Omeprazole vs. Pantoprazole: Similarities & Differences

Omeprazole (brand name: Prilosec) and pantoprazole (brand name: Protonix) are medications belonging to the proton pump inhibitors (PPIs) drug class. Omeprazole can be obtained over-the-counter (OTC) or via prescription (Rx), while pantoprazole is an Rx-only medication.

PPI medications, like omeprazole and pantoprazole, are commonly used alone or alongside other drugs to treat heartburn and stomach ulcers, among other conditions involving excess stomach acid.

Such conditions are often the byproduct of gastroesophageal reflux disease (GERD), the backward acid flow from the stomach that potentially causes heartburn and injury to the esophagus.

For context, reflux-related conditions may occur in adults and children of all ages, affecting about 20% and 10% of the population, respectively.

While omeprazole and pantoprazole are generally similar and comparably effective, they carry some notable distinctions.

As such, this article will provide an in-depth analysis of omeprazole and pantoprazole, comparing their effectiveness, uses, dosages, side effects, and more.

What Is Omeprazole?

The Rx and OTC versions of omeprazole are approved by the Food and Drug Administration (FDA) for treating different conditions. But they contain the same active ingredient: omeprazole.

The OTC version of omeprazole treats frequent heartburn in people 18 and older. It comes in a few different dosage forms, such as:

• Orally disintegrating tablet, delayed-release (the active ingredient gets released when the pill reaches your small intestine—not in the stomach)
• Oral capsule, delayed-release 
• Oral tablet, delayed-release 

The Rx version of omeprazole (Prilosec) is FDA-approved to manage more severe conditions requiring a healthcare provider’s diagnosis.

Specifically, Rx omeprazole is approved to:

• Treat active duodenal (intestine) ulcers in adults
• Treat active gastric (stomach) ulcers in adults
• Prevent recurrent duodenal ulcers in adults with Helicobacter pylori (H. Pylori) bacteria infection, along with antibiotics
• Treat GERD in adults and children 1 year and older 
• Treat erosive esophagitis in adults and children 1 month and older 
• Maintenance healing of erosive esophagitis in adults and children 1 year and older 
• Treat hypersecretory conditions, such as Zollinger-Ellison syndrome, in adults

Rx omeprazole comes in two forms: oral capsules and an oral suspension, both of which are delayed-release formulations.

How Does Omeprazole Work?

Omeprazole works by inhibiting (blocking) a specific enzyme system called H+/K+ ATPase, which is responsible for producing stomach acid.

This system is known as the “proton pump” on the stomach lining cells. Omeprazole and other PPIs work by blocking the final step of stomach acid production.

Omeprazole reduces normal and excessive stomach acid levels, regardless of the cause. Omeprazole begins working about an hour after taking a dose; however, it takes one to four days of treatment to reach its full benefit.

Note that OTC omeprazole is meant to be taken for up to 14 days. However, healthcare providers may prescribe the drug longer depending on the treated condition.

Discuss with your healthcare provider when to stop the medication and if you need to taper (for example, by decreasing the dose slowly over time).

What Is Pantoprazole?

Unlike omeprazole, pantoprazole is a prescription-only drug. The brand name is Protonix. The FDA approves oral pantoprazole to:

• Treat GERD associated with erosive esophagitis in adults and children 5 and older
• Maintain healing of erosive esophagitis in adults 
• Treat hypersecretory conditions, such as Zollinger-Ellison syndrome, in adults

Pantoprazole comes in three forms:

• Oral tablets, delayed-release (DR)
• Oral suspension, DR
• Solution for injection, which is given as an intravenous (IV) infusion
  

How Does Pantoprazole Work?

Pantoprazole works the same way as omeprazole. It binds to the proton pumps on the stomach lining and blocks the final step of stomach acid production.

This protects the lining of the stomach, esophagus, and intestines from the damaging effects of excessive stomach acid.

Pantoprazole oral tablets and suspension begin working within two and a half hours of taking the medication. The FDA approves these medications for treating GERD as a short-term eight-week treatment.

However, in certain instances, healthcare providers may continue pantoprazole longer to prevent reflux symptoms from returning and to prevent excess stomach acid from interrupting the healing process in the esophagus.

Also, the drug may be prescribed as a long-term treatment for hypersecretory conditions, such as Zollinger-Ellison syndrome.

Pantoprazole IV, on the other hand, begins working within 15 to 30 minutes of administration.

However, this medication is only approved for very short-term use (seven to 10 days) in adults. It may be given during a hospital stay.

Dosage Overview

The table below summarizes the typical dosages of omeprazole and pantoprazole oral forms. The treatment lengths vary with the condition, ranging from four to eight weeks.

Your healthcare provider will give specific instructions and may recommend longer-term use. Be sure to take the dosage your healthcare provider prescribes for you:

*1 kilogram (kg) equals about 2.2 pounds (lbs). Example: A 22-lb child weighs 10 kg.

Administration Instructions

Omeprazole and pantoprazole have slightly different administration instructions.

Omeprazole

Omeprazole tablets or capsules should be taken in the morning with a glass of water about 30 minutes before the day's first meal.

If you have difficulty swallowing the capsule, you may open it and sprinkle the pellet contents into applesauce. Swallow the mixture and immediately drink a glass of water. Be careful not to crush or chew the pellets.

Omeprazole oral suspension should also be taken before the day's first meal. The oral suspension comes in packets of dry powder. Mix the powder in water before taking it.

For the 2.5-mg packet, mix the powder in a cup with 5 milliliters (mL) of water; the 10-mg powder packet should be mixed with 15 mL of water. Stir, let sit for two to three minutes to thicken, then drink.

Pantoprazole

Pantoprazole tablets can be taken once daily, at any time of day, without regard to the timing of food. Swallow the tablet whole.

Pantoprazole oral suspension, like omeprazole, comes in powder packets and should be taken about 30 minutes before the day's first meal.

Mix pantoprazole powder into 1 teaspoonful of applesauce or apple juice. Do not crush or chew the powder granules, and do not mix them into other foods or drinks. After swallowing the mixture, drink some water to wash it down.

Omeprazole and pantoprazole can also be administered using a nasogastric (NG) tube. Consult your pharmacist or healthcare provider for more details.

Which Is More Effective?

Many studies are comparing the efficacy of omeprazole and pantoprazole. Generally, these two medications are similarly effective for treating ulcers and symptoms related to acid reflux, such as heartburn.

In one older study comparing omeprazole and pantoprazole for healing acid reflux-induced erosive esophagitis, the healing rates were equivalent between the two medications after four weeks of treatment.

In a more recent study comparing the two medications for healing stomach ulcers, treatment with either omeprazole 40 mg or pantoprazole 40 mg led to similar healing and pain reduction levels after eight weeks.

Alternative Treatment Options

Making lifestyle changes helps to reduce the symptoms of acid reflux. Some people can manage acid reflux with lifestyle changes alone without medication.

Lifestyle changes are also beneficial with medication like omeprazole or pantoprazole. From a diet perspective, experts recommend avoiding late meals and foods that trigger reflux before sleeping, such as spicy foods.

Additionally, elevating your head with an extra pillow during sleep can assist in the normal digestion of food and keep acid down.

Weight loss and smoking cessation are also beneficial for reducing acid reflux. Smoking can increase the chance of having reflux, and quitting will help prevent acid from coming up.

Similarly, obesity is closely associated with acid reflux. If you’re overweight, losing weight can help stomach acid production return to normal levels, which may ease symptoms.

Side Effects & Safety

Generally, both omeprazole and pantoprazole provide safe options to help manage acid reflux and other stomach acid-related conditions.

Both medications have been associated with the following mild side effects:

• Headache
• Abdominal pain
• Nausea
• Diarrhea
• Vomiting
• Flatulence

In rare cases, individuals may develop more severe side effects with omeprazole or pantoprazole.

These include:

• Inflammation of the kidney, leading to impaired kidney function
• Diarrhea caused by the bacteria, Clostridioides difficile (C. diff)
• Severe skin reactions
• Increased risk of bone fracture, especially with higher dosages or long-term use
• Vitamin B-12 deficiency, especially with long-term use (more than three years)
• Magnesium deficiency, especially with long-term use
• Increased risk of fundic gland polyp (an abnormal growth in the upper stomach), especially with long-term use for over a year
  

If you take omeprazole or pantoprazole long-term, your healthcare provider will monitor you closely for side effects. They may also recommend vitamin B-12 or magnesium supplements.

Precautions

Omeprazole and pantoprazole should be avoided in the following instances:

• If an individual has a history of allergic reactions to omeprazole, pantoprazole, or any other PPI.
• If someone is currently taking Edurant (rilpivirine)
  

Potential for Interaction

Drug interactions can change how a drug works, making it less effective or even more toxic.

The lists below are incomplete but highlight some interactions to be aware of while taking oral forms of pantoprazole or omeprazole.

Either drug may interact with the following medications:

• Certain antiretroviral drugs, such as Edurant (rilpivirine) and Retrovir (zidovudine)
• Blood thinning medications, such as Jantoven (warfarin)
• Medications that require certain levels of stomach acid to get absorbed properly, such as CellCept (mycophenolate mofetil) or various iron supplements

Omeprazole-Specific Interactions

In general, omeprazole has more drug interactions than pantoprazole.

Examples of additional drug interactions for omeprazole are:

• Antiplatelet medications, such as Plavix (clopidogrel). Plavix can potentially result in reduced effectiveness of clopidogrel
• Medications broken down by specific enzymes in the body, such as Celexa (citalopram), Dilantin (phenytoin), and Valium (diazepam)
• Antidepressant medications, such as St. John’s Wort (a herbal remedy)

Before taking omeprazole or pantoprazole, talk to a healthcare professional about all other medications, vitamins, or supplements you take.

This ensures omeprazole or pantoprazole will be safe and effective to take with the rest of your medications.

Summary

Omeprazole and pantoprazole are generic PPIs for treating acid reflux, stomach ulcers, and other excessive stomach acid production conditions. These two drugs share many similarities, including their work, side effects, and effectiveness.

However, there are critical differences between the drugs. Some omeprazole is available OTC to treat frequent heartburn in adults, while pantoprazole is prescription-only.

Healthcare providers commonly prescribe omeprazole for infants and younger children, while pantoprazole is used for older children and adults.

Omeprazole also has more drug interactions than pantoprazole.

If you’re interested in determining if one of these medications may be helpful for you, talk to a healthcare provider.