases of hepatitis, liver damage, and liver failure have occurred among persons taking pantoprazole.  Persons who experience pantoprazole-induced hepatitis or hepatic dysfunction might exhibit: jaundice (yellowing of the skin and/or eyes), abdominal pain, and/or swelling in the feet and ankles.  If hepatic dysfunction is suspected as resulting from pantoprazole, discontinuation of treatment will be necessary – along with liver panels to evaluate liver function.
  • Immune reactions: In rare cases, a person’s immune system may not respond well to the presence of pantoprazole. Some individuals may be more prone to developing infections during treatment as a result of the medication suppressing immune function.  Others may experience anaphylaxis (possibly even anaphylactic shock) or develop systemic lupus erythematosus as a byproduct of pantoprazole treatment.
  • Indigestion: Pantoprazole can induce many gastrointestinal side effects, one of which may be indigestion. The side effect of indigestion may be accompanied by flatulence, heartburn, burping, nausea, and/or constipation.  To minimize indigestion throughout treatment, it is recommended to: eat a balanced diet; avoid consuming excessive calories; avoid alcohol; avoid late night eating; and drink water after eating (rather than while eating).
  • Infection: It is known that pantoprazole users are at increased risk of developing certain types of infections, primarily due to suppression of stomach acid production. Stomach acid aids in killing pathogenic bacteria throughout the gastrointestinal tract.  Because pantoprazole is reducing stomach acid production, pathogenic bacteria are more likely to survive and/or proliferate – causing an infection.  Clostridium difficile is considered one of the more common infections reported by pantoprazole users.
  • Itchiness: There are numerous possible reasons that a person might become itchy while taking pantoprazole. Itchiness as an adverse effect could be attributable to onset of a serious dermatologic reaction such as: Stevens-Johnson syndrome or toxic epidermal necrolysis.  That said, itchiness might also result from an injection site reaction (if you’re using an injectable format of pantoprazole).
  • Metabolic reactions: Individuals using pantoprazole may exhibit metabolic abnormalities, including: elevated cholesterol and triglycerides; elevated liver enzymes (AST/ALT); and/or elevated creatine kinase (CK). If you’re at risk of developing metabolic abnormalities – or have a preexisting metabolic condition – it is recommended to have a medical doctor monitor this condition throughout pantoprazole treatment.
  • Muscle pain: Although joint pain occurs in around 2.8% of pantoprazole users, muscle pain is significantly less common. If you experience muscle pain accompanied by weakness or loss of strength, inform your doctor.  Muscle pain could be caused by electrolyte imbalances, inflammation, vitamin deficiencies, or other adverse reactions to pantoprazole.
  • Nutrient deficiencies: Anyone using a proton pump inhibitor (PPI), including pantoprazole, is at increased risk of developing nutrient deficiencies. Pantoprazole is understood to decrease the absorption of necessary nutrients, vitamins, and minerals, some of which include: vitamin B12, vitamin C, calcium, iron, sodium, and magnesium.  (Read more: “Magnesium Deficiency Symptoms”). Nutrient deficiencies can cause a variety of deleterious reactions and leave users at increased risk of developing pneumonia or contracting infections.  The longer a person consistently uses pantoprazole, the greater his/her risk of developing a nutrient deficiency.
  • Osteoporosis: Osteoporosis and bone fractures have been observed among persons taking pantoprazole at high doses and/or for a long-term (exceeding 1 year).  If you are at risk of developing osteoporosis, or suspect that pantoprazole may have triggered your osteoporosis, be sure to inform a medical doctor.  Pantoprazole might provoke osteoporosis by interfering with the absorption of essential vitamins and minerals.
  • Photosensitivity: Certain individuals may develop photosensitivity during pantoprazole treatment such that their skin becomes very sensitive to sunlight exposure. Signs of photosensitivity include exaggerated skin rash, sunburn, or blistering.  It is recommended to avoid excessive sun exposure if you develop photosensitivity as an adverse reaction to treatment.
  • Psychiatric symptoms: Psychiatric symptoms such as: anxiety, confusion, and hallucinations have been reported as potential adverse reactions to pantoprazole. If you find yourself feeling excessively nervous, suddenly become depressed, and/or hallucinate (e.g. hear voices) – inform your medical doctor and pursue alternative treatments.  It is unclear as to why psychiatric symptoms occur, but drug-induced changes in populations of gut bacteria may play a role.
  • Rash: Pantoprazole may cause some individuals to develop a skin rash or hives. In some cases, the rash may be localized (to a specific area of the body), whereas in other cases it might widespread.  For persons administering the injectable format of pantoprazole, rash could be simply an “injection site reaction.”  That said, it is important to always have a medical doctor evaluate the rash – as a rash could also be the sign of a life-threatening dermatologic reaction (e.g. toxic epidermal necrolysis).
  • Renal dysfunction: Certain individuals may experience renal dysfunction or a condition like acute interstitial nephritis that leads to kidney failure – while using pantoprazole. Signs of acute interstitial nephritis include: blood in urine, fever, changes in urinary output, rash, swelling, weight gain, and/or abnormal mental status.  If you have a history of renal dysfunction and/or exhibit signs of renal dysfunction – inform a medical doctor.
  • Skin reactions (Potentially-fatal): Although rare, some individuals taking pantoprazole may develop potentially-fatal dermatologic reactions, including: Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, cutaneous lupus erythematosus, and/or erythema multiforme. If at any point throughout treatment you notice a skin rash, hives, itchiness, etc. – contact your doctor immediately and report it.
  • Taste changes: Both loss of taste (ageusia) and taste distortion (dysgeusia) have been reported as adverse reactions to pantoprazole. If it seems as though your taste buds have somehow changed from pantoprazole treatment, and food tastes different, be sure to inform your doctor.  Taste changes might interfere with your appetite – possibly yielding unwanted weight loss.
  • Weakness: Extreme weakness or loss of physical strength may occur as an adverse reaction to pantoprazole treatment. Feeling extremely weak, especially if accompanied by other symptoms, could be the sign of a life-threatening reaction to pantoprazole.  Always report physical weakness to a medical professional as soon as it is noticed.

Note: The above lists of pantoprazole side effects and adverse reactions might be incomplete.  If you’re aware of additional pantoprazole side effects and/or adverse reactions that could occur, mention these reactions in the comments – preferably with a medical source to substantiate your information.

  • Source: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011580/
  • Source: https://www.ncbi.nlm.nih.gov/pubmed/11012560
  • Source: https://www.ncbi.nlm.nih.gov/pubmed/20882439
  • Source: https://www.ncbi.nlm.nih.gov/pubmed/24124705

Variables that influence Pantoprazole side effects

There are numerous variables that might influence the particular side effects and/or adverse reactions that you experience while using pantoprazole.  Variables that probably influence the specific side effects of pantoprazole that you experience (and the severities of those side effects) include: pantoprazole dose; length of pantoprazole use; pantoprazole format; user-specific factors (e.g. lifestyle, genetics, preexisting medical conditions).

  1. Pantoprazole dose (20 mg to 240 mg)

The specific dose of pantoprazole that you administer throughout treatment might determine the side effects that you experience, and the intensities of your side effects.  In general, the higher the dose of pantoprazole that’s administered, the more substantial its effect will be upon H+/K+ (hydrogen/potassium) ATPase.  Oppositely, the lower the dose of pantoprazole that’s administered, the lesser its effect will be upon H+/K+ ATPase.

The standard dose of pantoprazole is 40 mg per day for adults, and 20 mg per day for pediatrics.  Assuming you’re using the standard recommended pantoprazole dose, risk of side effects should be relatively low – and if side effects occur, they’re unlikely to be severe.  If you’re using a dose that’s even lower than the standard recommended dose, risk of side effects will be further reduced (largely because there’s less pantoprazole interacting with your physiology).

On the other hand, if you’re administering a high dose of pantoprazole that exceeds that standard recommended dose, your risk of developing severe side effects and adverse reactions dramatically increases.  This is because high doses of pantoprazole modulate physiology (e.g. suppress acid production, interfere with nutrient absorption, etc.) to a significant extent.  Though dosing may not always influence side effect occurrence among pantoprazole users, it often does.

  1. Length of pantoprazole use (Short-term vs. Long-term)

The total length of time over which you’ve consistently used pantoprazole to manage a medical condition could influence the side effects that you experience throughout treatment – and the severities of those side effects.  Someone who recently initiated pantoprazole treatment may experience side effects that are attributable to lack of physiologic adjustment to its effect.

In other words, certain side effects might occur and/or be pronounced in the first few days or weeks of treatment due to the fact that the body hasn’t adjusted itself to the presence of pantoprazole.  For certain individuals, side effects that emerge in the early days of treatment will eventually fade with continued pantoprazole administration as the body becomes better adjusted to the medication’s presence.

That said, some evidence suggests that using proton pump inhibitors like pantoprazole for a long-term may increase risk of serious side effects and/or adverse reactions (e.g. nutrient deficiencies).  In most cases, pantoprazole is used for a short-term (~8 weeks) and then discontinued, however, some individuals may continue using pantoprazole for a longer duration.

If you’ve been using pantoprazole for a long-term, realize that the extended length of treatment may have altered aspects of your physiology in ways that trigger new side effects – or exacerbate preexisting side effects.  In short, understand that side effects may be contingent upon how long you’ve taken pantoprazole.

  1. Pantoprazole format (oral vs. injectable)

The specific format of pantoprazole that you’re using might influence the prevalence and/or severities of certain side effects.  Pantoprazole is manufactured in the following formats: oral (delayed-release tablets and delayed-release oral suspension) and injectable (intravenous solution).  According to clinical research, there are no significant differences between pantoprazole formats in terms of physiologic effect and efficacy; each of the formats facilitate similar effects.

Nevertheless, there may be interindividual differences in terms of how certain users react to various pantoprazole formats.  For example, some individuals might experience fewer side effects when using the intravenous injection compared to taking the delayed-release tablets – or vice-versa.  However, it is known that persons using the intravenous injectable pantoprazole may develop “injection site reactions” that won’t occur in users of oral formats.

It is understood that administration instructions may slightly differ between various formats of pantoprazole.  Failing to properly follow administration instructions associated with the specific format of pantoprazole that you’re using might account for increased risk of side effects and/or adverse reactions to treatment – compared to another format.

  1. Substances used with pantoprazole

There are numerous substances (prescriptions, over-the-counter medications, supplements, etc.) that may interact with pantoprazole to trigger adverse reactions.  Examples of some medications that may interact with pantoprazole include: atazanavir, nelfinavir, ampicillin, blood thinners, digoxin, diuretics (water pills), ketoconazole, iron, methotrexate, amphetamine, and mycophenolate mofetil.

Medications that alter the pH of the stomach may be most likely to provoke interaction effects among pantoprazole users.  Always inform your doctor of substances that you plan on using along with pantoprazole to ensure that those substances are safe.  Another medication used with pantoprazole could interfere with its therapeutic effect – leading to decreased efficacy.

Similarly, another medication used with pantoprazole may augment its suppression of stomach acid – leading to a stronger effect and more prevalent side effects.  Moreover, because pantoprazole is metabolized by the CYP2C19 enzyme, any concurrently-used medication that interacts with CYP2C19 might increase risk of side effects.

On the other hand, there’s a chance that concurrent substances being used with pantoprazole might cover up or prevent certain side effects that would’ve otherwise occurred.  For example, someone using Imodium with pantoprazole may not develop diarrhea that he/she would’ve otherwise experienced.

Additionally, there’s a chance that some side effects of pantoprazole will be exacerbated by concurrent substance use via synergistic actions.  For example, if you’re taking a medication with pantoprazole that causes nausea – this side effect may end up more pronounced than it otherwise would’ve been due to the fact that both medications are contributing to the nausea.

  1. Pantoprazole user-specific factors

There are some user-specific factors that might impact the occurrence and/or severities of pantoprazole side effects.  User-specific factors that might influence pantoprazole side effects include: administration details; body size; genetics; lifestyle; and preexisting medical conditions.  Someone who administers pantoprazole properly and lives a healthy lifestyle may experience fewer side effects throughout treatment than someone who doesn’t follow proper administration instructions and/or lives an unhealthy lifestyle.

  • Administration details: Assuming you administer pantoprazole properly (in accordance with medical instruction), you’re more likely to benefit from the medication and less likely to end up with unwanted side effects – than someone who doesn’t follow proper dosing instructions. Documentation indicates that the delayed-release tablets are intended to be swallowed whole (with or without food) – whereas the delayed-release oral suspension is intended to be administered 30 minutes prior to a meal and combined with apple juice (or apple sauce).
  • Body size: The body size and composition of a pantoprazole user might influence the odds of experiencing certain side effects. For example, larger-sized individuals may require greater doses of pantoprazole to effectively manage medical symptoms – than smaller-sized persons.  In general, the greater the dose of pantoprazole that a person administers relative to his/her body size – the more likely he/she will be to experience side effects.
  • Genetics: A person’s gene expression may determine whether side effects are likely to occur while using pantoprazole. The CYP2C19 gene in particular may influence the efficacy of pantoprazole and its side effects.  Research suggests that persons with poor CYP2C19 expression exhibit 5-fold to 12-fold greater systemic exposure to pantoprazole than individuals with normative CYP2C19 expression – putting the poor metabolizers at increased risk of side effects.  On the other hand, persons with the CYP2C19 rapid metabolizer genotype may be at lower risk of side effects – but also find that the medication may not work very well.  (Source: https://www.ncbi.nlm.nih.gov/pubmed/15245569)
  • Lifestyle: The lifestyle of a person using pantoprazole may influence the severities of his/her side effects. For example, someone who: consumes an unhealthy diet (e.g. excessive calories, few nutrient-dense foods, etc.), fails to manage stress, and never exercises – may experience more severe side effects due to confounding influence of unhealthy lifestyle choices throughout treatment.  Oppositely, someone who: eats a sensible diet (e.g. nutrient-dense foods, limited calories), manages stress, and exercises regularly – may end up with fewer severe side effects due to healthy lifestyle choices.
  • Preexisting medical conditions: Preexisting medical conditions may influence severities of side effects that you experience while using pantoprazole. For example, assuming you’re taking pantoprazole to manage gastroesophageal reflux disease (GERD), but also have several neuropsychiatric disorders – you may be at increased risk of neuropsychiatric-related side effects throughout treatment (e.g. anxiety, depression, insomnia, etc.) – compared to someone without a neuropsychiatric disorder.  Moreover, any medications that you’re using to treat preexisting medical conditions – may interact with pantoprazole to provoke interaction effects.  If you don’t have a preexisting medical condition (in addition to the condition for which you’re using pantoprazole), you may be less likely to experience side effects than someone with a preexisting condition.

Possible ways to reduce Pantoprazole side effects

Included below are some strategies that might prove useful for reducing the prevalence and/or severities of side effects that are caused by pantoprazole.  It is important to realize that the effectiveness of these strategies is not guaranteed – some users may find them helpful, whereas others may derive zero benefit.  Before utilizing any of the strategies outlined below, consult a medical doctor to ensure your personal safety.

  1. Adjust pantoprazole dose and/or format: The dose and format of pantoprazole that you’re using might be culpable for the side effects that you’re experiencing. To minimize odds of side effects, the goal of your medical doctor should be to help you find the minimal effective dose – or lowest quantity of pantoprazole necessary to alleviate symptoms.  Taking the minimal necessary quantity should help reduce side effect risk.  Moreover, if you cannot tolerate one format of pantoprazole (e.g. injectables) – you may want to try using an oral format to determine whether the medication becomes more tolerable; or vice-versa.
  2. Add concurrent substances: There may be certain medications or supplements that you can use throughout pantoprazole treatment to help reduce its side effects. For example, if you experience diarrhea (one of the most common side effects), you may want to ask your doctor about using Imodium (an over-the-counter antidiarrheal) to help counteract it.  Adding concurrent medications (that don’t interact with pantoprazole) to specifically alleviate side effects may prove beneficial.
  3. Discontinue unnecessary agents: If you’re using substances that aren’t considered “medically necessary” – you may want to discontinue these agents while taking pantoprazole. Using medically unnecessary substances during pantoprazole treatment may increase risk of interaction effects.  Furthermore, some side effects that you think are from pantoprazole might actually be caused by another substance that you’re using.  Discontinuing medically unnecessary substances might make pantoprazole more tolerable.
  4. Administration modification: If you aren’t carefully following administration instructions associated with the format of pantoprazole that you’ve been prescribed, you may want to reevaluate those instructions and make a concerted effort to follow them. Properly following administration instructions such as taking pantoprazole in apple juice, 30 minutes before a meal may reduce certain side effects – and may increase its efficacy.
  5. Longer-term pantoprazole therapy: As was mentioned, some side effects of pantoprazole may emerge and/or be most pronounced in the first few days of treatment – mostly because the body hasn’t fully adjusted to the medication. With continued or longer-term pantoprazole therapy, the side effects that emerged over a short-term may eventually subside.  If you’re a new pantoprazole user (and are experiencing side effects), you may want to continue taking it for a few more weeks – as the side effects might subside once your body becomes more adjusted to the medication.

Note: Anyone who experiences severe side effects while taking pantoprazole should discuss them with a medical doctor.  If no side effect mitigation strategies seem to reduce the severities of side effects, you may need to undergo pantoprazole withdrawal – followed by a transition to another similar-acting medication.

Have you experienced Pantoprazole side effects?

In the event that you’re using pantoprazole (or previously used it), discuss all side effects that you’ve experienced as a result of the medication – in the comments section below.  In the comments, highlight the side effects of pantoprazole that you consider most noticeable – and rate the severities of those side effects (on a scale from 1 to 10 – with “10” being most severe).

To help other readers more accurately understand your situation, share some additional details in your comment like: the format of pantoprazole you use (e.g. delayed-release tablet); the dosage of pantoprazole that you take (e.g. 40 mg per day); and the total length of your treatment (e.g. 2 months).  Also note whether you use other substances along with pantoprazole such as medications (over-the-counter or prescription) and dietary supplements.

If you take other medications or supplements while using pantoprazole, have you considered that the side effects you’re experiencing may be more attributable to those other agents than pantoprazole?  Have you considered that other substances used with pantoprazole might cause an adverse interaction effect?  Assuming you’ve dealt with some disconcerting side effects while using pantoprazole, are there any strategies that you’ve employed to decrease these side effects?

Understand that pantoprazole is one of many proton pump inhibitors on the market.  If you don’t respond well to pantoprazole or cannot tolerate its side effects – there are effective alternative medications that a medical doctor can recommend.

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