Pan 40: Uses, How It Works, Side Effects

What is Pan 40 used for?

Pan 40 is used to lower stomach acid in conditions where acid causes symptoms or damage.

• Acid reflux, heartburn and acidity (gastro-oesophageal reflux disease, GERD)
• Inflammation or damage of the food pipe caused by acid (reflux oesophagitis), and helping to keep it from coming back
• Stomach (gastric) ulcers and duodenal ulcers
• Helicobacter pylori (H. pylori) infection, together with antibiotics
• Zollinger–Ellison syndrome and other rare conditions in which the stomach makes far too much acid
• Lowering the risk of stomach ulcers in people who need to take NSAID painkillers regularly (the doctor chooses the strength)

How does Pan 40 work?

The stomach lining contains parietal cells, which make acid using tiny 'proton pumps' (an enzyme called H+/K+ ATPase). Pantoprazole is switched on by the acid inside these cells, then attaches firmly and permanently to the pumps so they stop pushing acid into the stomach. Because the body has to make new pumps to restore acid production, one dose keeps acid low for about a day, even though the medicine itself leaves the blood within a few hours.

What happens in your body after you take it

1. You swallow the tablet

   Pantoprazole is broken down by acid, so the tablet has a special coating that does not dissolve in the stomach. The tablet passes through the stomach intact. This is why it must be swallowed whole, not crushed or chewed.

2. Absorbed in the small intestine

   In the less acidic small intestine the coating dissolves and pantoprazole is absorbed into the blood. About three-quarters of the dose reaches the bloodstream, and levels peak about 2 to 3 hours after the dose. Food can delay this but does not reduce the amount absorbed.

3. It gathers in the acid-making cells

   The blood carries pantoprazole to the parietal cells in the stomach lining. These cells have tiny, very acidic channels where the proton pumps sit, and pantoprazole collects there.

4. Acid switches it on

   In that acid, pantoprazole changes into its active form, which binds tightly to the proton pumps and switches them off for good. It only blocks pumps that are working. Eating turns pumps on, which is why the dose is usually taken before breakfast, so the medicine is in the blood when the pumps start working.

5. Stomach acid goes down

   Each blocked pump can no longer push acid into the stomach. On the first day, acid output falls by about half. With a dose each day, more pumps are blocked, and by about a week acid is reduced much further. This is why relief often builds over 2 to 3 days.

6. The liver clears the medicine

   The liver breaks pantoprazole down, mainly using an enzyme called CYP2C19, with a smaller part handled by CYP3A4. Blood levels halve in about an hour, and most of the broken-down medicine leaves in urine, with the rest in stool. The pumps it has already blocked stay switched off.

7. New pumps are made

   The stomach keeps making new proton pumps, so acid production slowly returns. That is why one dose works for about 24 hours and is usually taken once a day. After the last dose, acid levels typically return to normal within about a week.

How to take Pan 40

Take Pan 40 exactly as your doctor advises or as printed on the pack. The dose and how long you take it depend on the condition being treated.

• It is usually taken once a day, before breakfast (commonly 30 to 60 minutes before the meal). Some conditions need it twice a day; follow your prescription.
• Swallow the tablet whole with water. Do not crush, chew or break it, because the coating protects the medicine from stomach acid.
• If you miss a dose, take it when you remember. If it is almost time for the next dose, skip the missed one. Do not take two doses together.
• Symptoms often ease within 2 to 3 days, but full benefit can take up to 4 weeks. Take it for as long as your doctor advises.
• Long-term use should be reviewed by a doctor regularly. Do not keep taking it for months on your own.
• People with severe liver disease may need a lower dose. Tell your doctor about any liver problems.
• Pan 40 is not usually used for children. Any use in children is decided by a doctor.

Side effects of Pan 40

Most people take pantoprazole without problems, and side effects are usually mild. A few rare risks are linked mainly to long-term use.

Uncommon or mild

• Headache
• Diarrhoea
• Feeling sick (nausea) or being sick (vomiting)
• Stomach pain
• Wind (gas) or bloating
• Dizziness
• Joint pain

Who should be careful

Some people need to check with a doctor before taking pantoprazole, or need extra checks while taking it, especially for a long time.

• Warning signs that need a doctor's check first: unexplained weight loss, difficulty or pain when swallowing, repeated vomiting, vomiting blood, or black stools. Pantoprazole can ease symptoms and hide a more serious problem such as stomach cancer
• Long-term use (especially more than a year): it can lower vitamin B12 (tiredness, tingling, a sore red tongue) and slightly raise the risk of bone fractures, gut infections and harmless stomach growths called fundic gland polyps. Your doctor may review whether you still need it
• Low magnesium, or taking medicines such as water tablets (diuretics) or digoxin: your doctor may check magnesium levels
• Weak bones (osteoporosis) or a high risk of fractures
• Liver disease
• A past skin reaction to pantoprazole or a similar medicine, such as a lupus-type rash
• A planned blood test for chromogranin A or tests for neuroendocrine tumours: pantoprazole may need to be stopped for some time beforehand, so tell the doctor doing the test
• Pregnancy or breastfeeding: there is limited information in pregnancy, so ask your doctor; only very small amounts pass into breast milk
• Past allergic reaction to pantoprazole or similar medicines such as omeprazole, esomeprazole or rabeprazole

Medicines and things that interact with Pan 40

Pantoprazole lowers stomach acid, which changes how some medicines are absorbed, and it affects a few others directly. Tell your doctor or pharmacist about everything you take.

• HIV medicines atazanavir, nelfinavir and rilpivirine: pantoprazole can sharply lower their levels and make them less effective. Rilpivirine must not be taken with it
• Methotrexate, especially at high doses: levels of methotrexate may rise and stay high for longer
• Warfarin and similar blood thinners: changes in blood clotting tests and bleeding have been reported, so your doctor may check your INR more often
• Medicines that need stomach acid to be absorbed, such as ketoconazole and itraconazole (antifungals), iron tablets, and some cancer medicines such as erlotinib, dasatinib and nilotinib: they may work less well
• Mycophenolate (used after organ transplants): may be absorbed less well
• Rifampicin (a TB medicine) and St John's wort: may lower pantoprazole levels
• Some laboratory tests: pantoprazole can falsely raise chromogranin A levels and can rarely cause a false positive urine drug test for cannabis (THC)

If someone takes too much

Storage

Store below 30°C in a dry place, protected from light and moisture, in the original strip, and out of the reach of children. Do not use after the expiry date.

Regulatory status in India

Approved for sale in India. Single-ingredient pantoprazole is not on the CDSCO list of banned medicines. Some fixed-dose combinations that pair pantoprazole with other ingredients are prohibited, for example pantoprazole with zinc carnosine (2016) and sucralfate with pantoprazole, zinc gluconate and light magnesium carbonate (August 2024). Pan 40 contains pantoprazole only.

Other brands with the same medicine

Other brands with the same active ingredient include Pantocid 40 and Pantop 40. Generic pantoprazole 40 mg gastro-resistant tablets are also available, including at Pradhan Mantri Bhartiya Janaushadhi Kendras. They all contain pantoprazole and work the same way. Check the label for the strength. Pan D is different: it also contains domperidone.

Common questions