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Key takeaways
Famotidine and pantoprazole both reduce the amount of acid produced in the stomach and are used to treat digestive conditions, such as stomach ulcers, duodenal ulcers, and erosive esophagitis associated with gastroesophageal reflux disease (GERD), however, they have different mechanisms of action.
Famotidine reduces acid production by blocking histamine-2 receptors (H2 blocker) in the stomach, while pantoprazole acts as a proton pump inhibitor (PPI) to reduce acid in the stomach.
While both are effective treatment options, famotidine tends to work faster on heartburn symptoms than pantoprazole, while pantoprazole is considered more effective for long-term treatment.
Pantoprazole is only available by prescription and comes as 20 and 40 mg delayed-release tablets, a liquid suspension, and an intravenous (IV) injection.
Famotidine is available over the counter in 10, 20, and 40 mg oral tablets and liquid suspension.
Common side effects for both include headache, dizziness, nausea, and vomiting, with pantoprazole more likely than famotidine to cause dizziness.
Famotidine and pantoprazole are medications commonly used to treat heartburn as well as other digestive problems, such as stomach ulcers, duodenal ulcers and the damage and inflammation of the esophagus (erosive esophagitis) caused by gastroesophageal reflux disease (GERD). While both drugs decrease acid production in the stomach, they differ in how they work, for what conditions they are best suited, their side effect profiles, and their availability (over-the-counter vs. prescription-only).
What are the main differences between famotidine and pantoprazole?
Famotidine
Famotidine, also known by the brand names Pepcid and Zantac, is classified as a histamine-2 inhibitor (H2 blocker) and works by blocking a protein in stomach cells that reduces acid from being released into the stomach. The effects of famotidine may usually be felt within one hour and can last up to 12 hours. Famotidine tablets and liquid suspensions are available over-the-counter (OTC), and doses are typically taken once or twice daily, depending on the condition being treated.
Pantoprazole
Pantoprazole, also known by the brand name Protonix, belongs to a group of medications called proton pump inhibitors (PPIs) that work to prevent the gastric acid pump from secreting acid into the stomach. Pantoprazole may take longer than famotidine to work, but it provides longer-lasting acid suppression—up to 24 hours. Pantoprazole is only available by prescription and comes as a delayed-release tablet, a liquid suspension, and as an intravenous (IV) injection dosed once daily.
| Main differences between famotidine versus pantoprazole | ||
|---|---|---|
| Famotidine | Pantoprazole | |
| Drug class | H2 Blocker | Proton Pump Inhibitor (PPI) |
| Brand/generic status | Brand and generic version available | Brand and generic version available |
| What are the brand names? | Pepcid, Zantac | Protonix |
| What form(s) does the drug come in? | Tablets, chewable tablets, and liquid suspension | Delayed-release tablet, liquid suspension, and IV injection |
| What is the standard dosage? | Duodenal ulcers: 40 mg once daily or 20 mg twice daily
GERD: 20 mg twice daily |
40 mg once daily |
| How long is the typical treatment? | Duodenal ulcers: up to 8 weeks
GERD: up to 6 weeks |
Up to 8 weeks |
| Who typically uses the medication? | Adults and children weighing more than 40 kg (88 lbs) | Adults, children, and infants 1 month and older |
Conditions treated by famotidine and pantoprazole
Famotidine is FDA-approved to treat stomach ulcers and duodenal ulcers, while pantoprazole is often prescribed off-label for both ulcerative conditions. Both famotidine and pantoprazole are FDA-approved to treat GERD and erosive esophagitis, or inflammation of the lining of the esophagus, which is often caused by GERD.
Famotidine and pantoprazole are also FDA approved to treat gastric acid hypersecretory conditions, such as Zollinger-Ellison syndrome. Gastric acid hypersecretory conditions are characterized by excessive acid production that can lead to various symptoms and complications.
Off-label uses for both famotidine and pantoprazole include, with the combination of certain antibiotics, the eradication of the bacteria Helicobacter pylori (H. pylori) in the stomach. The presence of H. pylori is commonly associated with gastric and duodenal ulcers. Other off-label uses for both drugs include treatment of Barrett’s esophagus and ulcers that occur from the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
| Conditions treated by famotidine and pantoprazole | ||
|---|---|---|
| Condition | Famotidine | Pantoprazole |
| Stomach ulcers | Yes | Off-label |
| Duodenal ulcers | Yes | Off-label |
| Gastroesophageal reflux disease (GERD) | Yes | Yes |
| Erosive esophagitis | Yes | Yes |
| Hypersecretory conditions | Yes | Yes |
| H. Pylori infection | Off-label | Off-label |
| Barrett’s esophagus | Off-label | Off-label |
| NSAID-induced ulcers | Off-label | Off-label |
Is famotidine or pantoprazole more effective?
Both famotidine and pantoprazole are effective drugs for treating ulcers, GERD, and other digestive conditions. However, PPIs such as pantoprazole have proven to be more potent and longer-acting than the H2 blockers such as famotidine. Famotidine is commonly found to be effective for short-term treatment, and pantoprazole is typically effective for long-term treatment, as PPIs work better at healing and preventing stomach ulcers than H2 blockers.
In one clinical trial, a high dose of famotidine (40 mg twice daily) was compared to the standard dose of pantoprazole (20 mg once daily) in patients with aspirin (NSAID) related peptic ulcers. The study showed that high-dose famotidine therapy was not as effective as pantoprazole in preventing the recurrence of aspirin-related peptic ulcers or erosions.
Coverage and cost comparison of famotidine vs. pantoprazole
Famotidine is a commonly prescribed generic drug. Most people with health insurance, Medicare drug coverage, or Medicaid will have coverage for prescription-strength famotidine. The average cash price for 60, 20 mg tablets of prescription famotidine is about $91. You may be able to save more with a SingleCare famotidine coupon, which could bring the cost down to around $5.
Pantoprazole is a generic medication that is usually covered by Medicare and most insurance plans. The average retail cost of pantoprazole is around $138 for 30, 40 mg tablets. You may be able to save more with a SingleCare pantoprazole coupon, which could bring the cost down to around $4.
| Famotidine vs. pantoprazole costs | ||
|---|---|---|
| Famotidine | Pantoprazole | |
| Typically covered by insurance? | Yes | Yes |
| Typically covered by Medicare Part D? | Example: No | |
| Quantity | 20 mg tablets (quantity of 60) | 40 mg (quantity of 30) |
| Typical Medicare copay | Varies | Varies |
| SingleCare cost | $5 | $4 |
Common side effects of famotidine vs. pantoprazole
Famotidine and pantoprazole share many of the same side effects, especially gastrointestinal side effects. The most common side effects of famotidine and pantoprazole include headache, dizziness, constipation, and diarrhea. Pantoprazole may be more likely than famotidine to cause dizziness, joint pain, and rash. These side effects are generally mild and may go away within a few days or after a couple of weeks of treatment.
Serious side effects include allergic reactions to any of the ingredients in either of these medications. In some rare cases, more severe side effects can occur, such as confusion or irregular heartbeat with famotidine, bone fractures, vitamin and mineral deficiencies, and kidney disease while using pantoprazole. Seek medical attention if you experience serious adverse effects.
| Side effects offamotidine and pantoprazole | ||||
|---|---|---|---|---|
| Famotidine | Pantoprazole | |||
| Side Effect | Applicable? | Frequency | Applicable? | Frequency |
| Headache | Yes | ≥1% | Yes | 12.2% |
| Dizziness | Yes | ≥1% | Yes | 3.0% |
| Constipation | Yes | ≥1% | Yes | ≤2% |
| Diarrhea | Yes | ≥1% | Yes | 8.8% |
| Stomach ache | Yes | <1% | Yes | 6.2% |
| Nausea | Yes | <1% | Yes | 7.0% |
| Vomiting | Yes | <1% | Yes | 4.3% |
| Flatulence | No | – | Yes | 3.9% |
This may not be a complete list. Consult your doctor or pharmacist for possible side effects.
Source: DailyMed (famotidine), DailyMed (pantoprazole)
Drug interactions of famotidine vs. pantoprazole
Famotidine and pantoprazole may interact with drugs that depend on stomach acid for absorption. These drugs include certain cancer drugs and antifungals. Taking famotidine or pantoprazole can decrease the absorption of these drugs and decrease their overall effectiveness.
Pantoprazole is contraindicated with certain HIV antiretroviral medications. Taking pantoprazole with an antiretroviral drug may decrease the effectiveness of the antiretroviral drug or increase the risk of toxic effects.
Famotidine and pantoprazole may interact with other drugs not described here. Before starting treatment with famotidine or pantoprazole, it is important to tell your healthcare provider about all medications you take, including OTC drugs and supplements.
| Famotidine vs. pantoprazole interactions | |||
|---|---|---|---|
| Drug | Drug Class | Famotidine | Pantoprazole |
| Atazanavir
Rilpivirine Nelfinavir Ledipasvir/sofosbuvir Fosamprenavir |
Antiretroviral | Yes | Yes |
| Erlotinib
Dasatinib |
Chemotherapy | Yes | Yes |
| Ketoconazole
Itraconazole |
Antifungal | Yes | Yes |
| Tizanidine | Muscle relaxer | Yes | No |
| Tacrolimus
Methotrexate |
Immunosuppressant | No | Yes |
| Warfarin | Anticoagulant | No | Yes |
| Rifampin | Antimicrobial | No | Yes |
| Ferrous fumarate
Ferrous gluconate Ferrous sulfate Ferrous succinate |
Iron salts | No | Yes |
This may not be a complete list of all possible drug interactions. Consult your healthcare provider about all medications you may be taking.
Warnings of famotidine and pantoprazole
Severe GERD symptoms or ulcers may be signs of gastrointestinal cancer. Additional testing may be needed for those who don’t respond to treatment with an H2 blocker such as famotidine or a PPI such as pantoprazole.
Famotidine should be used with caution in elderly people, particularly those with impaired kidney function, as the drug can reach higher levels in the body resulting in a greater risk of side effects.
Pantoprazole can increase the risk of osteoporosis and bone fractures when used long-term. Low magnesium levels in the blood may occur after at least three months of use of pantoprazole, causing symptoms such as seizures, dizziness, irregular heartbeat, and muscle weakness. Long-term use of pantoprazole (over three years) may result in symptoms of low vitamin B-12, such as shortness of breath, lightheadedness, and muscle weakness.
Overall, pantoprazole tends to have more warnings and precautions associated with it compared to famotidine. Consult a healthcare provider about other possible safety concerns with H2 blockers and PPIs.
Frequently asked questions about famotidine vs. pantoprazole
Are famotidine and pantoprazole the same?
Although they treat similar gastrointestinal problems, famotidine and pantoprazole are not the same. They belong to different drug classes – famotidine is an H2 blocker, and pantoprazole is a PPI.
Is famotidine or pantoprazole better?
Famotidine is commonly utilized in the management of mild to moderate GERD, peptic ulcers, and heartburn-related symptoms. Pantoprazole, considered to be more potent than famotidine, is generally reserved for more severe or chronic acid-related conditions such as erosive esophagitis, gastric ulcers, and refractory GERD. The effects of pantoprazole also last longer than the effects of famotidine. On the negative side, pantoprazole has an increased risk of side effects, particularly with long-term use.
Can I take pantoprazole and famotidine at the same time?
There are no drug interactions between pantoprazole and famotidine, and each works differently to decrease stomach acid. Taking famotidine and pantoprazole together may increase the risk of side effects and is not recommended without consulting your healthcare professional.
Can I use famotidine or pantoprazole while pregnant?
There have not been any well-controlled studies for the use of either famotidine or pantoprazole to determine if they are safe to take during pregnancy. Consult your healthcare provider when choosing a treatment option while pregnant or breastfeeding.
Can I use famotidine or pantoprazole with alcohol?
There is no evidence that drinking alcohol with either famotidine or pantoprazole causes adverse effects, however, it may increase the absorption of the alcohol into the bloodstream. Alcohol may also increase the risk of acid reflux symptoms.
What is the safest heartburn medication to take long term?
Although each medication has risks, pantoprazole can cause more long-term adverse effects when compared to famotidine. These include osteoporosis, low vitamin B-12 and magnesium levels, and fundic gland polyps (a type of noncancerous growth in the stomach). For this reason, pantoprazole is typically only taken for four to eight weeks. In addition, pantoprazole has more potential drug interactions than famotidine. It’s important to talk to your healthcare provider about which drug is best for you.
Is it ok to take famotidine every day?
Depending on the condition being treated, famotidine may be taken daily for as many as 12 weeks. Consult with your healthcare professional about how long you should be taking the medication and for information on lifestyle changes that may help relieve your symptoms.
Sources
- Pepcid (famotidine) FDA label
- Protonix (pantoprazole) FDA label
- Famotidine tablet prescribing information, DailyMed
- Pantoprazole tablet prescribing information, DailyMed
- Famotidine (oral route), Mayo Clinic (2024)
- Pantoprazole (oral route), Mayo Clinic (2024)
- Famotidine Is inferior to pantoprazole in preventing recurrence of aspirin-related peptic ulcers or erosions, Gastroenterology (2010)