Pantoprazole magnesium belongs to the family of medications called proton pump inhibitors (PPIs). Proton pump inhibitors are used to treat conditions where a reduction in stomach acid is needed, such as stomach ulcers, duodenal (intestinal) ulcers, reflux esophagitis (a severe form of heartburn), and symptoms of gastroesophageal reflux disease (GERD; e.g., heartburn and acid regurgitation). Pantoprazole is also sometimes used along with antibiotics to treat duodenal ulcers that are caused by bacteria known as H. pylori.

Pantoprazole works to reduce the amount of acid the stomach produces by blocking the action of an enzyme (proton pump) that produces acid in the stomach.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended adult dose to treat reflux esophagitis is 40 mg once daily in the morning for 4 to 8 weeks.

To treat symptoms of GERD, including heartburn and acid regurgitation, the recommended dose is 40 mg once daily for up to 4 weeks. Contact your doctor if the symptoms have not improved after 4 weeks. Other, more serious, causes of heartburn and acid regurgitation may need to be ruled out.

To treat duodenal (intestinal) ulcers, the recommended adult dose is 40 mg once daily in the morning for 2 to 4 weeks.

The recommended dose of pantoprazole magnesium to treat gastric (stomach) ulcers, is 40 mg once daily in the morning for 4 to 8 weeks.

To treat duodenal (intestinal) ulcers caused by H. pylori in adults, the dose of pantoprazole magnesium is 40 mg twice daily taken with amoxicillin 1,000 mg twice daily and clarithromycin 500 mg twice daily, or pantoprazole magnesium 40 mg twice daily taken with metronidazole 500 mg twice daily and clarithromycin 500 mg twice daily. The usual duration of this treatment is 7 days.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Pantoprazole magnesium tablets must be swallowed whole. Do not chew or crush the tablets. Take this medication with a glass of water in the morning before, during, or after breakfast.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Each yellow, film-coated, round, biconvex tablet imprinted with PM1 in black ink on one side and blank on the other side, contains 40 mg of pantoprazole as pantoprazole magnesium hemipentahydrate. Nonmedicinal ingredients: calcium stearate, crospovidone, hypromellose, hydroxypropyl cellulose, mannitol, methacrylic acid copolymer, propylene glycol, povidone, sodium carbonate anhydrous, titanium dioxide, and triethyl citrate; coating: HPMC 2910/hypromellose, iron oxide yellow, propylene glycol, talc, and titanium dioxide; ink: ammonium hydroxide, iron oxide black, isopropyl alcohol, n-Butyl alcohol, propylene glycol, and shellac glaze.

Do not take pantoprazole magnesium if you:

• are allergic to pantoprazole or any ingredients of the medication
• are taking the medication rilpivirine

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal pain
• diarrhea (mild)
• dizziness
• headache
• nausea

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• any changes in vision
• new or worsening joint pain
• rash on the cheeks or arms that gets worse in the sun
• signs of liver damage (such as yellow skin or eyes, abdominal pain, dark urine, pale or clay-coloured stools, loss of appetite)
• symptoms of dehydration (e.g., extreme thirst, dark-coloured urine, fatigue, dizziness, confusion)
• symptoms of gut inflammation (e.g., ongoing watery diarrhea, abdominal pain, cramps, bloating, weight loss, nausea, dehydration)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• severe, watery diarrhea; may also be bloody
• severe skin rash, including skin blistering and peeling (possibly with headache, fever, coughing, or aching before the rash begins)
• signs of a serious allergic reaction (e.g., abdominal cramps; swelling of the face, throat, or tongue; hives; or difficulty breathing)
• signs of muscle damage (unexplained muscle pain, tenderness or weakness, or brown or discoloured urine - especially if you also have a fever or a general feeling of being unwell)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Cancer: Long-term use of proton pump inhibitors can cause changes in the body that may increase the risk of certain types of cancer, including liver and thyroid cancer. The lowest dose of this medication should be used for the shortest period of time to get relief. If you have concerns, talk to your doctor.

Diarrhea: When gastric acid is decreased, the number of bacteria normally in the digestive system increases. Occasionally, this can cause serious infection in the digestive tract. If you experience severe, watery or bloody diarrhea; fever; or abdominal pain while taking pantoprazole, contact your doctor as soon as possible.

Electrolyte balance: Long-term use of pantoprazole may cause the levels of electrolytes such as potassium, calcium, and magnesium in the blood to decrease. If you experience symptoms of fluid and electrolyte imbalance such as muscle pains or cramps; dry mouth; numb hands, feet, or lips; or racing heartbeat, contact your doctor as soon as possible. Your doctor may do blood tests periodically to monitor the levels of these electrolytes in your blood while you are taking this medication.

Kidney function: The kidneys are responsible for removing pantoprazole magnesium from the body. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: If you have severe liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Methotrexate interaction: Pantoprazole magnesium, like other medications in this group, may interact with methotrexate when the two medications are used at the same time. This combination may lead to higher than expected amounts of methotrexate in the body and can cause serious side effects, including kidney damage, irregular heartbeat, anemia, or infection. If you take pantoprazole and are also going to receive a dose of methotrexate, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Osteoporosis fractures: Long-term use of pantoprazole may be related to an increased risk of bone fractures in the hip, wrist, or spine, as a result of weakened bones. This risk is further increased if you are at risk of developing osteoporosis. If you have osteoporosis or have risk factors for developing osteoporosis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Severe stomach problems: If you experience recurrent vomiting, difficulty swallowing, blood in the stool (dark stools), significant unintentional weight loss, fatigue, or are coughing up blood, contact your doctor right away. These may be symptoms of other medical problems that should be checked out by your doctor.

Skin conditions: Some people taking pantoprazole magnesium or other similar medications may develop a skin condition called subacute cutaneous lupus erythematosus. If you develop a rash on areas of skin that are exposed to the sun, such as the face, arms, or shoulders, check with your doctor as soon as possible.

Vitamin B12: Long-term use of pantoprazole magnesium may lead to vitamin B12 deficiency. If you are a vegetarian or have low vitamin B12 levels, discuss with your doctor whether any special monitoring is required.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication may pass into breast milk. If you are breast-feeding and are taking pantoprazole magnesium, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

There may be an interaction between pantoprazole magnesium and any of the following:

• amphetamines
• "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
• bisphosphonates (e.g., alendronate, clodronate, risedronate)
• capecitabine
• cefuroxime
• clopidogrel
• cysteamine
• doxycycline
• HIV protease inhibitors (e.g., atazanavir, tipranavir)
• lumacaftor and ivacaftor
• methotrexate
• monoclonal antibodies (e.g., atezolizumab, durvalumab, ipilimumab)
• multivitamin/mineral supplements
• mycophenolate
• nivolumab
• octreotide
• pioglitazone
• certain protein kinase inhibitors (e.g., acalabrutinib, bosutinib, dasatinib, erlotinib, nilotinib, pazopanib)
• riociguat
• rosiglitazone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.