Pantoprazole vs. omeprazole: Key differences and uses

In this article:

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost comparison
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost comparison
• Side effects
• Interactions
• Warnings
• FAQs

Pantoprazole and omeprazole are proton pump inhibitors (PPIs) used to treat digestive conditions. Both drugs are used to treat damage and inflammation of the esophagus (erosive esophagitis) due to gastroesophageal reflux disease (GERD). 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 only available with a prescription. It is FDA approved to treat inflammation of the esophagus due to GERD in adults and children aged five 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, also known by its brand name, Prilosec, can be purchased with a prescription or over the counter (OTC). It works similarly to pantoprazole as a PPI and can be used to treat erosive esophagitis due to GERD in adults, children, and infants one month 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 brand name?	Protonix	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, children, and infants 1 month and older

Conditions treated by pantoprazole and omeprazole

Pantoprazole and omeprazole are both FDA-approved to treat symptoms associated with GERD. They are also approved to 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 (the first part of the small intestine).

Pantoprazole and omeprazole can help treat peptic ulcers, including duodenal ulcers and gastric or stomach 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 may be used off-label for this purpose. 

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

Is pantoprazole or omeprazole more effective?

Pantoprazole and omeprazole have been shown to be effective in treating GERD, peptic ulcers, and H. pylori infections. 

Based on data from a meta-analysis that pooled over 40 different studies, pantoprazole may be equally effective as omeprazole. Results from the study found no significant differences in effectiveness between other PPIs, including Nexium (esomeprazole), lansoprazole (Prevacid), and rabeprazole (Aciphex). The results suggest that higher doses may be more important than the specific type of medication. 

One PPI may be preferred over the other depending on the condition being treated and the cost of the medication. Consult a healthcare provider 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 $179 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 $6.

Omeprazole is a generic medication that is usually covered by Medicare and most insurance plans. The average retail cost of omeprazole is around $100 for 30, 20 mg capsules. With an omeprazole coupon, you may be able to pay around $6 for the same quantity. Keep in mind that omeprazole is also available as an OTC drug, which may come with lower costs than the prescription version. 

	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	Varies	Varies
SingleCare cost	$6	$6

Common side effects of pantoprazole and omeprazole

Pantoprazole and omeprazole share many of the same side effects, especially gastrointestinal side effects. The most common side effects of pantoprazole and omeprazole include:

• Headache
• Diarrhea
• Nausea
• Vomiting
• Stomach pain
• Gas
• Fever
• Upper respiratory tract infections

In addition to these side effects, pantoprazole may be more likely than omeprazole to cause dizziness, joint pain, and rash. On the other hand, omeprazole may be more likely than pantoprazole to cause back pain and coughing. 

Drug interactions of pantoprazole vs. omeprazole

Both pantoprazole and omeprazole can interact with antiretroviral medications, such as rilpivirine, atazanavir, and saquinavir. Taking pantoprazole or omeprazole with an antiretroviral drug may decrease the effectiveness of the antiretroviral drug or increase the risk of toxic 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. 

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

Omeprazole has more drug interactions than pantoprazole

Omeprazole generally has more drug interactions than pantoprazole. This is because omeprazole is broken down in the liver by enzymes that also process many other medications. Pantoprazole may interact less with these liver enzymes, leading to fewer drug interactions.

For example, many liver-processed drugs, including phenytoin, citalopram, and diazepam, are not known to have a significant interaction with pantoprazole. Still, it is important to discuss any medications you take with a healthcare provider before taking a PPI. 

Pantoprazole and omeprazole drug interactions
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	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	No	Yes
Citalopram	Selective serotonin reuptake inhibitor (SSRI) antidepressant	No	Yes
St. John’s Wort	Herbal	No	Yes

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

Warnings of pantoprazole and omeprazole

Both pantoprazole and omeprazole carry similar warnings for serious side effects:

• Acute tubulointerstitial nephritis: This kidney problem can occur at any time during treatment. If you notice a decrease in urination or blood in your urine, contact your doctor immediately.
• Clostridium difficile-associated diarrhea: This type of diarrhea consists of persistent watery stools and severe stomach pain. If you experience these symptoms, contact your doctor.
• Bone fractures: Long-term use (a year or longer), especially in multiple daily doses, may increase the risk of fractures in the hip, wrist, or spine. Inform your doctor if you experience a bone fracture.
• Lupus erythematosus: PPIs may cause or worsen certain types of this autoimmune disorder. If you develop new or worsening joint pain or a rash on your cheeks or arms that worsens in the sun, consult your doctor.
• Low magnesium levels: Low magnesium may occur after at least three months of use, causing symptoms such as seizures, dizziness, irregular heartbeat, and muscle weakness.
• Low vitamin B-12 levels: Long-term use of these PPIs (over three years) may result in symptoms of low vitamin B-12, such as shortness of breath, lightheadedness, and muscle weakness.
• Fundic gland polyps: Prolonged use (more than one year) increases the risk of developing these stomach growths.
• Severe skin reactions: Though rare, these reactions include blistering, peeling, or bleeding of the skin and may be accompanied by fever, chills, body aches, and enlarged lymph nodes. Seek immediate medical attention if these symptoms occur.

Consult a healthcare provider for other possible warnings and precautions before starting treatment with a PPI. 

Frequently asked questions about pantoprazole vs. omeprazole

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. 

Should I take Pantoprazole and Omeprazole at the same time?

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

Can I use pantoprazole or omeprazole while pregnant?

There is not enough evidence to suggest that pantoprazole and omeprazole may or may not be harmful to an unborn baby. However, in some cases, the benefits may outweigh the risks. Consult a healthcare provider if you are pregnant or planning to become pregnant before taking a PPI. 

Can I use pantoprazole or omeprazole with alcohol?

Consuming alcohol may increase certain side effects associated with pantoprazole or omeprazole. Alcohol may worsen certain side effects of pantoprazole and omeprazole, such as headache and nausea. 

Is OTC omeprazole the same as a prescription?

OTC omeprazole contains the same drug and strength as 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 four months.

What is the safest PPI for long-term use?

The safety of PPIs for long-term use varies. Generally, PPIs like omeprazole and pantoprazole are considered safe for long-term use when necessary. Still, long-term use may come with certain risks, such as nutrient deficiencies and bone fractures. Your doctor can help determine the best and safest option based on your overall condition.