Pantoprazole: uses, doses and side effects

Pantoprazole stops the acid pumps in the stomach lining from working properly, so the stomach makes less acid. The NHS lists heartburn and acid reflux, gastro-oesophageal reflux disease, preventing and treating stomach ulcers, and Zollinger-Ellison syndrome among its uses.

It is only taken by mouth, as tablets. The NHS names Pantoloc Control as a brand. You may also see it dispensed under its generic name.

The NHS describes typical daily amounts of 20 mg for heartburn and acid reflux, 20 mg to 40 mg for reflux disease, 40 mg for stomach ulcers and a starting 80 mg for Zollinger-Ellison syndrome, which may be raised later. These figures are for orientation only; the prescriber and label decide the right amount for you.

Pantoprazole is usually swallowed whole with water first thing in the morning, about an hour before eating. Some people are asked to take it twice a day, morning and evening.

• If you bought the 20 mg tablets, use them for up to 2 weeks, and a second 2 weeks only if you improved; do not go beyond 4 weeks without seeing a doctor.

• On prescription, treatment can last weeks, months or years, and some people move to taking it only when symptoms flare.

• Missed a once-daily tablet? Take it unless the next dose is within 12 hours. For twice daily, the gap is 4 hours.

• Taking one or two extra tablets is unlikely to be harmful. Call NHS 111 if you have exceeded the dose and feel unwell, or 999 if seriously ill.

Most adults can take pantoprazole, and children from 12 years if prescribed. You should check with a doctor or pharmacist before starting if you have ever reacted badly to it or another medicine, if you have liver problems, or if your vitamin B12 is low.

The NHS also asks you to mention pregnancy, trying for a baby and breastfeeding, and any endoscopy that is planned, because pantoprazole may hide problems that would normally be seen.

Before using the over-the-counter tablets, see a doctor if you have unexplained weight loss, ongoing vomiting or vomiting blood, unusual weakness or paleness, dark tar-like stools, chest or stomach pain, severe or persistent diarrhoea, or difficulty swallowing.

Most people have no side effects. Those that do occur, at fewer than 1 in 100, are headache, diarrhoea, feeling or being sick, constipation, a dry mouth and tiredness, and they usually go once treatment ends.

Rare effects, below 1 in 1,000, deserve prompt advice from a doctor or NHS 111. They include joint pain with a rash on sun-exposed skin, worsening stomach pain with yellow skin or eyes and dark urine (a liver problem), and pain passing urine, passing less urine, back pain, swollen ankles, rash or fever (which may point to the kidneys). Severe or persistent diarrhoea can signal an inflamed bowel.

• Call 999 if your lips, mouth, throat or tongue swell, you struggle to breathe or swallow, or you become pale, confused, faint or unresponsive.

• After 3 months or more, blood magnesium can fall, causing tiredness, confusion, dizziness, twitching and an irregular heartbeat.

• After a year there is a higher chance of fractures, gut infections and low vitamin B12.

Pantoprazole is not usually recommended during pregnancy because safety information is limited, and omeprazole may be suggested. Breastfeeding while taking it is considered safe, as only tiny amounts reach the milk, though you should watch a baby for poor feeding, bowel changes, vomiting or irritability. No evidence suggests it lowers fertility.

The NHS names these medicines as ones to mention: the antifungals itraconazole, posaconazole and voriconazole, methotrexate, HIV medicines, rifampicin and warfarin. St John's wort may stop pantoprazole working properly and is best avoided. Little is known about other herbal products, so say what you use.

Alcohol is allowed but makes the stomach produce more acid, so heavy drinking can undo the benefit. Rich, spicy, fatty and acidic foods and caffeine are worth cutting back on.

Dizziness or drowsiness can occur. If you feel affected, do not drive; the responsibility for deciding if you are fit to drive is yours.

After a year of continuous prescription use, regular health checks are arranged to see whether you still need the medicine. The NHS also notes research suggesting a possible slight increase in stomach cancer risk after three or more years, though studies are inconclusive.

Pantoprazole is available on prescription, with 20 mg tablets also on sale over the counter in pharmacies for adults with heartburn and reflux.

Other proton pump inhibitors, including omeprazole, esomeprazole and lansoprazole, are alternatives that your prescriber may choose between depending on pregnancy, other medicines and past response. Suspected side effects can be reported through the Yellow Card scheme.