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Pantoprazole – 8 important side effects

by egpat         30 May 2024

Pantoprazole is one of the well-known medications that is classified as a proton pump inhibitor (PPI). This drug has the suffix "-prazole", which can be observed in many of the proton pump inhibitors like omeprazole, rabeprazole, and lanseprazole. All of these are proton pump inhibitors. Their main role is to decrease gastric acid secretion. Gastric acid is essential for digestion and proteolysis, which mainly contain gastric acid, HCl. But when this HCl is excessively secreted, it can increase the gastric acidity, leading to abdominal pain, burning sensations, indigestion, and flatulence.

In such conditions, we can use proton pump inhibitors like pantoprazole. But while using pantoprazole, we can observe the different types of side effects that can be classified as acute side effects. These side effects are immediately developed within the first few weeks of the treatment. Generally, these side effects are mild and well-tolerated. Similarly, we can see the long-term side effects of pantoprazole, which are mainly associated with the suppression of gastric acid.

The main purpose of pantoprazole is to reduce gastric acid secretion, but at the same time, this gastric acid is essential for digestion, proteolysis, and even the absorption of a few of the important minerals. So suppression of gastric acid for several days may lead to long-term side effects. The induction of long-term side effects depends on how long pantoprazole is used and at what dose it is going to be used. Generally, pantoprazole can be given at a low dose, starting from 20 mg to 40 mg taken once daily on an empty stomach.

However, based on the patient's conditions and the extent of gastric ulcers, pantoprazole can also be given in multiple doses for longer periods of time. In such conditions, we can observe the long-term side effects of pantoprazole. Typically, pantoprazole can be used for up to 8 weeks in order to control the excess gastric acid, but in a few cases, based on the gastric ulceration, it can be used for up to one year and, in a few cases, up to 3 years. So in such people, we can observe long-term side effects of pantoprazole.

Interestingly, in a few of the cases, these long-term side effects can also be observed within 8 weeks of the treatment because of any coexisting conditions. That's why it is very essential to know the side effects of pantoprazole, so in this post we are going to discuss eight important side effects of pantoprazole and how they are managed.

1. Gastric side effects

Since pantoprazole is going to reduce gastric acid secretion, we can observe gastric side effects with the use of pantoprazole. These are acute side effects that are commonly observed in many people. With the use of pantoprazole, we can observe diarrhea, nausea, a feeling of vomiting, and even some abdominal pain and flatulence.

But among these side effects, one of the most important is diarrhea. Many people have mild diarrhea, but in a few cases, it can be severe. If diarrhea is uncontrolled with the use of pantoprazole, there may be a chance of the development of a few of the small microorganisms, like Clostridium difficle. This results in a bacterial infection in the colon that can induce severe diarrhea. In such people, we can observe watery stools and severe abdominal pain that is not restored even after several days.

Particularly, such infections can be more pronounced when this pantoprazole is combined with a few antibiotics. Since antibiotics reduce the gut flora, they increase the risk of clostridium difficle infection. Except for severe diarrhea, all other gastric side effects of pantoprazole are well tolerated within the period of treatment.

2. Upper respiratory tract infection

Pantoprazole can produce upper respiratory tract infections, particularly in children. That's why, in children, pantoprazole should be used at a very low dose for a short period of time. It can cause sneezing, headaches, the induction of coughs, fever, and muscle weakness. So these side effects should be closely monitored in children when this pantoprazole is prescribed.

3. Vitamin B12 deficiency

This vitamin B12 is also called cobalamin. The absorption of vitamin B12 is influenced by pantoprazole. Normally, this vitamin is present in the dietary protein in a complex form. It can be released and absorbed into the systemic circulation only after proteolysis. This proteolysis is carried out by one of the enzymes, pepsin. Pepsin is available in its inactive form, pepsinogen. This pepsinogen is going to be converted into pepsin in the presence of gastric acid. So, gastric acid is required for the activation of pepsinogen into pepsin. Once it is activated, pepsin is going to cleave this dietary protein where vitamin B12 is going to be released, and this vitamin can be absorbed into the systemic circulation with the help of intrinsic factors.

But here, the release of vitamin B12 from the dietary protein is very important, which requires an acidic environment. Now, pantoprazole can inhibit gastric acid secretion, thereby inhibiting pepsin activation. When the pepsin is not activated, it can reduce the proteolysis, thereby preventing vitamin B12 from being released and absorbed. This results in a vitamin B12 deficiency. However, this process may take a long time, so it is a long-term side effect of pantoprazole.

Vitamin B12 deficiency can produce symptoms like fatigue, weakness, headaches, muscle weakness, and numbness. Decreased functionality of the neurons leads to numbness, loss of sensation, and even some mood changes. A decrease in the mood, dizziness, and lightheadedness can be observed. These symptoms may be observed with the long-term use of pantoprazole. In a few cases, vitamin B12 supplementation is required, particularly in people with diabetes or coexisting conditions.

4. Iron deficiency

This is another effect of pantoprazole. Iron is present as ferric iron in the dietary source, but this ferric iron is not readily absorbed into the intestine. It should be reduced into ferrous iron, which is ready for absorption. Again, this process requires an acidic environment, and HCl is required. Now pantoprazole can inhibit gastric acid secretion, which reduces the conversion of ferric iron into ferrous iron. Because of this effect, iron is not properly absorbed, resulting in the development of anemia in people.

So long-term use of pantoprazole can cause weakness, fatigue, and the development of muscle pain. All these side effects can be observed because of the development of iron deficiency. In those with pre-existing anemic conditions, iron deficiency is more pronounced. If it is required, iron supplements should be taken in order to counteract the anemia produced by pantoprazole.

5. Bone demineralization

This is another effect of pantoprazole on calcium absorption. With long-term use of pantoprazole, it can affect bone functionality and reduce calcium absorption, which results in an increased risk of fractures. The risk of fractures is particularly observed with multiple doses of pantoprazole for longer periods of time.

When this pantoprazole is used for a longer period of time, greater than one year, the risk of bone fractures is increased, as is the risk of osteoporosis. Particularly, it can affect the bones at the hip, wrist, and spine, and in those people with pre-existing osteoporosis or a risk of bone fractures, pantoprazole should be carefully used.

6. Magnesium deficiency

Just like calcium, pantoprazole can also reduce magnesium absorption, leading to hypomagnesia. This condition may result in various symptoms, like muscle cramps, because magnesium is required for muscle functionality, and it can also produce some tremors and shakiness. It can also increase weakness, particularly muscle weakness.

7. Effect on kidney

Generally, pantoprazole is metabolized in the liver and excreted in the kidney. On long-term use, pantoprazole can affect the kidneys, resulting in interstitial nephritis. It is one of the inflammations of renal tubules that increases the space between the tubules and mainly results in decreased renal functionality.

Even though it is a rare side effect, it can be observed in a few people when this pantoprazole is used for more than four weeks. In such people, we can observe unexpected weight loss and the development of a fever, which may indicate decreased renal functionality.

8. Lupus-like reaction

Pantoprazole can produce a lupus-like reaction. It can produce some skin rashes and even some joint pain, fatigue, and weakness. Such types of symptoms can be observed because of an autoimmune disorder called lupus infection. Again, this is a rare side effect, but in people with decreased immunity or any coexisting infections, lupus reactions can be observed, leading to the development of skin rashes and joint pains.


So these are the eight important side effects of pantoprazole that can be observed. The common side effects are mainly gastrointestinal side effects like diarrhea, nausea, flatulence, and abdominal pain, but diarrhea can be more pronounced in conditions like clostridium difficle infection. Upper respiratory tract infections can be observed in children, and many of the side effects of pantoprazole are because of its long-term use.

It can produce iron deficiency, vitamin B12 deficiency, and magnesium deficiency, and it can also increase the risk of bone fractures. It can even increase the lupus-like reaction. When pantoprazole is used for a short-term period at a low dose, the side effects are very mild, but in the long term, it can produce some significant side effects.