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Drug vs. Drug

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

Gerardo Sison medical writer headshot By | December 19, 2019

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Pantoprazole and omeprazole are two proton pump inhibitors (PPIs) that are used to treat digestive conditions. Both drugs can be used for gastroesophageal reflux disease (GERD), a more chronic form of heartburn, and erosive esophagitis. They work by decreasing acid secretion in the stomach. While pantoprazole and omeprazole are similar medications, they also have some differences.

What are the main differences between pantoprazole and omeprazole?

Pantoprazole is the generic name for Protonix and is currently purchased with a prescription only. It is FDA-approved to treat GERD in adults and children aged 5 years and older for a usual duration of up to 8 weeks. Pantoprazole is supplied as a delayed-release tablet or liquid suspension. It can also be administered as an intravenous (IV) injection at a hospital or clinic.

Omeprazole is also known by its brand name, Prilosec, and can be purchased with a prescription or over-the-counter. It works similar to pantoprazole as a PPI. However, it is also FDA-approved to treat duodenal ulcers, helicobacter pylori (H. pylori) infections, and gastric ulcers in addition to GERD and erosive esophagitis. Omeprazole can treat GERD in adults and children 1 year and older. It comes as a delayed-release capsule, tablet, and liquid suspension.

Main differences between pantoprazole and omeprazole
Pantoprazole Omeprazole
Drug class Proton pump inhibitor (PPI) Proton pump inhibitor (PPI)
Brand/generic status Generic version available Generic version available
What is the generic name?
What is the brand name?
Pantoprazole
Protonix
Omeprazole
Prilosec
What form(s) does the drug come in? Oral tablet, delayed-release
Oral suspension
IV injection/infusion
Oral tablet, delayed-release
Oral capsule, delayed-release
Oral suspension
IV injection/infusion
What is the standard dosage? 40 mg once daily 20 mg once daily
How long is the typical treatment? Up to 8 weeks 4 to 8 weeks
Who typically uses the medication? Adults and children 5 years and older Adults and children 1 year and older

Conditions treated by pantoprazole and omeprazole

Pantoprazole and omeprazole are both FDA approved to treat heartburn symptoms from GERD and erosive esophagitis. PPIs like pantoprazole and omeprazole are more potent than regular antacids, such as histamine (H2) blockers. They are usually prescribed for short-term treatment not lasting more than 8 weeks long.

Pantoprazole and omeprazole can also treat hypersecretory conditions that cause the stomach to produce too much gastric acid. Zollinger-Ellison syndrome is a condition that can cause acid hypersecretion and involves tumors in the pancreas or duodenum (first part of the small intestine).

Pantoprazole and omeprazole can also help treat other conditions such as duodenal ulcers, gastric or stomach ulcers, and peptic ulcers. These ulcers are often caused by an infection from a bacteria called H. pylori. While omeprazole is approved to treat H. pylori in combination with other drugs, pantoprazole is used off label for this infection as well.

Other off-label uses for both drugs include Barrett’s esophagus and ulcers that stem from the use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Condition Pantoprazole Omeprazole
Gastroesophageal Reflux Disease (GERD) Yes Yes
Erosive Esophagitis Yes Yes
Zollinger-Ellison syndrome Yes Yes
Hypersecretory conditions Yes Yes
Duodenal ulcers Off-label Yes
Gastric ulcers Off-label Yes
H. Pylori infection Off-label Yes
Barrett’s esophagus Off-label Off-label
Indigestion Off-label Off-label
NSAID induced ulcers Off-label Off-label
Peptic ulcers Off-label Off-label

Is pantoprazole or omeprazole more effective?

Pantoprazole and omeprazole have been shown to be effective at treating GERD. In a meta-analysis that pooled over 40 different studies, results found no significant differences in effectiveness between PPIs. Pantoprazole was found to be equally as effective as omeprazole. Some double-blind clinical trials also included other PPIs such as Nexium (esomeprazole), lansoprazole (Prevacid), and rabeprazole (Aciphex).

One study included in the meta-analysis found that pantoprazole was more effective than omeprazole in the treatment of stomach ulcers. Results pooled from 5 studies in the review-based effectiveness on healing rates. While pantoprazole was found to be more effective, there may have been flaws with unequal dosing.

Pantoprazole and omeprazole are both comparable drugs in terms of effectiveness. One may be preferred over the other depending on the condition being treated and the cost of the medication. Consult a doctor to determine which PPI may be better for you.

Coverage and cost comparison of pantoprazole vs. omeprazole

Pantoprazole is a generic medication that is usually covered by Medicare and most insurance plans. The average retail cost of pantoprazole is around $522. You may be able to save more with a SingleCare coupon which can bring the cost down to $28.

Omeprazole is a generic medication that is usually covered by Medicare and most insurance plans. The average retail cost of omeprazole is around $67.99. With a SingleCare coupon you can expect to pay around $9-20 for 30, 20mg capsules.

  Pantoprazole Omeprazole
Typically covered by insurance? Yes Yes
Typically covered by Medicare? Yes Yes
Standard dosage 40 mg (quantity of 30) 20 mg (quantity of 30)
Typical Medicare copay Depends on your insurance plan Depends on your insurance plan
SingleCare cost $28 $9-20

Common side effects of pantoprazole and omeprazole

Pantoprazole and omeprazole can cause side effects such as headache, dizziness, nausea, and vomiting. They can also cause other gastrointestinal side effects such as diarrhea, constipation, abdominal or stomach pain, and flatulence or gas. Other shared side effects may include joint pain, upper respiratory tract infections, and asthenia or lack of energy.

Omeprazole can also cause side effects such as acid regurgitation, back pain, and coughing. Pantoprazole has not been studied to show these particular side effects as often.

  Pantoprazole Omeprazole
Side Effect Applicable? Frequency Applicable? Frequency
Headache Yes 12.2% Yes 7%
Nausea Yes 7% Yes 4%
Diarrhea Yes 8.8% Yes 4%
Constipation Yes <2% Yes 2%
Abdominal pain Yes 6.2% Yes 5%
Vomiting Yes 4.3% Yes 3%
Flatulence Yes 3.9% Yes 3%
Dizziness Yes 3% Yes 2%
Joint pain Yes 2.8% Yes N/A
Rash Yes <2% Yes 2%
Acid regurgitation No Yes 2%
Upper respiratory tract infection Yes N/A Yes 2%
Weakness/Lack of energy Yes N/A Yes 1%
Back pain No Yes 1%
Cough No Yes 1%

*Consult a doctor or pharmacist for all possible side effects.
Source: DailyMed (pantoprazole), DailyMed (omeprazole)

Drug interactions of pantoprazole vs. omeprazole

 Both pantoprazole and omeprazole can interact with the same drugs. They both can interact with antiretroviral medications such as rilpivirine, atazanavir, and saquinavir. Taking these medications together can alter the effectiveness of the antiretroviral drug and increase its toxicity. Taking pantoprazole or omeprazole with warfarin can increase the risk of bleeding. Therefore, they should not be taken together. While clopidogrel may not affected by pantoprazole, it should be avoided with omeprazole.

Pantoprazole and omeprazole interact with methotrexate, an antimetabolite medication, and can cause an increased risk of toxicity and side effects.

Pantoprazole and omeprazole should not be taken at the same time as iron salts and other drugs that depend on stomach acid for absorption. Other medications that depend on stomach acid for absorption include chemotherapy drugs such as erlotinib and dasatinib and antifungals such as ketoconazole and itraconazole.

Because both PPIs are metabolized in the liver, they may interact with other drugs that are processed by similar enzymes, including the CYP2C19 enzyme. However, according to the FDA label, some of these drugs, including phenytoin, citalopram, and diazepam, were not shown to have a significant interaction with pantoprazole. Still, it is important to discuss any medications you take with a doctor before taking a PPI.

PPIs can affect the results of certain lab tests. PPIs are known to cause false positives for THC urine tests.

Drug Drug Class Pantoprazole Omeprazole
Rilpivirine
Nelfinavir
Atazanavir
Saquinavir
Ritonavir
Antiretrovirals Yes Yes
Warfarin Anticoagulant Yes Yes
Clopidogrel Antiplatelet No Yes
Methotrexate Antimetabolite Yes Yes
Mycophenolate mofetil
Tacrolimus
Immunosuppressive Yes Yes
Ketoconazole
Itraconazole
Voriconazole
Antifungal Yes Yes
Erlotinib
Dasatinib
Nilotinib
Chemotherapy Yes Yes
Ferrous fumarate
Ferrous gluconate
Ferrous sulfate
Ferrous succinate
Iron salts Yes Yes
Diazepam
Midazolam
Benzodiazepine No Yes
Phenytoin Antiepileptic No Yes
Clarithromycin
Rifampin
Antibiotic Yes Yes
Citalopram Selective serotonin reuptake inhibitor (SSRI) antidepressant No Yes
St. John’s Wort Herbal Yes Yes

*This may not be a complete list of all possible drug interactions. Consult a doctor with all medications you may be taking.

Warnings of pantoprazole and omeprazole

Pantoprazole and omeprazole are not recommended for long-term use. Long-term use has been associated with an increased risk of bone fractures. If you have osteoporosis, you may want to monitor any use of PPIs.

Some data has suggested that PPI drugs can increase the risk of cardiovascular events such as heart attack and stroke. However, the FDA and other reports reinforce the benefits of PPIs outweigh this risk.

Because pantoprazole and omeprazole are processed in the liver, they may be adjusted or avoided in those with liver impairment.

Pantoprazole and omeprazole can worsen or increase the risk of systemic lupus erythematosus, a rare autoimmune disease.

Treatment with PPIs can increase the risk of diarrhea from Clostridium difficile infections. This risk may be higher in those who are hospitalized for a long time.

Both pantoprazole and omeprazole are in Pregnancy Category C and may cause harm to the unborn baby. Consult a doctor or healthcare provider if you are pregnant or breastfeeding.

Frequently asked questions about pantoprazole vs. Omeprazole

What is pantoprazole?

Pantoprazole (Protonix) is a proton pump inhibitor (PPI) medication prescribed to treat GERD and erosive esophagitis. It is often taken as a 40 mg delayed-release tablet for up to 8 weeks. It can be taken in adults and children 5 years and older.

What is omeprazole?

Omeprazole (Prilosec) is a PPI medication prescribed to treat GERD and erosive esophagitis. It is also FDA approved for H. pylori infection and duodenal or gastric ulcers. It can be taken as a 20 mg delayed-release capsule for 4 to 8 weeks in adults and children 1 year and older.

Are pantoprazole and omeprazole the same?

Pantoprazole and omeprazole are in the same class of medications. However, they have different approved uses and side effects. They also come in different dosages and formulations.

Is pantoprazole or omeprazole better?

Pantoprazole and omeprazole are both effective for GERD and erosive esophagitis. One PPI drug may be preferred over the other depending on the condition being treated and the cost of the medication.

Can I use pantoprazole or omeprazole while pregnant?

Pantoprazole and omeprazole are not recommended in pregnant women due to the risk of fetal harm. However, in some cases, the benefits may outweigh the risk. Consult a doctor if you are pregnant.

Can I use pantoprazole or omeprazole with alcohol?

Consuming alcohol may increase certain side effects associated with pantoprazole or omeprazole. Because headache and nausea are common side effects of PPIs, these side effects can worsen when PPIs are taken with alcohol.

Is OTC omeprazole the same as a prescription?

Over-the-counter (OTC) omeprazole contains the same drug and strength of prescription omeprazole. OTC omeprazole can be found as OTC Prilosec in a 14-day supply of 20 mg tablets. This treatment course should not be taken more than once every 4 months.

Should I take Pantoprazole and Omeprazole at the same time?

Pantoprazole and omeprazole should not be taken at the same time. They work in identical ways by shutting down the production of gastric acid in the stomach. Taking them together could increase the risk of adverse effects.