Which to choose?
Omeprazole: first line on experience and cost. Pantoprazole: if the patient takes clopidogrel, immunosuppressants or drugs sensitive to CYP2C19. Both are clinically equivalent in GORD.
Point-by-point comparison
OmeprazoleProton pump inhibitor (PPI)
Brands: Losec · Prilosec
VS
PantoprazoleProton pump inhibitor (PPI)
Brands: Protium · Protonix
| Omeprazole | Pantoprazole | |
|---|---|---|
| Mechanism | Irreversibly inhibits the H+/K+-ATPase in the gastric parietal cell. Metabolised by CYP2C19 and CYP3A4. | Same mechanism. Metabolised by CYP2C19 plus sulfotransferase (an alternative route). |
| Indications | GORD, peptic ulcer, gastroprotection with NSAIDs, Helicobacter eradication (in combination). | Same as omeprazole. |
| Adult dose | 20-40 mg/day. | 20-40 mg/day. |
| Onset of effect | 1-2 h | 1-2 h |
| Duration of effect | 24 h (maximum effect after 3-5 days) | 24 h |
| Pregnancy | Compatible. | Compatible. |
| Breastfeeding | Compatible. | Compatible. |
| Paediatric use | From 1 year. | From 5 years. |
| Advantages | Most studied and most widely used. Available over the counter. Usually cheaper. | Fewer drug interactions. Preferred if the patient takes clopidogrel. |
| Disadvantages | More drug interactions (CYP2C19): clopidogrel (reduced efficacy), tacrolimus, phenytoin. | Slightly more expensive. Prescription only in some presentations. |
Source: BNF, NICE CG184, Spanish SmPC (AEMPS)
For guidance only. This does not replace the pharmacist's judgement or medical advice. Check the official Summary of Product Characteristics before any clinical decision.
Frequently asked questions
Which is better, omeprazole or pantoprazole?
Omeprazole: first line on experience and cost. Pantoprazole: if the patient takes clopidogrel, immunosuppressants or drugs sensitive to CYP2C19. Both are clinically equivalent in GORD.
Can omeprazole or pantoprazole be taken in pregnancy?
Omeprazole: Compatible. Pantoprazole: Compatible. Always ask a doctor or pharmacist before taking a medicine in pregnancy.
And while breastfeeding?
Omeprazole: Compatible. Pantoprazole: Compatible.