Protonix 40 mg tbec: Protonix Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing
Pantoprazole Dosage Guide + Max Dose, Adjustments
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Medically reviewed by Drugs.com. Last updated on Dec 26, 2022.
Applies to the following strengths: 40 mg; 20 mg
Usual Adult Dose for:
- Erosive Esophagitis
- Gastroesophageal Reflux Disease
- Zollinger-Ellison Syndrome
- Pathological Hypersecretory Conditions
Usual Pediatric Dose for:
- Erosive Esophagitis
- Gastroesophageal Reflux Disease
Additional dosage information:
- Renal Dose Adjustments
- Liver Dose Adjustments
- Dose Adjustments
- Precautions
- Dialysis
- Other Comments
Usual Adult Dose for Erosive Esophagitis
Treatment: 40 mg orally once a day
- Duration of therapy: 8 weeks
Maintenance: 40 mg orally once daily
Comments:
- If patients are not healed after 8 weeks or erosive esophagitis (EE) recurs with the oral formulation, treatment for another 8 weeks may be considered.
- Controlled studies using the oral formulation for maintenance did not extend beyond 12 months.
Uses:
- Short-term treatment in the healing and symptomatic relief of EE
- Maintenance of healing of EE
Usual Adult Dose for Gastroesophageal Reflux Disease
Oral: 40 mg orally once a day
- Duration of therapy: 8 weeks
Parenteral: 40 mg via IV infusion once a day, given over at least 2 minutes OR over 15 minutes
- Duration of therapy: 7 to 10 days
Comments:
- IV treatment should be discontinued once the patient is able to take an oral formulation.
- Use of the IV formulation has not been studied for longer than 10 days.
- Safety and efficacy for uses otherwise described (e.g., life-threatening gastrointestinal bleeds) are not available; however, use of this drug at 40 mg/day doses did not raise gastric pH to sufficient levels to contribute to the treatment of life-threatening conditions.
- If patients are not healed after 8 weeks with the oral formulation, treatment for another 8 weeks may be considered.
Uses:
- Short-term treatment of gastroesophageal reflux disease (GERD) in patients with a history of erosive esophagitis
- Reduction of relapse rates of daytime and nighttime heartburn symptoms in adult patients with GERD
Usual Adult Dose for Zollinger-Ellison Syndrome
Oral: 40 mg orally 2 times a day
- Maximum dose: 240 mg/day
Parenteral:
- Initial dose: 80 mg via IV infusion every 12 hours, given over at least 2 minutes OR over 15 minutes
- Maintenance dose: 80 mg via IV infusion every 8 to 12 hours, given over at least 2 minutes OR over 15 minutes
- Maximum dose: 240 mg/day
- Maximum duration of therapy: 6 days
Comments:
- IV treatment should be discontinued once the patient is able to take an oral formulation.
- Use of the IV formulation for longer than 6 days and/or with doses higher than 240 mg has not been adequately studied.
- Patients may be vulnerable to increased acid production despite a short period of loss of effective inhibition.
- Patients given the oral formulation should be continued on therapy for as long as clinically necessary.
Uses:
- Treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome
- Pathological hypersecretion conditions, including Zollinger-Ellison syndrome
Usual Adult Dose for Pathological Hypersecretory Conditions
Oral: 40 mg orally 2 times a day
- Maximum dose: 240 mg/day
Parenteral:
- Initial dose: 80 mg via IV infusion every 12 hours, given over at least 2 minutes OR over 15 minutes
- Maintenance dose: 80 mg via IV infusion every 8 to 12 hours, given over at least 2 minutes OR over 15 minutes
- Maximum dose: 240 mg/day
- Maximum duration of therapy: 6 days
Comments:
- IV treatment should be discontinued once the patient is able to take an oral formulation.
- Use of the IV formulation for longer than 6 days and/or with doses higher than 240 mg has not been adequately studied.
- Patients may be vulnerable to increased acid production despite a short period of loss of effective inhibition.
- Patients given the oral formulation should be continued on therapy for as long as clinically necessary.
Uses:
- Treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome
- Pathological hypersecretion conditions, including Zollinger-Ellison syndrome
Usual Pediatric Dose for Erosive Esophagitis
5 years and older:
15 to less than 40 kg: 20 mg orally once a day
40 kg and greater: 40 mg orally once a day
Duration of therapy: Up to 8 weeks
Comment: Safety has not been established in treatment beyond 8 weeks.
Uses:
- Short-term treatment in the healing and symptomatic relief of EE
- Short-term treatment of GERD in patients with a history of EE
Usual Pediatric Dose for Gastroesophageal Reflux Disease
5 years and older:
15 to less than 40 kg: 20 mg orally once a day
40 kg and greater: 40 mg orally once a day
Duration of therapy: Up to 8 weeks
Comment: Safety has not been established in treatment beyond 8 weeks.
Uses:
- Short-term treatment in the healing and symptomatic relief of EE
- Short-term treatment of GERD in patients with a history of EE
Renal Dose Adjustments
Data not available
Liver Dose Adjustments
IV: Data not available
Oral: Doses over 40 mg/day have not been studied in patients with liver impairment. No adjustment recommended.
Dose Adjustments
CYP450 2C19 Poor Metabolizers:
Adults: No adjustment recommended.
Pediatric patients: Oral dose reductions should be considered.
Pathological Hypersecretion (including Zollinger-Ellison syndrome):
- Acid output target range: Less than 10 mEq/h
Precautions
CONTRAINDICATIONS:
- Hypersensitivity to the active component, substituted benzimidazoles, or any of the ingredients
- Patients receiving rilpivirine-containing products
Safety and efficacy of oral formulations have not been established in patients younger than 5 years.
The IV formulation is not recommended for use in children.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Administration advice:
- Tablet formulations should be swallowed whole, without crushing/chewing; tablets may be taken with or without food.
- For patients unable to swallow a 40 mg tablet, two 20 mg tablets may be taken; however, the 40 mg oral suspension packet formulation should not be divided to create two-20 mg dosages.
- Oral suspension/granule formulations should be taken on an empty stomach, preferably 30 to 60 minutes before a meal.
- The granule formulation may be sprinkled into applesauce or mixed into a small volume of either apple juice or orange juice and swallowed immediately. This drug may be mixed with apple juice and administered via nasogastric tube.
Storage requirements: The manufacturer product information should be consulted.
Reconstitution/preparation techniques: The manufacturer product information should be consulted.
IV compatibility: The manufacturer product information should be consulted.
General:
- This drug may be used concomitantly with antacids without affecting the absorption.
- Reflux symptoms may take 2 to 3 days to improve after initiation.
- Rapid acid control may be achieved within an hour at an IV dose of 160 mg.
Monitoring:
- HEPATIC: Liver function tests, especially in patients with impaired liver function
- METABOLIC: Magnesium levels, especially in patients taking other drugs that could result in hypomagnesemia or those on long-term therapy; Vitamin B12 levels, especially in patients on long-term therapy
- MUSCULOSKELETAL: Bone fractures, especially in patients at high-risk for osteoporosis-related events
- RENAL: Renal function tests
Patient advice:
- Advise patients to avoid taking concomitant proton pump inhibitors and/or h3 antagonists during treatment.
- If using this drug to treat H pylori, tell patients that it is important to complete the full regimen.
- Instruct patients to seek medical attention if signs/symptoms of hypersensitivity, Clostridium difficile, or systemic cutaneous lupus erythematosus occur.
- Patients should be told that treatment may not provide immediate relief and that they should not take this drug for prophylaxis. Symptomatic relief may occur after 1 day of treatment, but patients should continue treatment for the full duration to achieve complete symptom control.
- Inform patients that this drug may cause dizziness or blurred vision, and they should avoid driving or operating machinery if these side effects occur.
- Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
Frequently asked questions
- Pantoprazole vs. omeprazole: What’s the difference between them?
- Can you take pantoprazole 40 mg twice a day?
- How long can I take pantoprazole?
- Does pantoprazole cause bloating?
More about pantoprazole
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- Compare alternatives
- Pricing & coupons
- Reviews (415)
- Drug images
- Side effects
- Patient tips
- During pregnancy
- Support group
- Drug class: proton pump inhibitors
- Breastfeeding
- En español
Patient resources
- Drug Information
- Pantoprazole (Intravenous) (Advanced Reading)
- Pantoprazole (Oral) (Advanced Reading)
- Pantoprazole Delayed-Release Granules
- Pantoprazole Delayed-Release Tablets
- Pantoprazole Injection
Other brands
Protonix, Protonix IV
Professional resources
- Prescribing Information
Related treatment guides
- Erosive Esophagitis
- Barrett’s Esophagus
- Dumping Syndrome
- Duodenal Ulcer
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Medical Disclaimer
Pantoprazole Interactions Checker – Drugs.com
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There are 163 drugs known to interact with
pantoprazole, along with
4 disease interactions.
Of the total drug interactions,
16 are major, 128 are moderate, and 19 are minor.
Does pantoprazole interact with my other drugs?
Enter other medications to view a detailed report.
- View all 163 medications that may interact with pantoprazole
- View pantoprazole disease interactions (4)
Most frequently checked interactions
View interaction reports for pantoprazole and the medicines listed below.
- Major
- Moderate
- Minor
- Unknown
- Aspir 81 (aspirin)
- Aspirin Low Strength (aspirin)
- Benadryl (diphenhydramine)
- CoQ10 (ubiquinone)
- Crestor (rosuvastatin)
- Cymbalta (duloxetine)
- Eliquis (apixaban)
- Fish Oil (omega-3 polyunsaturated fatty acids)
- Flonase (fluticasone nasal)
- Lasix (furosemide)
- Lexapro (escitalopram)
- Lipitor (atorvastatin)
- Lyrica (pregabalin)
- Metoprolol Succinate ER (metoprolol)
- Metoprolol Tartrate (metoprolol)
- MiraLAX (polyethylene glycol 3350)
- Norco (acetaminophen / hydrocodone)
- Plavix (clopidogrel)
- ProAir HFA (albuterol)
- Singulair (montelukast)
- Symbicort (budesonide / formoterol)
- Synthroid (levothyroxine)
- Tylenol (acetaminophen)
- Vitamin B12 (cyanocobalamin)
- Vitamin C (ascorbic acid)
- Vitamin D2 (ergocalciferol)
- Vitamin D3 (cholecalciferol)
- Xanax (alprazolam)
- Xarelto (rivaroxaban)
- Zyrtec (cetirizine)
Pantoprazole disease interactions
There are 4 disease interactions with pantoprazole which include:
- C. diff
- liver disease
- bone fractures
- hypomagnesemia
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More about pantoprazole
- pantoprazole consumer information
- Compare alternatives
- Pricing & coupons
- Reviews (415)
- Drug images
- Side effects
- Dosage information
- Patient tips
- During pregnancy
- Support group
- Drug class: proton pump inhibitors
- Breastfeeding
- En español
Related treatment guides
- Erosive Esophagitis
- Barrett’s Esophagus
- Dumping Syndrome
- Duodenal Ulcer
