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Here are important safety warnings and precautions associated with the use of pantoprazole (Protonix). Please review these details carefully and consult your healthcare provider if you have any questions or concerns.

• Masking Serious Conditions: Persistent or worsening heartburn might indicate serious conditions like stomach cancer. Contact your healthcare provider if you experience worsening heartburn, loss of appetite, unexplained weight loss, or weakness.

• Kidney Issues: Some individuals using PPIs, including pantoprazole, have developed sudden kidney problems. Symptoms may include changes in urination, nausea, weakness, fever, rash, or joint pain. If you notice any of these, seek medical advice promptly.

• Infectious Diarrhea: Pantoprazole may increase the risk of Clostridioides difficile infection, leading to severe diarrhea. Those over 65, who have been hospitalized or have weakened immune systems, are at higher risk. If symptoms such as severe diarrhea, fever, or abdominal pain occur, consult your healthcare provider immediately.

• Bone Fractures: Long-term or high-dose use of pantoprazole can elevate the risk of fractures in the hip, wrist, or spine. Limit use to the lowest effective dose for the shortest duration. Discuss your risk with your provider if you have a history of fractures or osteoporosis.

• Serious Skin Reactions: Rarely, pantoprazole can cause severe skin reactions like Stevens-Johnson syndrome or toxic epidermal necrolysis. Symptoms include fever, rash, blisters, or facial swelling. Seek immediate medical attention if these occur.

• Lupus: Pantoprazole may trigger or worsen lupus, an autoimmune disease, with symptoms like joint pain or rash. These usually improve within a few months after stopping the medication. Contact your provider if symptoms develop.

• Vitamin B12 and Magnesium Deficiency: Long-term use may lead to low vitamin B12 or magnesium levels. If you've been on pantoprazole for over three years or notice symptoms of deficiency, such as fatigue or muscle weakness, discuss with your provider.

• Drug Interactions: Pantoprazole can affect the effectiveness of other medications, notably Edurant (rilpivirine) used for HIV, potentially reducing its effectiveness. Avoid taking these medications together.

• Inaccurate Lab Tests: Pantoprazole can interfere with certain lab tests, leading to inaccurate results. Inform your healthcare provider or radiologist about your use of this medication before undergoing any testing.

Contraindications:

• History of allergies to PPIs.
• Concurrent use of Edurant (rilpivirine) or medications containing rilpivirine (e.g., Complera).

If any of these warnings pertain to you, or if you have concerns about taking pantoprazole, consult your healthcare provider for guidance.

Common side effects:

• Headaches
• Diarrhea
• Nausea
• Abdominal pain

Less common but important to monitor:

• Vomiting
• Excessive gas
• Dizziness
• Joint pain

Serious side effects:

• Severe abdominal pain
• Persistent diarrhea
• Symptoms of kidney issues (changes in urination, fever, decreased appetite)
• Signs of lupus (joint pain, worsening skin rash sensitive to sunlight)
• Serious skin reactions (blistering, peeling)
• Vitamin B-12 deficiency symptoms (unusual weakness, sore tongue, numbness and tingling in extremities)
• Severe allergic reaction (fever, swollen lymph nodes, rash, difficulty breathing)

Interactions with high risk of serious adverse effects and should be avoided:

• Rilpivirine

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Methotrexate (especially high-dose treatment)
• Acalabrutinib
• Atazanavir
• Erlotinib
• Ketoconazole
• Nelfinavir