Protonix (pantoprazole) dosing, indications, interactions, adverse effects, and more (2022)

  • acalabrutinib

    pantoprazole decreases levels of acalabrutinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Acalabrutinib solubility decreases with increasing gastric pH. Due to the long-lasting effect of PPIs, separation of doses may not eliminate the interaction.

  • alpelisib

    pantoprazole will increase the level or effect of alpelisib by Other (see comment). Avoid or Use Alternate Drug. Coadministration of alpelisib (BCRP substrate) with a BCRP inhibitor may increase alpelisib concentration, which may increase the risk of toxicities. If unable to avoid or use alternant drugs, closely monitor for increased adverse reactions.

  • apalutamide

    apalutamide will decrease the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.

  • atazanavir

    pantoprazole will decrease the level or effect of atazanavir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Atazanavir solubility decreases as pH increases. Substantially reduced plasma concentrations of atazanavir are expected if PPIs are coadministered. PPI dose should not exceed a dose comparable to omeprazole 20 mg and must be taken ~12 h before atazanavir/ritonavir in treatment naive-patients. PPIs are not recommended in treatment-experienced taking atazanavir.

  • dacomitinib

    pantoprazole will increase the level or effect of dacomitinib by unspecified interaction mechanism. Avoid or Use Alternate Drug. Concomitant use with a PPI decreases dacomitinib concentrations, which may reduce dacomitinib efficacy. Avoid use of PPIs with dacomitinib. As an alternative to PPIs, use locally-acting antacids or an H2-receptor antagonist. Administer at least 6 hours before or 10 hours after taking an H2-receptor antagonist.

  • darolutamide

    darolutamide will increase the level or effect of pantoprazole by Other (see comment). Avoid or Use Alternate Drug. Darolutamide is a BCRP inhibitor. Avoid coadministration with BCRP inhibitors. If use is unavoidable, closely monitor for adverse reactions and consider dose reduction of BCRP substrate drug (refer BCRP substrate prescribing information).

  • dasatinib

    pantoprazole will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

  • digoxin

    pantoprazole will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

  • indinavir

    pantoprazole will decrease the level or effect of indinavir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

  • infigratinib

    pantoprazole will decrease the level or effect of infigratinib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

  • itraconazole

    pantoprazole will decrease the level or effect of itraconazole by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

  • ketoconazole

    pantoprazole will decrease the level or effect of ketoconazole by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

  • lasmiditan

    lasmiditan increases levels of pantoprazole by Other (see comment). Avoid or Use Alternate Drug. Comment: Lasmiditan inhibits BCRP in vitro. Avoid coadministration of lasmiditan with BCRP substrates.

  • levoketoconazole

    pantoprazole will decrease the level or effect of levoketoconazole by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

  • lonafarnib

    pantoprazole will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.lonafarnib will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Lonafarnib may increase the AUC and peak concentration of CYP2C19 substrates. If coadministration unavoidable, monitor for adverse reactions and reduce the CYP2C19 substrate dose in accordance with its approved product labeling.

  • mesalamine

    pantoprazole decreases effects of mesalamine by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Applies only to sustained release dosage form.

  • neratinib

    pantoprazole will decrease the level or effect of neratinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

  • nilotinib

    pantoprazole will decrease the level or effect of nilotinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Nilotinib has a pH-dependent solubility and solubility is decreased at higher pH; separating doses may not eliminate this effect because of PPI extended duration of action

  • nisoldipine

    pantoprazole will increase the level or effect of nisoldipine by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

  • ozanimod

    pantoprazole increases toxicity of ozanimod by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of ozanimod (a BCRP substrate) with BCRP inhibitors increases the exposure of the minor (RP101988, RP101075) and major active metabolites (CC112273, CC1084037) of ozanimod, which may increase the risk of ozanimod adverse reactions. .

  • pazopanib

    pantoprazole will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; consider short-acting antacids in place of PPIs and H2 antagonists; separate antacid and pazopanib dosing by several hours

  • pexidartinib

    pantoprazole will decrease the level or effect of pexidartinib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of proton pump inhibitors (PPIs) with pexidartinib. Use H2-receptor antagonists or antacids if needed. When using alternatives to PPIs, administer pexidartinib 2 hr before or after taking locally-acting antacids OR administer pexidartinib at least 2 hr before or 10 hr after taking an H2-receptor antagonist.

  • rimegepant

    pantoprazole will increase the level or effect of rimegepant by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of rimegepant (a BCRP substrate) with inhibitors of BCRP.

  • riociguat

    pantoprazole will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed

  • secretin

    pantoprazole, secretin. Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant use of PPIs may cause a hyperresponse in gastrin secretion in response to stimulation testing with secretin, falsely suggesting gastrinoma. The time it takes for serum gastrin concentrations to return to baseline following discontinuation of PPIs is specific to the individual PPI. Following short-term treatment with pantoprazole, elevated gastrin levels return to normal by at least 3 months.

  • sofosbuvir/velpatasvir

    pantoprazole will decrease the level or effect of sofosbuvir/velpatasvir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Velpatasvir solubility decreases as gastric pH increases (practically insoluble at pH >5). Coadministration of sofosbuvir/velpatasvir with omeprazole or other PPIs is not recommended. If considered medically necessary, give sofosbuvir/velpatasvir with food 4 hr before omeprazole 20 mg. Use with other PPIs has not been studied.

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  • sotorasib

    pantoprazole will decrease the level or effect of sotorasib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer sotorasib 4 hr before or 10 hr after administration of a locally-acting antacid.

  • talazoparib

    pantoprazole will increase the level or effect of talazoparib by Other (see comment). Avoid or Use Alternate Drug. BCRP inhibitors may increase systemic exposure of talazoparib (a BCRP substrate). If coadministration cannot be avoided, monitor for potential adverse reactions.

  • acalabrutinib

    acalabrutinib increases levels of pantoprazole by Other (see comment). Use Caution/Monitor. Comment: Acalabrutinib may increase exposure to coadministered BCRP substrates by inhibition of intestinal BCRP.

  • amobarbital

    amobarbital will decrease the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • ampicillin

    pantoprazole will decrease the level or effect of ampicillin by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

  • apalutamide

    apalutamide will decrease the level or effect of pantoprazole by increasing elimination. Use Caution/Monitor. Apalutamide weakly induces BCRP and may decrease systemic exposure of drugs that are BCRP substrates.

  • atogepant

    pantoprazole will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • belumosudil

    pantoprazole will decrease the level or effect of belumosudil by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Increase belumosudil dosage to 200 mg PO BID when coadministered with proton pump inhibitors.

  • berotralstat

    pantoprazole increases levels of berotralstat by Other (see comment). Modify Therapy/Monitor Closely. Comment: Reduced dose of berotralstat (a BCRP substrate) to 110 mg/day when coadministered with BCRP inhibitors.

  • bortezomib

    bortezomib will decrease the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • bosutinib

    pantoprazole decreases levels of bosutinib by Other (see comment). Use Caution/Monitor. Comment: PPIs may decrease bosutinib concentration by ~45%; bosutinib displays pH-dependent solubility.

  • budesonide

    pantoprazole decreases effects of budesonide by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Enteric-coated budesonide dissolves at pH >5.5. Also, dissolution of extended-release budesonide tablets is pH dependent. Coadministration with drugs that increase gastric pH may cause these budesonide products to prematurely dissolve, and possibly affect release properties and absorption of the drug in the duodenum.

  • butabarbital

    butabarbital will decrease the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • cannabidiol

    pantoprazole will increase the level or effect of cannabidiol by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the cannabidiol dose when coadministered with a moderate CYP2C19 inhibitor.cannabidiol will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.

  • capecitabine

    pantoprazole decreases effects of capecitabine by unknown mechanism. Use Caution/Monitor. Retrospective data suggest elevated gastric pH caused by PPI use may impair capecitabine tablet dissolution and/or reduce absorption.

  • carbamazepine

    carbamazepine will decrease the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • carbonyl iron

    pantoprazole will decrease the level or effect of carbonyl iron by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

  • cenobamate

    cenobamate will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

  • ceritinib

    pantoprazole will decrease the level or effect of ceritinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely.

  • cilostazol

    pantoprazole increases toxicity of cilostazol by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider decreasing cilostazol dose; moderate CYP2C19 inhibitors may increase serum levels of 3,4-dehydrocilostazol (active metabolite).

  • clopidogrel

    pantoprazole decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to the active clopidogrel metabolite. Clopidogrel is metabolized in part by CYP2C19. Pantoprazole prescribing information state that coadministration with clopidogrel had no clinically important effect on exposure to clopidogrel active metabolite; no dose adjustment of clopidogrel is required .

  • crizotinib

    pantoprazole decreases levels of crizotinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that elevate the gastric pH may decrease the solubility of crizotinib and subsequently reduce its bioavailability. However, no formal studies have been conducted. .

  • cyclosporine

    pantoprazole, cyclosporine.Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: When used for prolonged periods of time PPIs may cause hypomagnesemia and the risk is further increased when used concomitantly with drugs that also have the same effects.

  • dabrafenib

    pantoprazole will decrease the level or effect of dabrafenib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that alter upper GI tract pH (eg, PPIs, H2-blockers, antacids) may decrease dabrafenib solubility and reduce its bioavailabilitydabrafenib will decrease the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Use alternative if available

  • dextroamphetamine

    pantoprazole, dextroamphetamine. Other (see comment). Use Caution/Monitor. Comment: Reduced gastric acidity caused by proton pump inhibitors decreases time to Tmax for amphetamine and dextroamphetamine. AUC was unaffected. .

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  • diazepam intranasal

    pantoprazole will increase the level or effect of diazepam intranasal by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Strong or moderate CYP2C19 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam.

  • digoxin

    pantoprazole increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.

  • duvelisib

    pantoprazole will increase the level or effect of duvelisib by Other (see comment). Use Caution/Monitor. Coadministration of duvelisib (a BCRP substrate) with a BCRP transport inhibitor may increase levels or effects of duvelisib.

  • elagolix

    elagolix will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak CYP2C19 inhibitor. Caution with sensitive CYP2C19 substrates.

  • encorafenib

    encorafenib will increase the level or effect of pantoprazole by Other (see comment). Modify Therapy/Monitor Closely. Encorafenib (a BCRP inhibitor) may increase the concentration and toxicities of BCRP substrates. Closely monitor for signs and symptoms of increased exposure and consider adjusting the dose of these substrates.

  • eslicarbazepine acetate

    eslicarbazepine acetate will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • ferric gluconate

    pantoprazole will decrease the level or effect of ferric gluconate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

  • ferric maltol

    pantoprazole will decrease the level or effect of ferric maltol by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

  • ferrous fumarate

    pantoprazole will decrease the level or effect of ferrous fumarate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

  • ferrous gluconate

    pantoprazole will decrease the level or effect of ferrous gluconate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

  • ferrous sulfate

    pantoprazole will decrease the level or effect of ferrous sulfate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

  • fexinidazole

    fexinidazole will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • finerenone

    pantoprazole will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

  • fluvoxamine

    fluvoxamine will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • fosamprenavir

    pantoprazole will decrease the level or effect of fosamprenavir by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

  • fostemsavir

    fostemsavir will increase the level or effect of pantoprazole by Other (see comment). Modify Therapy/Monitor Closely. Fostemsavir inhibits BCRP transporters. If possible, avoid coadministration or modify dose of BCRP substrate coadministered with fostemsavir.

  • gefitinib

    pantoprazole decreases levels of gefitinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Avoid coadministration of gefitinib with PPIs if possible. If treatment with a PPI is required, separate gefitinib and PPI doses by 12 hr.

  • glecaprevir/pibrentasvir

    pantoprazole will increase the level or effect of glecaprevir/pibrentasvir by decreasing metabolism. Use Caution/Monitor. Caution when coadministering glecaprevir/pibrentasvir with P-gp/BCRP inhibitors.glecaprevir/pibrentasvir will increase the level or effect of pantoprazole by Other (see comment). Use Caution/Monitor. Glecaprevir/pibrentasvir may increase plasma concentration of P-gp and BCRP substrates.

  • iron dextran complex

    pantoprazole will decrease the level or effect of iron dextran complex by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

  • iron sucrose

    pantoprazole will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

  • isavuconazonium sulfate

    pantoprazole will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • itraconazole

    itraconazole will increase the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. For patients using the Sporanox brand of itraconazole (capsules or solution), administer proton pump inhibitors at least 2 hr before or 2 hr after itraconazole. Use of Sporanox oral solution or administration of itraconazole with an acidic beverage (eg, cola) may minimize the significance of this interaction.

  • ledipasvir/sofosbuvir

    pantoprazole decreases levels of ledipasvir/sofosbuvir by Other (see comment). Use Caution/Monitor. Comment: Ledipasvir solubility decreases as pH increases; drugs that increase gastric pH are expected to decrease levels of ledipasvir; proton-pump inhibitor doses comparable to omeprazole <20 mg can be administered simultaneously with ledipasvir/sofosbuvir under fasted conditions.

  • letermovir

    letermovir increases levels of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor and dose adjustment may be necessary.

  • lumacaftor/ivacaftor

    lumacaftor/ivacaftor, pantoprazole. affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. .lumacaftor/ivacaftor will decrease the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lumacaftor/ivacaftor is a strong CYP3A4 inhibitor and also has the potential to induce CYP2C19 and both induce and inhibitor P-gp.

  • methotrexate

    pantoprazole increases levels of methotrexate by decreasing renal clearance. Use Caution/Monitor. Increased risk of toxicity with higher doses.

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  • methylphenidate

    pantoprazole decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

  • mycophenolate

    pantoprazole will decrease the level or effect of mycophenolate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Potential interaction applies to the prodrug mycophenolate mofetil conversion to active mycophenolic acid. Enteric coated mycophenolate sodium formulation is less sensitive to this interaction.

  • oteseconazole

    oteseconazole will increase the level or effect of pantoprazole by Other (see comment). Modify Therapy/Monitor Closely. Otesezonale, a BCRP inhibitor, may increase the effects and risk of toxicities of BCRP substrates. Use lowest starting dose of BCRP substrate, or consider reducing BCRP substrate dose.

  • phenytoin

    phenytoin will decrease the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • polysaccharide iron

    pantoprazole will decrease the level or effect of polysaccharide iron by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

  • posaconazole

    pantoprazole will decrease the level or effect of posaconazole by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

  • regorafenib

    regorafenib will increase the level or effect of pantoprazole by Other (see comment). Modify Therapy/Monitor Closely. Regorafenib likely inhibits BCRP (ABCG2) transport. Coadministration with a BCRP substrate may increase systemic exposure to the substrate and related toxicity.

  • rifampin

    rifampin will decrease the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • rose hips

    pantoprazole will decrease the level or effect of rose hips by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

  • rucaparib

    rucaparib will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP2C19 substrates, if clinically indicated.

  • safinamide

    safinamide will increase the level or effect of pantoprazole by Other (see comment). Use Caution/Monitor. Safinamide and its major metabolite may inhibit intestinal BCRP. Monitor BCRP substrates for increased pharmacologic or adverse effects.

  • saquinavir

    pantoprazole will decrease the level or effect of saquinavir by unknown mechanism. Use Caution/Monitor. Potential for increased toxicity.

  • secobarbital

    secobarbital will decrease the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.secobarbital will decrease the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • selexipag

    pantoprazole will increase the level or effect of selexipag by Other (see comment). Use Caution/Monitor. Selexipag is a ABCG2 (BCRP) substrate. Monitor selexipag for increased pharmacologic or adverse effects when coadministered with ABCG2 (BCRP) inhibitors.

  • St John's Wort

    St John's Wort will decrease the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • stiripentol

    stiripentol will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of CYP2C19 substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.stiripentol will increase the level or effect of pantoprazole by Other (see comment). Modify Therapy/Monitor Closely. Stiripentol is a BCRP transport inhibitor. Consider dosage reduction for BCRP substrates if adverse effects are experienced when coadministered.

  • tacrolimus

    pantoprazole will increase the level or effect of tacrolimus by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Concomitant administration may increase tacrolimus whole blood concentrations, particularly in intermediate or poor metabolizers of CYP2C19

  • tafamidis

    tafamidis will increase the level or effect of pantoprazole by Other (see comment). Use Caution/Monitor. Tafamidis inhibits breast cancer resistant protein (BCRP) in vitro and may increase exposure of BCRP substrates following tafamidis or tafamidis meglumine administration. Dosage adjustment of these BCRP substrates may be necessary.

  • tafamidis meglumine

    tafamidis meglumine will increase the level or effect of pantoprazole by Other (see comment). Use Caution/Monitor. Tafamidis inhibits breast cancer resistant protein (BCRP) in vitro and may increase exposure of BCRP substrates following tafamidis or tafamidis meglumine administration. Dosage adjustment of these BCRP substrates may be necessary.

  • tecovirimat

    tecovirimat will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.

  • theophylline

    pantoprazole increases toxicity of theophylline by Other (see comment). Use Caution/Monitor. Comment: Prolonged use of proton pump inhibitors can cause hypochlorhydria, which in turn causes peristalsis in small intestine to increase and peristalsis in the proximal colon to decrease; monitor for toxicity.

  • triclabendazole

    triclabendazole will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

  • vismodegib

    pantoprazole will decrease the level or effect of vismodegib by Other (see comment). Use Caution/Monitor. Drugs that increase gastric pH alter vismodegib solubility and therefore reduce bioavailability; effect on efficacy unknown

  • voriconazole

    voriconazole will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.voriconazole will increase the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • blessed thistle

    blessed thistle decreases effects of pantoprazole by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction.

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  • clobazam

    pantoprazole will increase the level or effect of clobazam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown. Dosage adjustment may be required; CYP2C19 inhibitors may result in increased exposure to N-desmethylclobazam (active metabolite).

  • cyanocobalamin

    pantoprazole decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

  • darifenacin

    darifenacin decreases effects of pantoprazole by Other (see comment). Minor/Significance Unknown. Comment: Effectiveness of proton pump inhibitors may be decreased theoretically if administered with other antisecretory agents .

  • devil's claw

    devil's claw decreases effects of pantoprazole by pharmacodynamic antagonism. Minor/Significance Unknown.

  • dexamethasone

    dexamethasone will decrease the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

  • dronedarone

    dronedarone will increase the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

  • efavirenz

    efavirenz will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

  • elvitegravir/cobicistat/emtricitabine/tenofovir DF

    elvitegravir/cobicistat/emtricitabine/tenofovir DF, pantoprazole. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Based on drug interaction studies conducted with the components of Stribild, no clinically significant drug interactions have been either observed or are expected when coadministered with PPIs.

  • eslicarbazepine acetate

    eslicarbazepine acetate will decrease the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Monitor for GI symptoms; net increased or decreased effect on PPI action unclear due to opposing CYP450 actions.

  • etravirine

    etravirine will decrease the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

  • ferric carboxymaltose

    pantoprazole will decrease the level or effect of ferric carboxymaltose by increasing gastric pH. Applies only to oral form of both agents. Minor/Significance Unknown.

  • fluconazole

    fluconazole will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

  • fosphenytoin

    fosphenytoin will decrease the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

  • ketoconazole

    ketoconazole will increase the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ketoconazole will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

  • levoketoconazole

    levoketoconazole will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.levoketoconazole will increase the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

  • levothyroxine

    pantoprazole decreases levels of levothyroxine by increasing gastric pH. Applies only to oral form of both agents. Minor/Significance Unknown. Conflicting evidence regarding this interaction exists.

  • liothyronine

    pantoprazole decreases levels of liothyronine by increasing gastric pH. Applies only to oral form of both agents. Minor/Significance Unknown. Conflicting evidence regarding this interaction exists.

  • liotrix

    pantoprazole decreases levels of liotrix by increasing gastric pH. Applies only to oral form of both agents. Minor/Significance Unknown. Conflicting evidence regarding this interaction exists.

  • lisdexamfetamine

    pantoprazole, lisdexamfetamine. Other (see comment). Minor/Significance Unknown. Comment: Reduced gastric acidity caused by proton pump inhibitors decreases time to Tmax for amphetamine and dextroamphetamine. AUC was unaffected. .

  • methamphetamine

    pantoprazole decreases levels of methamphetamine by Other (see comment). Minor/Significance Unknown. Comment: Time to maximum concentration (Tmax) of amphetamine is decreased compared to when administered alone; monitor patients for changes in clinical effect and adjust therapy based on clinical response.

  • modafinil

    modafinil will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown. Net effect on pantoprazole actions unknown due to opposing effects of CYP450 enzymes; monitor

  • oxcarbazepine

    oxcarbazepine will decrease the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Unclear on net effect of pantoprazole action due to opposing effects by CYP450 enzymes; monitoroxcarbazepine will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown. Unclear on net effect of pantoprazole action due to opposing effects by CYP450 enzymes; monitor

  • pentobarbital

    pentobarbital will decrease the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

  • phenobarbital

    phenobarbital will decrease the level or effect of pantoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

  • phytoestrogens

    pantoprazole decreases levels of phytoestrogens by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

  • ponatinib

    pantoprazole decreases levels of ponatinib by increasing gastric pH. Applies only to oral form of both agents. Minor/Significance Unknown.

    (Video) What Is Pantoprazole? Indications I Dose Form I Contraindications I Side Effects I Brand Name

  • thyroid desiccated

    pantoprazole decreases levels of thyroid desiccated by increasing gastric pH. Applies only to oral form of both agents. Minor/Significance Unknown. Conflicting evidence regarding this interaction exists.

  • FAQs

    What is the indication for pantoprazole? ›

    Pantoprazole is used to treat damage from gastroesophageal reflux disease (GERD), a condition in which backward flow of acid from the stomach causes heartburn and possible injury of the esophagus (the tube between the throat and stomach) in adults and children 5 years of age and older.

    Does pantoprazole have any interactions? ›

    Compared to other PPIs, pantoprazole tends to have fewer interactions. Even so, interactions are still possible. This can include medications that require acid to be absorbed in your stomach. Some medications need to be avoided when taking pantoprazole.

    What is pantoprazole used for and side effects? ›

    It's used for heartburn, acid reflux and gastro-oesophageal reflux disease (GORD) – GORD is when you keep getting acid reflux. It's also taken to prevent and treat stomach ulcers. Sometimes, pantoprazole is taken for a rare condition caused by a tumour in the pancreas or gut called Zollinger-Ellison syndrome.

    What are serious side effects of pantoprazole? ›

    Serious stomach conditions may occur while taking this medicine. Check with your doctor immediately if you or your child has stomach cramps, bloated feeling, watery and severe diarrhea which may also be bloody sometimes, fever, nausea or vomiting, or unusual tiredness or weakness.

    What are the side effects of Protonix? ›

    The most common side effects of PROTONIX in adults include: headache, diarrhea, nausea, stomach-area (abdominal) pain, vomiting, gas, dizziness, and joint pain.

    Who should not use pantoprazole? ›

    Tell your doctor if you are pregnant or breastfeeding. Pantoprazole is not approved for use by anyone younger than 5 years old.

    Does pantoprazole affect blood pressure? ›

    Infusion of pantoprazole at increasing rates lead to a significant decline of end systolic LV pressure by decreasing heart rate, myocardial contractility and arterial elastance.

    Can pantoprazole affect your heart? ›

    “The present work shows that PPI use is an independent predictor of [heart failure] or death. Although there are no previous studies reporting this association, it is known that pantoprazole may exert negative inotropic effects on isolated myocardium from humans and rabbits,” the researchers wrote.

    What is the best time of day to take pantoprazole? ›

    Pantoprazole is best taken before breakfast or 30 to 60 minutes before a meal. If administering twice daily take the first dose before breakfast and the second dose before dinner.

    What are contraindications of Protonix? ›

    PROTONIX is contraindicated in patients with known hypersensitivity to any component of the formulation or any substituted benzimidazole. Hypersensitivity reactions may include anaphylaxis, anaphylactic shock, angioedema, bronchospasm, acute interstitial nephritis, and urticaria [see Adverse Reactions (6)].

    Does pantoprazole cause joint pain? ›

    Common side effects may include: headache, dizziness; stomach pain, gas, nausea, vomiting, diarrhea; joint pain; or.

    Can pantoprazole cause kidney damage? ›

    The underlying mechanism of pantoprazole-induced acute kidney injury is complex. Sensitivity to pantoprazole is the primary reason for the onset of acute kidney injury and may only be confirmed by renal pathology (27).

    Is pantoprazole a high risk medication? ›

    Pantoprazole may increase your risk of having fractures of the hip, wrist, and spine. This is more likely if you are 50 years of age and older, if you receive high doses of this medicine, or use it for one year or more. Call your doctor right away if you have severe bone pain or are unable to walk or sit normally.

    Can pantoprazole cause strokes? ›

    For example, a recent RCT including over 17,000 participants found that pantoprazole appeared to have a modest, although not statistically significant, increased risk of stroke when compared with placebo (hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.94 to 1.44) [19].

    Why is pantoprazole not good long term? ›

    Severe side effects include increased risk of heart attack, stroke, and kidney failure. Long-term PPI use has also been linked to dementia. A major population study revealed a direct correlation between long-term PPI use and the development of Berrett's syndrome and adenocarcinoma of the esophagus.

    Is Protonix a safe drug? ›

    PPIs (including Protonix) have been associated with an increased risk of osteoporosis-related fractures of the hip, wrist, or spine. People on high-dose or long-term therapy are more at risk. Has also been associated with other conditions such as lupus erythematosus and magnesium deficiency.

    What happens if you take Protonix long-term? ›

    The most common side effects reported include headache, diarrhea, nausea, and vomiting. Reports of more serious side effects include kidney disease, fractures, infections and vitamin deficiencies, but these are very rare and are generally associated with long-term use (using these products for more than a year).

    Why you shouldn't take Protonix long-term? ›

    Recent studies, however, have cited dangers thought to be associated with the long-term use of PPIs. Among them: an increased risk of kidney disease, osteoporosis, low magnesium or vitamin B12 in the blood, pneumonia, stroke, and contracting the Clostridium difficile (C. diff) bacterium.

    When should you not take pantoprazole? ›

    Pantoprazole may increase your risk of having fractures of the hip, wrist, and spine. This is more likely if you are 50 years of age and older, if you receive high doses of this medicine, or use it for one year or more. Call your doctor right away if you have severe bone pain or are unable to walk or sit normally.

    Can I take vitamin D with pantoprazole? ›

    No interactions were found between pantoprazole and Vitamin D3.

    Can pantoprazole cause your heart to race? ›

    But exacerbations of the heart rate are a known side effect of pantoprazole, and it might be due to magnesium deficiency. This can be tested by your doctor; alternatively, you could ask your doctor about a magnesium supplement to see if that prevents the fast heart rate you experience with pantoprazole.

    Does pantoprazole raise blood sugar levels? ›

    Conclusions: Pantoprazole therapy increases plasma gastrin and insulin levels, thereby improving the glycemic control in T2DM.

    Does pantoprazole affect blood sugar? ›

    In conclusion, pantoprazole therapy increases fasting plasma gastrin and insulin levels, thereby improving glycemic control. The effect of PPIs on glucose-insulin homeostasis requires further studies in this area.

    Is pantoprazole hard on the liver? ›

    Clinically apparent liver injury due to pantoprazole is rare, but calls for prompt withdrawal of the agent. Cases of acute liver failure due to proton pump inhibitors have been described, but are exceedingly rare.

    Can pantoprazole cause permanent damage? ›

    Taking pantoprazole long-term may cause you to develop stomach growths called fundic gland polyps. Talk with your doctor about this risk. If you use pantoprazole for longer than 3 years, you could develop a vitamin B-12 deficiency. Talk to your doctor about how to manage this condition if you develop it.

    What happens if I take pantoprazole after eating? ›

    Pantoprazole can be taken before or after food, although taking it before food is preferable. If you forget to take a dose at your usual time, you can take it when you remember (unless it is nearly time for your next dose, in which case leave out the missed dose).

    Can I take Protonix at night before bed? ›

    Delayed-release PPIs should not be given before bed on an empty stomach as they do not effectively control intragastric pH in the early part of the sleeping period when the majority of nighttime reflux occurs (see Questions 9 and 10).

    What should be monitored when taking pantoprazole? ›

    Patients who are prescribed pantoprazole require monitoring for signs and symptoms of gastroesophageal reflux disease and peptic ulcer disease. If symptoms of these conditions arise, an increase in dosage or medication change should merit clinician consideration.

    What vitamins should not be taken with Protonix? ›

    If you are iron-deficient or have anemia, you should talk to your doctor before using multivitamin, prenatal together with pantoprazole. By reducing stomach acid, pantoprazole may reduce the absorption of iron and make multivitamin, prenatal less effective in treating your condition.

    Can you take Protonix with other medications? ›

    Protonix may be used alone or with other medications. Protonix belongs to a class of drugs called proton pump inhibitors (PPIs).

    Do Protonix side effects go away? ›

    Some side effects of pantoprazole may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine.

    Can pantoprazole cause brain fog? ›

    It helped with the heartburn from the first day I took it, but the side effects are too much. Pains all over, headache, brain fog, burping ALL day long, and just didn't feel right. As far as side effects go, for the first 6 months to a year, it felt like a rock was sitting in my stomach.

    Is there a lawsuit against Protonix? ›

    More than 13,300 PPI lawsuits have been filed against the manufacturers of Nexium, Prilosec, Prevacid, Protonix and Dexilant for causing various health injuries. Individuals claim to have suffered kidney disease, kidney injury, kidney failure and acute interstitial nephritis.

    How long should a person take pantoprazole? ›

    Adults—40 milligrams (mg) once a day for up to 8 weeks. Your doctor may want you to take pantoprazole for more than 8 weeks for certain conditions. Children 5 years of age and older weighing 40 kilograms (kg) or more—40 mg once a day for up to 8 weeks.

    Why does everyone in the hospital get Protonix? ›

    Many patients who are admitted into hospitals are put on proton pump inhibitors (PPIs) both to prevent gastrointestinal bleeding and as heartburn/gastroesophageal reflux disease relief after discharge.

    Can pantoprazole cause dementia? ›

    Three studies have found a positive association between dementia and omeprazole, esomeprazole, lansoprazole, and pantropazole, with an approximately 1.4-fold increased risk of any dementia in cohorts using PPIs (95% CI, 1.36–1.52; P < 0.001) [76].

    Can Protonix cause mental problems? ›

    A new study — now published in the journal Psychotherapy and Psychosomatics — has found a link between a common class of stomach drugs called proton pump inhibitors and depression. The researchers suggest that the pills might lead to major depressive disorder by disrupting the gut's bacteria.

    Can pantoprazole cause nerve damage? ›

    These include: Increased risk of bone fracture in people taking higher, multiple daily doses for more than 1 year. Vitamin B12 deficiency, which can lead to serious nerve damage and deteriorating brain functions. This has been seen in some people taking pantoprazole for longer than 3 years.

    What is a natural alternative to pantoprazole? ›

    Herbal Remedies: Some people find herbal remedies such as ginger root, chamomile, slippery elm, marshmallow and licorice effective in treating heartburn.

    Can I take pantoprazole for years? ›

    Otherwise, a maintenance treatment is advocated because of the high incidence of relapse of esophagitis. Prolonged pantoprazole therapy, also lasting up to 5 years, is also effective for the long term management of severe ulcers and reflux disease (Bardhan et al 2005).

    Does pantoprazole cause bone loss? ›

    Background: Epidemiological studies suggest that long-term administration of proton pump inhibitors (PPIs) may decrease bone mineral density (BMD) and increase the risk of osteoporotic fractures.

    Why pantoprazole is taken in empty stomach? ›

    Proton pump inhibitors: better acid suppression when taken before a meal than without a meal.

    When is the best time to take Pantoprazole? ›

    Usually taken once daily. Swallow tablets whole; do not split, crush, or chew. Pantoprazole is best taken before breakfast or 30 to 60 minutes before a meal. If administering twice daily take the first dose before breakfast and the second dose before dinner.

    When should you not take Pantoprazole? ›

    Pantoprazole may increase your risk of having fractures of the hip, wrist, and spine. This is more likely if you are 50 years of age and older, if you receive high doses of this medicine, or use it for one year or more. Call your doctor right away if you have severe bone pain or are unable to walk or sit normally.

    Why do you take Pantoprazole first thing in the morning? ›

    Pantoprazole is a proton pump inhibitor, which decreases the amount of acid produced in the stomach. Doctors often recommend taking Pantoprazole once a day, first thing in the morning, for conditions such as heartburn and GERD.

    How long does it take for pantoprazole to kick in? ›

    You should start to feel better within 2 to 3 days. It may take up to 4 weeks for pantoprazole to work properly. You may still have symptoms during this time. Do not take this medicine for more than 4 weeks without consulting a doctor.

    How long can you stay on pantoprazole? ›

    Adults—40 milligrams (mg) once a day for up to 8 weeks. Your doctor may want you to take pantoprazole for more than 8 weeks for certain conditions. Children 5 years of age and older weighing 40 kilograms (kg) or more—40 mg once a day for up to 8 weeks.

    Can I take vitamins with pantoprazole? ›

    If you are iron-deficient or have anemia, you should talk to your doctor before using multivitamin, prenatal together with pantoprazole. By reducing stomach acid, pantoprazole may reduce the absorption of iron and make multivitamin, prenatal less effective in treating your condition.

    What medications Cannot be taken with pantoprazole? ›

    Serious Interactions of pantoprazole include:
    • afatinib.
    • atazanavir.
    • dasatinib.
    • delavirdine.
    • digoxin.
    • edoxaban.
    • indinavir.
    • itraconazole.

    Can you take vitamin D while taking pantoprazole? ›

    No interactions were found between pantoprazole and Vitamin D3.

    Why do you take Protonix 30 minutes before a meal? ›

    As a medication that belongs to the class of drugs called proton pump inhibitors (PPIs), Pantoprazole takes effect on the gastric parietal cells, preventing “pumping” of hydrochloric acid into the stomach. When taken 30 to 60 minutes before a meal, it aids in the prevention of heartburn.

    Can you lay down after taking pantoprazole? ›

    Do not lie down immediately after taking medicine, to make sure the pills have gone through the esophagus into the stomach. Notify your healthcare provider if you experience painful swallowing or feel that the medicine is sticking in your throat.

    Can Protonix help with anxiety? ›

    Pantoprazole may not treat your anxiety, but the drug can be used to help manage GERD, which is a possible symptom of anxiety. To learn more about using pantoprazole for symptoms of anxiety, talk with your doctor.

    Videos

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    4. Pantoprazole (Protonix): No More Heartburn, but is it safe?
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