Treatment > Medications

Pantoprazole – effects, side effects, intake and dosage

Dr. med. Andre Sommer

Dr. med. Andre Sommer

Pantoprazole is a medicine used to protect the stomach. Whether it's for the treatment of heartburn, stomach ulcers or as an accompanying drug when taking ibuprofen or aspirin, pantoprazole is one of the most commonly prescribed drugs in Germany. At Cara Care, you will find out how pantoprazole works, what you need to consider when taking pantoprazole and what side effects can occur.

How does pantoprazole work?

Pantoprazole belongs to the group of medicines known as proton pump inhibitors. These are active ingredients that block a Transporter in the gastric mucosa. This transporter, which carries the technical name “H+/K+-ATPase”, is responsible for transporting hydrogen protons (H +) from the cells of the gastric mucosa. That is why it is also called “proton pump”.

Hydrogen protons are vital for the production of stomach acid. The effect of a proton pump inhibitor is therefore to make the mucous membrane produce less stomach acid.

Pantoprazole inhibits the production of stomach acid in this way.

What diseases is pantoprazole used for?

Because of its acid-inhibiting effect, pantoprazole is used primarily in diseases caused by excess production of stomach acid. That includes heartburn, which is referred to medically as gastroesophageal reflux disease (GERD). Stomach ulcers are also treated with pantoprazole, as are more rare diseases, which include cured inflammation of the esophagus (esophagitis) or Zollinger-Ellison syndrome.

As a preventative measure, pantoprazole is often used in patients who take drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac or ASA. That is because taking NSAIDs regularly increases the risk of developing a stomach ulcer.

Pantoprazole is also part of a treatment plan for eliminating the gastric germ Helicobacter pylori (H. pylori), i.e. in “eradication therapy”.

Tip: The non-medicinal approach is particularly promising for heartburn and stomach problems. Nutritional therapy can help you to alleviate the symptoms significantly and is subsidized by almost all health insurance companies in Germany. We also offer help from selected experts. Click here for more information on our therapy program.

Is a prescription required for pantoprazole?

Pantoprazole is available in Germany in pharmacies, but does not require a prescription. This means that as a patient you can buy pantoprazole in the pharmacy without a prescription from a doctor. However, the corresponding packs per tablet may only contain a maximum of 20 mg of the active ingredient and a pack may contain a maximum of 14 tablets.

Pantoprazole is an over the counter (no prescription) medication

Higher dosages or larger packaging may only be bought with a prescription from the doctor.

How to take pantoprazole

The dosage of pantoprazole is usually 20 mg per tablet. Unless otherwise prescribed by the doctor, take one tablet of pantoprazole with a glass of water (approx. 200 ml) in the morning, at least one hour before breakfast. The distance to the first meal is important so that the drug can develop its effects optimally and food components do not interfere with the absorption of the active ingredient.

If pantoprazole is taken twice a day, the second intake should be before dinner. As with the morning intake, it should be taken at least one hour before dinner and the tablet should be taken with a glass of water.

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What side effects can occur when taking pantoprazole?

In general, proton pump inhibitors and thus pantoprazole are medications that are well tolerated with few side effects.

The side effects are roughly divided into general and specific side effects. General side effects can occur with almost any medication, and specific side effects have been observed especially with pantoprazole.

General side effects include nausea, diarrhea, headache, constipation and skin rash. One or more of these side effects are observed in a maximum of one to three out of 100 patients.

A specific side effect of pantoprazole is the appearance of blurred vision. This extremely rare side effect occurs especially when taking large amounts of pantoprazole. Liver (acute inflammation of the liver) and kidney disease (inflammation of the kidneys) are very rare side effects.

Is long-term use of pantoprazole dangerous?

Some studies indicate that long-term use of proton pump inhibitors and thus pantoprazole for years elevates the risk of osteoporosis. It is believed that the decreased production of gastric acid hampers calcium intake, which is of great importance for bone metabolism.

This side effect may be counteracted by taking calcium citrate at the same time.

Also the uptake of other minerals and vitamins, for example vitamin B12 can be reduced by long-term use of pantoprazole.

Due to the lower gastric acid production and the higher pH value in the stomach, the risk of gastrointestinal infections increases for long-term consumption. Under normal conditions, stomach acid is a first barrier that destroys many potentially harmful germs.

There are also a number of possible side effects such as increased risk of dementia or heart attack currently being discussed by doctors. However, there are not yet enough studies to conclude whether the effects of the treatment with proton pump inhibitors are really involved or whether other causes are in the foreground.

How do I stop using pantoprazole correctly?

Since pantoprazole does not require a prescription, many people take the drug without first consulting a doctor. Therefore, the question often arises of how best to stop taking the drug.

Specialists recommend gradually discontinuing pantoprazole and other proton pump inhibitors. That is, the dose and frequency of use should be gradually reduced. For example, one tablet can be taken every two days, then every four days, then the tablet is completely discontinued.

This recommendation stems from the fact that long-term use of pantoprazole leads to habituation. The body gets used to the lower gastric acid levels and the drug. When the medication is suddenly stopped so-called “hypersecretion” can occur. The body produces too much stomach acid in a kind of overreaction, resulting in stomach pain and heartburn.

Are there alternatives to pantoprazole?

Many patients use pantoprazole if they have stomach problems or heartburn. However, there are a number of other treatment options for these diseases that are considered an alternative to the pantoprazole tablet.

Adjustment of the diet for example can have a very positive impact. Heartburn is mostly promoted by alcohol consumption, smoking cigarettes and coffee consumption. Also fatty foods exacerbate the symptoms. A complete absence of these foods or a reduction in the amount consumed helps many patients to alleviate the symptoms.

If the heartburn occurs predominantly at night, sleeping with a raised upper body - for example by placing a pillow under it - can also provide relief.

Other, milder medications, so-called antacids,are available for the treatment of stomach complaints. They are usually available in the form of chewable tablets that are taken between meals in the pharmacy. Antacids do not inhibit the production of stomach acid, but bind the existing stomach acid and thereby neutralize it.

Can pantoprazole be used during pregnancy?

Both in the first trimester of pregnancy, as well as in the second and third trimester, pantoprazole is well studied and can be taken by pregnant women.

However, experts at Charité Berlin recommend another proton pump inhibitor, omeprazole, during pregnancy, Because there are significantly more safety studies on this drug than on pantoprazole. Read more about the side effects of omeprazole here.

Pantoprazole is an effective medication for the treatment of gastric complaints and has a good safety profile and is therefore one of the most frequently prescribed medications in Germany. However, the discussion about possible, previously unknown side effects has arisen among doctors in recent years. It is therefore advisable to think carefully about taking pantoprazole and to consider alternatives, preferably together with a doctor.

Schubert‐Zsilavecz, M., & Stark, H. (2005). Protonenpumpeninhibitoren: Strukturen, Mechanismen und Entwicklungen. Pharmazie in unserer Zeit, 34(3), 194-199. Downloaded on 02.04.18 from: http://onlinelibrary.wiley.com/doi/10.1002/pauz.200500118/full

Kunsch, S., Neesse, A., Linhart, T., Steinkamp, M., Fensterer, H., Adler, G., ... & Ellenrieder, V. (2009). Impact of pantoprazole on duodeno-gastro-esophageal reflux (DGER). Zeitschrift für Gastroenterologie, 47(03), 277-282. Downloaded on 02.04.18 from https://www.ncbi.nlm.nih.gov/pubmed/19280541

von Rahden, B. H. A., Scheurlen, M., Filser, J., Stein, H. J., & Germer, C. T. (2012). Neu erkannte Nebenwirkungen von Protonenpumpeninhibitoren. Der Chirurg, 83(1), 38-44. Downloaded on 02.04.18 from https://link.springer.com/article/10.1007%2Fs00104-011-2173-x

Schwarz, K. (2010). Evidenzbasierter Einsatz von Protonenpumpeninhibitoren (Doctoral dissertation, Universität Wien)

Internetquelle: https://www.embryotox.de/pantoprazol.html, aufgerufen am 02.04.18

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.

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