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Protonix (pantoprazole) is a proton-pump inhibitor used to treat gastroesophageal reflux disease (GERD), help with the healing of erosive esophagitis, and to treat Zollinger–Ellison syndrome or similar conditions.

Like all proton-pump inhibitors, Protonix works by reducing production of stomach acid. All medications in this class are well-tolerated, with side effects being rare and mild when used as directed. Proton-pump inhibitors are among the most widely-used medications in the world, with Protonix being somewhat more popular than similar medications.

Protonix can be used in patients age 5 years old and up, though dosage modification is required for younger patients.

Taking Protonix

This medication comes in tablets or oral solution; the oral solution is ideal for those who are unable or reluctant---as is often the case with young children---to swallow whole tablets. Tablets are preferred for other patients. Note that 20 mg tablets are smaller than 40 mg tablets; patients can take two 20 mg tablets for the same effect as a single 40 mg tablets, if the 40 mg tablet is difficult to swallow.

Protonix tablets must be swallowed whole; they cannot be split, crushed or dissolved. This is because they're designed to gradually release medication over time. Tablets can be taken with or without food according to personal preference.

Treatment of otherwise healthy adults varies to some degree depending on what's being treated.

To treat GERD:

• Take 40 mg once per day.
• Continue treatment for up to 8 weeks.

To help heal erosive esophagitis:

• Take 40 mg once per day.
• Continue treatment for up to 8 weeks.

To help with Zollinger-Ellison syndrome or similar conditions in which excessive stomach acid is produced:

• Take 40 mg twice per day.
• Continue treatment for as long as a doctor recommends.

To treat GERD in children weighing 88 lbs (40 kg) or less:

• Take 20 mg once per day.
• Continue treatment for 8 weeks.

Protonix will reduce the amount of stomach acid produced; this will help reduce the heartburn, difficulty swallowing, coughing, and other symptoms. It will help the esophagus heal without exposure to gastric acids and, in the case of Zollinger-Ellison syndrome, will eliminate many of the associated symptoms, including pain and diarrhea.

Warnings & Side Effects

Protonix, used as directed, is a remarkably safe medication. Side effects are rare and mild, usually well-worth the trade-off for reduction of stomach acid. Rarely, though, and more commonly when the medication is used in greater quantity or for longer than recommended, serious side effects may develop:

• Low vitamin B12
• Low magnesium
• Kidney problems
• Risk of broken bones in the hip or spine (particularly in the elderly)

Note that low levels of magnesium in particular can lead to heart and other muscle problems. Seek medical attention if the heart beats rapidly, slowly, or irregularly, and if any muscle spams or cramps develop.

Low levels of stomach acid, as produced by Protonix use, may reduce the stomach's ability to destroy bacteria that are ingested. While this is usually only an issue for individuals in a hospital setting---thus exposed to a relatively high rate of bacteria---patients should be alert for symptoms of infection.

Protonix can interact with certain other medications, including:

• Blood thinners
• Diuretics
• Iron supplementation
• Antifungals
• HIV medications

Patients who are allergic to any other proton-pump inhibitor will likely be allergic to Protonix. A doctor can safely test for this.

Protonix should not be used while pregnant or breastfeeding unless the benefits clearly outweigh the risks. In animal studies, at much higher doses, Protonix did produce birth defects, though it's not know if this happens in humans, or at doses administered to humans.