Protonix (Pantoprazole Sodium)

(pan toe' pra zole)

Pantoprazole is used to treat 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). Pantoprazole is used to treat the symptoms of GERD, allow the esophagus to heal, and prevent further damage to the esophagus. It is also used to treat conditions where the stomach produces too much acid, such as Zollinger-Ellison syndrome. Pantoprazole is in a class of medications called proton-pump inhibitors. It works by decreasing the amount of acid made in the stomach.

Pantoprazole comes as a delayed-release (releases the medication in the intestine to prevent break-down of the medication by stomach acids) tablet and as delayed-release granules to take by mouth. The packets of delayed-release granules must be mixed with applesauce or apple juice and taken by mouth or given through a feeding tube. For the treatment and maintenance of GERD, pantoprazole is usually taken once a day. For the treatment of conditions where the stomach produces too much acid, pantoprazole is usually taken twice a day. The delayed-release tablets are usually taken with or without food, and the granules are usually taken 30 minutes before a meal. Take pantoprazole at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take pantoprazole exactly as directed. Do not take more or less of it or take it more often or for a longer period of time than prescribed by your doctor. Swallow the tablets whole; do not split, chew, or crush them. If your doctor has prescribed the 40 mg tablet and it is too big for you to swallow, ask your doctor to prescribe two of the 20 mg tablets instead. To take the granules, open the packet and either sprinkle the granules onto one teaspoonful of applesauce or into a cup containing one teaspoonful of apple juice. Do not mix the granules with water, other liquids, or other foods. Use all of the granules in the packet; do not divide the granules into smaller doses. If you sprinkle the granules into apple juice, stir the mixture for 5 seconds. Swallow the mixture of applesauce or apple juice and medication right away (within 10 minutes) without chewing or crushing the granules. If you sprinkled the granules on applesauce, take several sips of water to wash the granules down to your stomach. If you sprinkled the granules into apple juice, rinse the cup once or twice with apple juice and drink the apple juice right away to be sure you swallow any leftover granules. Pantoprazole granules mixed with apple juice may be given through a feeding tube. If you have a feeding tube, ask your doctor how you should take pantoprazole. Continue to take pantoprazole even if you feel well. Do not stop taking pantoprazole without talking to your doctor. If your condition does not improve or gets worse, call your doctor.

Before taking pantoprazole,
• tell your doctor and pharmacist if you are allergic to pantoprazole, dexlansoprazole (Dexilant), esomeprazole (Nexium, in Vimovo), lansoprazole (Prevacid), omeprazole (Prilosec, in Zegerid), rabeprazole (AcipHex), any other medications, or any of the ingredients in pantoprazole tablets or granules. Ask your pharmacist for a list of the ingredients.
• tell your doctor if you are taking rilpivirine (Edurant, in Complera, Odefsey). Your doctor will probably tell you not to take pantoprazole if you are taking this medication.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants (blood thinners) such as warfarin (Coumadin, Jantoven), atazanavir (Reyataz), digoxin (Lanoxin), dasatinib (Sprycel), diuretics ('water pills'), erlotinib (Tarceva), iron supplements, ketoconazole (Nizoral), methotrexate (Trexall), mycophenolate mofetil (Cellcept), nelfinavir (Viracept), nilotinib (Tasigna), and saquinavir (Invirase). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you are being treated with antibiotic medications, or if you have or have ever had a low level of magnesium in your blood,. osteoporosis (a condition in which the bones become thin and weak and break easily), or lupus (condition in which the immune system attacks many tissues and organs including the skin, joints, blood, and kidneys).
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking pantoprazole, call your doctor.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed dose.

Pantoprazole may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• headache
• nausea
• vomiting
• gas
• joint pain
• diarrhea
• dizziness

Some side effects may be serious. If you experience any of the following symptoms, call your doctor immediately, or get emergency medical help:

• blistering or peeling skin
• rash; hives; itching; swelling of the eyes, face, lips, mouth, throat, or tongue; difficulty breathing or swallowing; or hoarseness
• irregular, fast, or pounding heartbeat; muscle spasms; uncontrollable shaking of a part of the body; excessive tiredness; lightheadedness; seizures
• severe diarrhea with watery stools, stomach pain, or fever
• decreased urination or blood in urine
• joint pain and rash on cheeks or arms that gets worse in the sun

Pantoprazole may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. People who take proton pump inhibitors such as pantoprazole may be more likely to fracture their wrists, hips, or spine than people who do not take one of these medications. The risk is highest in people who take high doses of one of these medications or take them for one year or longer. People who take pantoprazole for a long time may develop weakening of the stomach lining and a low level of vitamin B12 in the blood. Talk to your doctor about the risks of taking pantoprazole.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Keep all appointments with your doctor and the laboratory. Your doctor may order certain laboratory tests before and during your treatment, especially if you have severe diarrhea. Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking pantoprazole. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.