Suppose you’ve ever encountered acidity in the stomach or throat. In that case, the first thing you look out for is acidity meds, which are very cheap and commonly available in pharmacies without requiring a prescription. These over-the-counter (OTC) acid meds are technically called “Proton Pump Inhibitors/PPIs”, like Pantoprazole, often used for short-term or quick relief of acidity. However, there is an increased trend of using pantoprazole, especially among elderly patients. This irrational and long-term use is linked to potential health risks.
Should you be worried about taking pantoprazole every day? The answer to this is discussed below.
Approved by the FDA and introduced into clinical practice in the late 1990s, Pantoprazole is considered to be the most widely prescribed medicine in hospital and outpatient settings. [1,2] Around the globe, for more than 30 years, they have revolutionized diminishing acid secretion (Hypochlorhydria).
Therapeutically, it is commonly prescribed for managing:
Gastritis
Esophagitis
Barrett's esophagus
Zollinger-Ellison syndrome
Peptic ulcer disease
Nonsteroidal anti-inflammatory drug-associated ulcers
Helicobacter pylori (H. Pylori) eradication [3]
Even though pantoprazole is a relatively benign medication, there is still a risk of adverse effects due to the practice of irrational prescribing and dispensing in clinical practice and lack of public awareness. [4,5]
The long-term use of pantoprazole causes a snowballing rise in risks among malnourished, elderly, chronically ill, immune-compromised and osteoporotic patients. [6]
Associated adverse effects include: [1,3]
| Serious side effects | Reason |
|---|---|
| Renal Problems (AKI, CKD, ESRD) | Due to excessive accumulation of drug or its metabolites in the kidney causing an immune response, which triggers kidney injury |
| Cardiovascular Risks ( Myocardial Infarction, Stroke)� | The use of pantoprazole alongside antiplatelets is believed to reduce their effectiveness due to their competitive interaction with an enzyme |
| Bone Fractures | Long-term use of pantoprazole causes a reduction in enteral absorption of calcium, increasing fracture risk |
| Vitamin B12 Deficiency | Pantoprazole inhibits acid production in the stomach, which leads to decreased release and absorption of Vit B12 from foods |
| Dementia | Hypothetically, it may be due to Vit B12 deficiency or increased build-up of beta-amyloid progressing dementia |
| Infections (C.difficile infection, Community-acquired pneumonia, COVID-19) | The effect of suppressed gastric acid secretion by pantoprazole diminishes the protective effect, suppresses the immune system, and small intestinal bacterial overgrowth |
| Gastric Cancer | Chronic pantoprazole use may cause hypergastrinemia, resulting in endocrine cell hyperplasia and pre-neoplastic changes |
MedBound Times connected with Dr. Nikhil Kenny Thomas (MBBS, MD, DM, DrNB), Consultant Gastroenterologist at Dr. KM Cherian Institute of Medical Sciences, Kerala to share his expert insights.
The crux is that PPIs are very essential for patients, especially the elderly, if they are on antiplatelets/NSAIDs. But all medications come with side effects, so prolonged durations of decreased acid levels make patients more prone to developing infections; use them judiciously.Dr. Nikhil Kenny Thomas, Consultant Gastroenterologist, Dr. KM Cherian Institute of Medical Sciences, Kerala
There is a growing concern because previous studies have shown that PPIs are prescribed for up to 70% of cases without any clear indication.[3] Also, a study conducted at KIMS, India revealed that among 150 pantoprazole prescriptions, 22.67% of prescriptions were irrationally prescribed. [5]
Inappropriate use of acid meds among patients can increase healthcare costs, as well as the risk of adverse effects, polypharmacy and complications of an existing condition. [3]
Around the globe, PPIs in general are the most widely consumed and are considered one of the top ten most used drugs. Medical professionals should consider working together in promoting the rational use of pantoprazole by making interventions like educational programs and implementing institutional-specific guidelines to reduce the inappropriate use of acid meds.
References:
PMC. "Pantoprazole Study." PubMed Central. Accessed February 16, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC10882567/.
National Center for Biotechnology Information. "Pantoprazole." NCBI Bookshelf. Accessed February 16, 2025. https://www.ncbi.nlm.nih.gov/books/NBK499945/#:~:text=Even%20though%20pantoprazole%20is%20a,Contraindications.
Lee, Ji Hoon, Sung Soo Ahn, Ji Hyung Hong, and Joon Seok Lim. "Pantoprazole and Its Clinical Effects: A Study." Chonnam Medical Journal 59, no. 2 (2023): 115. Accessed February 16, 2025. https://cmj.ac.kr/DOIx.php?id=10.4068/cmj.2023.59.2.115.
Dadhich, Anil, Sanjay Agrawal, and Mahesh Verma. "An Expert Review and Recommendations on the Rational Use of Proton Pump Inhibitors: Indian Perspective." ResearchGate. Accessed February 17, 2025. https://www.researchgate.net/publication/334520794_An_Expert_Review_and_Recommendations_on_the_Rational_Use_of_Proton_Pump_Inhibitors_Indian_Perspective.
Gupta, R., Sharma, M., and Patel, S. "Drug Utilization Evaluation of Pantoprazole." Journal of Family Medicine and Primary Care 11, no. 6 (2022): 141. Accessed February 17, 2025. https://journals.lww.com/jfmpc/fulltext/2022/06000/drug_utilization_evaluation_of_pantoprazole_in.141.aspx.
Smith, John, Emily Roberts, and Daniel Lee. "Pantoprazole and Gastric Acid Suppression: A Review of Recent Studies." Scientific Reports. Accessed February 17, 2025. https://www.sciencedirect.com/science/article/abs/pii/S004059572030127X?via%3Dihub.
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