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

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 can only be purchased with a prescription. It is FDA-approved to treat GERD in adults and children aged 5 years and older. 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 known by its brand name, Prilosec, and can be purchased with a prescription or over-the-counter. Like pantoprazole, it works as a proton pump inhibitor to treat GERD. However, it is also FDA-approved to treat helicobacter pylori (H. pylori) infections, duodenal ulcers, and stomach ulcers. Omeprazole can treat GERD in adults and children aged 1 year and older. It comes as a delayed-release capsule, tablet, and liquid suspension. 

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 and histamine (H2) blockers. PPIs are usually prescribed as a short-term treatment that is taken for up to 8 weeks. 

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

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

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

Is pantoprazole or omeprazole more effective?

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

One study found that pantoprazole was more effective than omeprazole in the treatment of stomach ulcers. Effectiveness was determined based on how fast the ulcers healed. Pantoprazole was found to be more effective in the study, although a high dosage may have played a role in its effectiveness

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 pantoprazole coupon which can lower the cost to approximately $10.

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 an omeprazole coupon you can expect to pay around $10 for a 30-day supply of 20 mg capsules. 

Common side effects of pantoprazole vs. 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 pain, and gas. Other possible side effects may include joint pain, upper respiratory tract infections, and asthenia, or lack of energy. 

Omeprazole can also cause side effects such as back pain and coughing. Pantoprazole has not been found to cause these particular side effects as often as omeprazole.

*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. 

Some drugs that affect blood clotting should not be taken with certain PPIs. Taking pantoprazole or omeprazole with warfarin can increase the risk of bleeding. While clopidogrel, an antiplatelet drug, may not be affected by pantoprazole, it should be avoided with omeprazole. 

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

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 pantoprazole FDA label, some drugs that are metabolized in the liver, including phenytoin, citalopram, and diazepam, have not been shown to have significant interaction with pantoprazole. Still, it is important to discuss any medications you take with a doctor before taking a PPI. 

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

*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 since there may be an increased risk of bone fractures. Those with osteoporosis should monitor or avoid the use of PPIs.

Long-term use of 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. 

PPIs can interfere with the absorption of vitamin B12 in the body, which can lead to vitamin B12 deficiency over time. PPIs can also affect the absorption of magnesium, which can lead to low levels of magnesium in the body (hypomagnesemia).

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

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. Alcohol may worsen PPI side effects, such as headache and nausea.

Is OTC omeprazole the same as the prescription?

Over-the-counter (OTC) omeprazole contains the same active ingredient found in prescription-strength 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?

Since pantoprazole and omeprazole work in identical ways, they should not be taken at the same time. They both work as PPIs to reduce the production of acid in the stomach. Taking them together could increase the risk of adverse effects.