When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use it if you had an allergic reaction to pantoprazole.

How to Use This Medicine:
Packet, Tablet, Delayed Release Tablet, Long Acting Tablet

• Your doctor will tell you how much medicine to use. Do not use more than directed. Take the medicine at least 30 minutes before a meal.
• Delayed-release tablet: Swallow the tablet whole. Do not crush, break, or chew it.
• Delayed-release packet:
  
  • To prepare with applesauce:
    
    • Mix the packet contents with 1 teaspoon of applesauce. Do not mix with water, or other liquids or food. Do not divide the packet contents to make smaller doses.
    • Swallow the mixture within 10 minutes after you mix it. Do not chew or crush the granules.
    • Sip some water after you take the mixture to make sure you swallow all of the medicine.
  • To prepare with apple juice:
    
    • Mix the packet contents with 1 teaspoon of apple juice in a small cup. Do not divide the packet contents to make smaller doses.
    • Stir for 5 seconds and drink the mixture immediately. Do not chew or crush the granules.
    • To make sure you get all of the medicine, add more apple juice to the cup. Drink it immediately.
  • To prepare for a feeding tube:
    
    • Pour the packet contents in a 2-ounce (60 milliliter [mL]) catheter-tip syringe.
    • Add 10 mL of apple juice to the syringe. Add the mixture to the tube. Gently tap or shake the barrel of the syringe to help empty it.
    • Add 10 mL of apple juice to the syringe and put it in the tube. Do this at least 2 times. There should be no granules left in the syringe.
• This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.
• Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some medicines can affect how pantoprazole works. Tell your doctor if you are using any of the following:
  
  • Ampicillin, atazanavir, digoxin, erlotinib, ketoconazole, methotrexate, mycophenolate mofetil, or nelfinavir
  • Blood thinner (such as warfarin)
  • Diuretic (water pill)
  • Iron supplements

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have liver disease or osteoporosis.
• This medicine may cause the following problems:
  
  • Kidney problems
  • Low vitamin B12 or magnesium levels
  • Increased risk of broken bones in the hip, wrist, or spine
• This medicine can cause diarrhea. Call your doctor if the diarrhea becomes severe, does not stop, or is bloody. Do not take any medicine to stop diarrhea until you have talked to your doctor. Diarrhea can occur 2 months or more after you stop taking this medicine.
• Tell any doctor or dentist who treats you that you are using this medicine. This medicine may affect certain medical test results.
• Your doctor will check your progress and the effects of this medicine at regular visits. Keep all appointments.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blistering, peeling, red skin rash
• Fever, joint pain, swelling in your body, unusual weight gain, change in how much or how often you urinate
• Seizures, dizziness, uneven heartbeat, muscle cramps or twitching
• Severe diarrhea, stomach cramps, fever
• Stomach pain, nausea, vomiting, weight loss

If you notice these less serious side effects, talk with your doctor:

• Mild diarrhea

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088