Proton Pump Inhibitor (PPI) Pregnancy: A moderate amount of data on pregnant women (between 300-1000 pregnancy outcomes) indicate no malformative or feto/neonatal toxicity; animal studies have shown reproductive toxicity. As a precautionary measure, it is preferable to avoid use during pregnancy. Excretion into human milk has been reported and a risk to newborns/infants cannot be excluded — decide whether to discontinue breast-feeding or discontinue/abstain from therapy.

Pantoprazole

Brand names: Protium

Used in: Gastrointestinal Bleeding

Pantoprazole is a proton-pump inhibitor used for gastro-oesophageal reflux disease, peptic ulcer disease, and gastroprotection.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 20 mg (symptomatic gastro-oesophageal reflux disease)

Route: Oral — swallow tablets whole (do not chew or crush) 1 hour before a meal with some water

Frequency: Once daily

Source SPC is the 20 mg gastro-resistant tablet. Adults and adolescents 12 years of age and above — symptomatic GORD: 20 mg once daily; symptom relief is generally accomplished within 2-4 weeks and, if not sufficient, normally within a further 4 weeks. Once symptom relief is achieved, recurring symptoms can be controlled with an on-demand regimen of 20 mg once daily when required; switch to continuous therapy if on-demand control is unsatisfactory. Long-term management and prevention of relapse in reflux oesophagitis: maintenance 20 mg once daily, increasing to 40 mg pantoprazole per day if a relapse occurs (a 40 mg strength is available), then reducing again to 20 mg after healing of the relapse. Adults — prevention of gastroduodenal ulcers induced by non-selective NSAIDs in at-risk patients needing continuous NSAID treatment: 20 mg once daily. Severe liver impairment: a daily dose of 20 mg should not be exceeded, and liver enzymes should be monitored regularly (discontinue if they rise). Elderly: no dose adjustment necessary. Paediatric population: not recommended for use in children below 12 years of age due to limited safety and efficacy data.

Dose adjustments

Renal

No dose adjustment is necessary in patients with impaired renal function.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

GERD and a History of EE Adults: The recommended dosage is 40 mg once daily by intravenous injection (over at least 2 minutes) or intravenous infusion (for 15 minutes) for up to 10 days. ( 2.1 ) Discontinue as soon as the patient is able to receive oral treatment. Switch to an appropriate oral medication within 10 days of starting pantoprazole sodium for injection. ( 2.1 ) Pathological Hypersecretion Conditions, Including ZE Syndrome The recommended adult dosage is 80 mg every 12 hours by intravenous injection (over at least 2 minutes) or intravenous infusion (for 15 minutes). ( 2.2 ) For information on how to adjust dosing for individual patient needs, see the full prescribing information. …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-06-27. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance, substituted benzimidazoles or to any of the excipients

Side effects

Headache and dizziness
Diarrhoea
Nausea / vomiting
Abdominal pain and discomfort, abdominal distension and bloating, constipation, dry mouth
Rash / exanthema / eruption, pruritus
Fundic gland polyps (benign); liver enzymes increased (transaminases, gamma-GT)

Interactions

HIV protease inhibitors whose absorption is dependent on acidic intragastric pH, such as atazanavir — co-administration is not recommended due to significant reduction in their bioavailability (SPC 4.4)
Note: SPC section 4.5 was not captured in this source bundle — the interaction above is drawn from section 4.4

Clinical monograph

How it works

It irreversibly inhibits the gastric H-K-ATPase (proton pump) in parietal cells, strongly reducing acid secretion.

Prescribing in practice

Use the lowest effective dose for the shortest appropriate time, and review long-term use.
It has comparatively few CYP interactions among the PPIs; long-term effects can include low magnesium, reduced vitamin B12 absorption, and small increases in some infections and fractures.
It can mask the symptoms of gastric cancer — investigate alarm features.

Monitoring

No routine monitoring for short courses; consider magnesium with long-term use and review the ongoing need.

Counselling the patient

Take it before food.
Report difficulty swallowing, unintended weight loss, or black stools.

Evidence & guidelines

A PPI for GORD, peptic ulcer disease and gastroprotection, valued for relatively few drug interactions.

Reference: NICE CG141 Peptic Ulcer; ESC AFib PPI guidance; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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