Proton pump inhibitors · Gastrointestinal
Pantoprazole
Pantoloc® · Protonix®(brand names vary by market)
The proton pump inhibitor that stays out of other drugs' way.
Also: modified release, injection, infusion
Mechanism
Irreversibly inhibits the gastric H+/K+ ATPase. Acid secretion resumes only as new pumps are made, which is why the effect outlasts the drug by days.
Open the interactive pathwayIndications
- Gastro-oesophageal reflux disease
- Peptic ulcer disease
- Upper gastrointestinal bleeding
- Gastroprotection alongside NSAIDs or dual antiplatelet therapy
- H. pylori eradication regimens
Formulations
Dosing concepts
Timing
Taken 30 to 60 minutes before a meal, because it only inhibits pumps that are actively secreting. A dose taken with no meal to follow does much less.
Duration
Most indications are time-limited. An open-ended prescription with no review date is the commonest problem with this class.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- ~77%
- Half-life
- ~1 h, with acid suppression lasting far longer
- Elimination
- hepatic: CYP2C19 and CYP3A4, but a much weaker CYP2C19 inhibitor than omeprazole
- Protein binding
- ~98%
Adverse effects
- Headache and diarrhoeacommon
- HypomagnesemiaseriousWith prolonged use; can cause tetany, arrhythmia and refractory hypokalemia.
- C. difficile and enteric infectionserious
- Vitamin B12 and iron malabsorption with long-term useserious
- Fracture risk with prolonged high-dose useserious
- Acute interstitial nephritisseriousIdiosyncratic and easily missed as a cause of unexplained AKI.
Contraindications & precautions
Contraindications
- Known hypersensitivity
Precautions
- Long-term use without review
- Concurrent methotrexate at high dose
- Masking of gastric malignancy in an undiagnosed patient
Interactions
Monitoring
Whether the indication still applies
The main harm of this class is duration, not dose · At every medication review
Magnesium on prolonged therapy
Under-recognised and occasionally dramatic
B12 and iron in long-term users
Absorption of both depends on acid
Counselling points
- Take it 30 to 60 minutes before your first meal of the day.
- Swallow the tablet whole.
- This is not usually a lifelong medicine; we will review whether you still need it.
- Tell us about persistent diarrhoea, muscle cramps or palpitations.
Clinical pearls
- It is the proton pump inhibitor of choice alongside clopidogrel, because its CYP2C19 inhibition is minimal where omeprazole's is not.
- A patient on long-term therapy with refractory hypokalemia often has hypomagnesemia driving it, and the magnesium has to be replaced before the potassium will hold.
References & review
- Pantoprazole product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-16 · jurisdiction: global · drug information changes; verify against current references before practice use.