Treatment > Medications

Pantoprazole: Acid blockers with unwanted side effects

Dr. med. Andre Sommer

Dr. med. Andre Sommer

Proton pump inhibitors such as pantoprazole are effective against heartburn, acid regurgitation, and other complaints of the stomach and intestines, such as stomach ulcers. They have an effect against everything that is associated with the undesirable release of stomach acid. Thus, pantoprazole is very popular as a form of stomach protection and is often used. However, the immediate effect of the popular drug is offset by side effects that should be taken into account, especially with regard to intake and dosage.

How and where does pantoprazole work?

Pantoprazole works directly on the stomach lining, where it blocks transporters responsible for the release of gastric acid. It acts immediately, directly, and effectively against all ailments related to the unwanted release of gastric acid. Specifically, it helps with heartburn, acid regurgitation, or inflammation of the esophagus (reflux oesophagitis), as well as with stomach ulcers.


Overview of pantoprazole uses

  • Reflux esophagitis (reflux disease with inflammation of the esophagus)
  • Duodenal and/or gastric ulcers
  • Morbidly increased gastric acid production: Zollinger-Ellison syndrome
  • Helicobacter pylori (in combination with other medicines)
  • As gastric protection for co-medication when using drugs that attack the stomach (e.g. ASA)

What happens when the proton pumps are inhibited?

Pantoprazole inhibits the proton pumps, which are responsible for ensuring that sufficient gastric acid is released in the lining cells of the gastric mucosa, hence the name proton pump inhibitor (PPI). The release of gastric acid is a necessary process to balance the acidity in the stomach and to ensure microbial defense. Without gastric acid, the pH increases there, whereupon the food can no longer be sufficiently digested before it is transported further into the intestine. One problem above all with long-term use of pantoprazole is that it can lead to a number of side effects. Sometimes with long-term use gastrointestinal infections can result.

The most common side effects of pantoprazole

The most common side effects of pantoprazole 40 include the following:

  • Gastrointestinal complaints such as nausea, vomiting, diarrhea, constipation and gas
  • Headache, dizziness, tiredness, general weakness, sleep disorders and magnesium deficiency
  • Skin hypersensitivity reactions such as itching or rash
  • Increase in liver function tests

Where can I buy pantoprazole?

Pantoprazole is available in drugstores. As an active ingredient, pantoprazole can be found in numerous medicines and various dosage forms. Depending on the dosage, pantoprazole may require a prescription.

Do all acid blockers have the same side effects?

While proton pump inhibitors like pantoprazole are generally considered to be extremely well tolerated, they can still lead to side effects, especially if they are taken long-term or in high doses. This is often the case with pantoprazole because the acid blocker is administered as a gastric protective supplement to painkillers. The side effects of long-term use generally manifest themselves in the form of headaches, malaise, nausea, diarrhea, dizziness and similar complaints. Pantoprazole also has specific side effects such as visual disturbances or an increased risk of osteoporosis. Some patients also report weight gain or the appearance of an irritable cough.


Caution with long-term use of pantoprazole

As studies have shown, the long-term intake of pantoprazole can lead to unwanted side effects. The proton pump inhibitor not only prevents the release of gastric acid, it also blocks the uptake of important vitamins and minerals like B12 and calcium, an important component of bone metabolism.


What side effects of pantoprazole can I expect?

The specific side effects of pantoprazole include, among other things, blurred vision. According to studies, they affect 5 percent of patients. The likelihood of such side effects increases if the proton pump inhibitor is overdosed. The latter also applies to most of the other specific side effects of pantoprazole.

The permanent inhibition from proton pumps also leads to insufficient supply of the important vitamin B12. In its role as PPI, pantoprazole also blocks the absorption of calcium, causing pantoprazole to promote long-term side effects such as bone loss (osteoporosis). Long-term use of pantoprazole, including lower doses over a year, may increase the risk of developing broken bones (fractures) in the hips, wrists, or spine in older patients.

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How long and how often should I take pantoprazole?

The duration of use and the amount of the dose depend primarily on the type and severity of the symptoms. But above all the long-term use of pantoprazole should be clarified with a doctor.

Pantoprazole 40 mg tablets for example are administered for 2–4 weeks for a duodenal ulcer. A gastric ulcer or reflux oesophagitis requires approximately 4–8 weeks of treatment, while fighting Helicobacter pylori bacteria takes about a week or two.

With a pathologically increased release of gastric acid, as in Zollinger-Ellison syndrome, however, the duration of use should be discussed individually with a doctor.

Can I just stop pantoprazole without side effects?

Sudden discontinuation of pantoprazole causes discomfort, especially after long-term use. The reason for this is the so-called rebound effect, which occurs frequently once pantoprazole is discontinued. This initially intensifies the symptoms that pantoprazole is actually supposed to fight, since more stomach acid develops in the short term than it did before. Surviving this phase without resorting to pantoprazole makes stopping the effective drug difficult for many. Alternative remedies can sometimes be helpful here.

Are there effective alternatives to pantoprazole?

Short-term intake of pantoprazole makes sense, since the active ingredient works efficiently exactly where it is supposed to work and therefore hardly leads to acute side effects. However, you should definitely discuss long-term intake with a doctor and look for alternatives together.

If you want to discontinue pantoprazole, you may find something useful in the plant kingdom. Natural acid blockers such as flax seed tea can help here. If you want to continue taking pantoprazole, you can try switching to another dosage form of the active ingredient. Pantoprazole can act differently as an active ingredient depending on the product form and is available in tablet form, as granules or as an injection.

But the excessive release of stomach acid can be counteracted in ways other than with medications. For example with enough movement and a high-fiber and protein-rich diet. For example, flax seed tea before every meal stimulates the closing mechanism between the stomach and esophagus and thus prevents the backflow of stomach acid - the main symptom of reflux disease.

If you need support with your diet adjustment, our certified nutritionists are at your side. Find out in a free initial consultation whether a therapy is suitable for you. The consultation is tailored to your special needs and is generously covered by most health insurance companies

Natural alternatives to pantoprazole

  • Diet changes: high-fiber, protein-containing and binding foods
  • A lot of movement: Exercise and activity stimulate the functionality of the stomach and intestines
  • Natural remedies: Flax seed tea, chewing gum, potato juice, etc

Cheer S.M., Prakash A., Faulds D., Lamb H.M. Pantoprazole: an update of its pharmacological properties and therapeutic use in the management of acid-related disorders. Drugs, 2003, 63(1), 101-33 https://www.ncbi.nlm.nih.gov/pubmed/12487624

Sandig, C., Fleichenmacher, C., Stremmel, W., & Eisenbach, C. (2011). Pantoprazole induces severe acute hepatitis. Zeitschrift für Gastroenterologie, 49(02), 207-210. https://www.ncbi.nlm.nih.gov/pubmed/21298607

Shirazi, M., Alimoradi, H., Kheirandish, Y., Etemad-Moghadam, S., Alaeddini, M., Meysamie, A. & Dehpour, AR (2014). Pantoprazole, a proton pump inhibitor, increases orthodontic tooth movement in rats. Iranian journal of basic medical sciences. 17(6), 448. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137949/

Dr. med. Andre Sommer

Dr. med. Andre Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara Care.

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