Pantoprazole (Protonix) alternatives: What can I take instead of pantoprazole?

Compare pantoprazole alternatives | Omeprazole | Esomeprazole | Lansoprazole | Dexlansoprazole | Rabeprazole | Natural alternatives | How to switch meds

Pantoprazole is a commonly used prescription medication used to treat gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and other stomach acid-related conditions. This generic medication is also available under the brand-name Protonix. Pantoprazole belongs to a group of medications called proton pump inhibitors (PPIs) that work to prevent the gastric acid pump from secreting gastric acid, also called stomach acid. Gastric acid travels from the stomach up to the throat in conditions like GERD that can lead to symptoms such as heartburn, regurgitation of food, chest pain, trouble swallowing, coughing, or a sore throat. 

As highly effective acid-suppressing medications, PPIs are one of the most widely used groups of drugs worldwide. Pantoprazole is also approved for the treatment of Zollinger-Ellison syndrome, a rare condition of gastric tumors that lead to excess stomach acid production and can be used off-label to treat a bacterial infection called Helicobacter pylori (H. pylori) in the stomach or duodenum (first part of the small intestine). Pantoprazole is available as tablets and granule packets that are sprinkled into applesauce or apple juice.

While an effective treatment for some people, pantoprazole may not be the best and safest treatment for everyone managing stomach acid-related conditions. PPIs like pantoprazole can cause an increased risk of gastrointestinal (GI) infections like gastroenteritis and Clostridioides/clostridium difficile (C. diff) associated diarrhea. PPI use may also increase the risk of bone fractures in children, young adults, and older adults, including osteoporosis-related fractures. Additionally, PPIs can cause deficiencies in vitamin B12 and magnesium (hypomagnesemia) with long-term use. While all available PPIs are effective treatment options, the metabolism of these drugs can vary between people, meaning efficacy can also vary. This is why if one PPI isn’t working well enough, a different one can be tried.

RELATED: What’s the best heartburn medicine for you?

What can I take in place of pantoprazole?

There are other options available to treat GERD or other stomach acid-related conditions that do not improve with pantoprazole. All of the available PPIs are equally effective in equipotent dosages, so the price is often a deciding factor in choosing one PPI over another. Along with PPIs, other alternatives include Histamine H2 Antagonists (H2 blockers) and antacids. These options may be more suitable for certain individuals due to their different uses, side effect profiles, dosages, and cost.

Other alternatives to pantoprazole

Other alternatives to help treat stomach acid-related conditions include over-the-counter medications (OTCs) that may be useful for milder cases or occasional symptoms. OTC medications do not require a prescription, and some options include:

• Maalox (aluminum hydroxide, magnesium hydroxide, and simethicone)
• Pepto Bismol (bismuth subsalicylate)
• Tums (calcium carbonate)
• Tagamet (cimetidine)

Top 5 pantoprazole alternatives

The following are some of the most common alternatives to pantoprazole.

1. Omeprazole (Prilosec)

Omeprazole is one of the most commonly used PPIs and works just like pantoprazole to lower stomach acid secretion. This medication is available as an over-the-counter (OTC) medication that also comes as a brand name called Prilosec, and also a prescription medication that includes more dosage strengths (10 mg, 20 mg, and 40 mg). The capsule form of omeprazole can be opened and mixed with one tablespoon of applesauce for adults or children who have difficulty swallowing the capsule. Typically, omeprazole is best taken before breakfast on an empty stomach (about 30 to 60 minutes before eating). Omeprazole has similar side effects as pantoprazole, including nausea, diarrhea, abdominal pain, constipation, headache, and rash. This may be a suitable alternative for those who would like to purchase over the counter at a convenience store or for those who have not responded to pantoprazole.

RELATED: Pantoprazole vs. omeprazole: Differences, similarities, and which is better for you

2. Esomeprazole (Nexium)

Esomeprazole is another PPI that works to lower stomach acid secretion. Also known by the brand name Nexium, this medication is available as both an OTC medication and a prescription medication. For people with difficulty swallowing capsules, esomeprazole capsules can be opened and mixed with one tablespoon of applesauce. Esomeprazole is best taken at least one hour before eating and is usually taken before breakfast. Like the other available PPIs, esomeprazole shares similar common side effects. Esomeprazole is another great alternative for people who would like to purchase OTC or who have not had luck with pantoprazole for treatment of their stomach acid-related condition.

RELATED: Nexium side effects and how to avoid them

3. Lansoprazole (Prevacid)

Lansoprazole, also available as a brand name called Prevacid, is another PPI alternative option. Lansoprazole is available both as an OTC medication and prescription medication. This alternative has a few different options for dosing, including an oral disintegrating tablet (ODT) that dissolves on the tongue. The capsules can be opened and mixed with one tablespoon of applesauce, cottage cheese, yogurt, or strained pears. Lansoprazole capsules can also be opened and emptied into about 60 mL of orange juice, apple juice, or tomato juice. Lansoprazole has similar adverse effects as pantoprazole and is best if taken about 30 to 60 minutes before breakfast. This may be a well-suited alternative for people who have difficulty swallowing capsules or would like an OTC treatment option.

RELATED: How much is lansoprazole without insurance?

4. Dexlansoprazole (Dexilant)

Dexlansoprazole is another PPI alternative option that is also available as a brand name called Dexilant. Like pantoprazole, dexlansoprazole is currently only available with a  prescription. Dexlansoprazole capsules have the dosing option of being opened and mixed with one tablespoon of applesauce for adults and children unable to swallow capsules. Dexlansoprazole can be taken any time of day without regard to meals. This may be a great alternative for people who prefer an easier dosing schedule and who want to take their treatment at their own selected time.

RELATED: Dexilant side effects and how to avoid them

5. Rabeprazole (Aciphex)

Rabeprazole is a generic PPI that is also available as a brand name called Aciphex. Rabeprazole requires a prescription, just like pantoprazole. The capsule form of rabeprazole can be opened and sprinkled on a small amount of soft food (applesauce, fruit or vegetable-based baby food, or yogurt) or emptied into a small amount of liquid (infant formula, apple juice, or pediatric electrolyte solution), and is usually taken 30 minutes before a meal. The tablet form can sometimes be taken at any time of day without regard to food, depending on the condition being treated. Rabeprazole may be a suitable alternative for those who have not had improvement with pantoprazole.

Natural alternatives to pantoprazole

Alternative remedies for pantoprazole include lifestyle changes and diet modifications to help lessen reflux and heartburn symptoms. Along with medication treatment, The American College of Gastroenterology recommends the following modifications based on their review of clinical studies.

Recommended lifestyle modifications include losing weight for overweight people, quitting smoking for current smokers, and adjusting the bed or pillows so that the head is elevated at bedtime. Recommended diet modifications include avoiding fatty meals, eating smaller meals, avoiding citrus, choosing decaffeinated beverages, avoiding spicy foods, and avoiding alcoholic beverages. People will notice different foods that trigger their GERD symptoms, like heartburn and regurgitation of food, so it’s important to learn what those foods are and avoid them when possible.

For people who want to try supplements to help ease symptoms of GERD, there is some limited data supporting their use. Some supplements with limited evidence include melatonin and marine alginate.

RELATED: 12 home remedies for heartburn

How to switch to a pantoprazole alternative

1. Discuss all health conditions with a healthcare provider

Before switching from pantoprazole to an alternative, it’s important that the prescribing doctor is aware of all medical conditions. Some alternatives should be used with caution or avoided with certain medical conditions.

2. Do not suddenly stop taking pantoprazole without medical advice

Only stop taking pantoprazole if the prescribing doctor has been consulted and decided stopping the medication is safe. If pantoprazole is stopped suddenly, there may be sudden rebound stomach acid symptoms. It’s important for a therapy plan to be established prior to stopping pantoprazole suddenly. The pantoprazole dose should be gradually reduced over 2 to 4 weeks rather than stopping abruptly whenever possible.

3. Discuss all prescription and over-the-counter medications with a healthcare provider

Before switching from pantoprazole to an alternative, it’s important that the prescribing healthcare provider has reviewed a patient’s medication list, including prescription drugs and over-the-counter meds. Some alternatives have dangerous drug interactions that must be avoided.

4.  Continue to improve lifestyle and diet changes for managing GERD

It’s important for people treating GERD to follow healthy diet changes and lifestyle habits. Healthcare providers and pharmacists can help give useful GERD management advice, which may include the following tips:

• Manage weight and lose weight if overweight.
• Elevate the head of the bed at night.
• Avoid late-night meals and bedtime snacks.
• Avoid foods that worsen symptoms, such as coffee, chocolate, spicy foods, fatty foods, or citrus.