Nolpaza 20 mg and 40 mg gastro-resistant tablets – pantoprazole for reflux, heartburn and stomach ulcers

Nolpaza gastro-resistant tablets contain pantoprazole, a medicine from the group of selective proton pump inhibitors (ATC A02BC02). Pantoprazole reduces the production of stomach acid and is used to treat diseases of the stomach and intestine caused by increased acid secretion.

The medicine is available in two strengths – 20 mg and 40 mg – with different indications and dosing (see table). There is also Nolpaza 40 mg powder for solution for injection, which is used only in healthcare facilities and is not covered on this page; Nolpaza control (20 mg, non-prescription) is a separate medicine with its own leaflet.

What is Nolpaza used for and how should it be taken?

Key facts about the medicine

What is Nolpaza used for?

Nolpaza 20 mg – adults and adolescents from 12 years: treatment of symptoms of gastro-oesophageal reflux disease (heartburn, acid regurgitation, pain on swallowing); long-term treatment of reflux oesophagitis and prevention of its relapse. Adults: prevention of stomach and duodenal ulcers in at-risk patients who must take NSAIDs (e.g. ibuprofen) continuously.

Nolpaza 40 mg – adults and adolescents from 12 years: treatment of reflux oesophagitis. Adults: eradication of Helicobacter pylori in patients with stomach or duodenal ulcers (in combination with two antibiotics); treatment of stomach and duodenal ulcers; Zollinger-Ellison syndrome and other conditions of excessive acid secretion.

How is Nolpaza taken and dosed?

Unless the doctor prescribes otherwise, the usual doses according to the 20 mg and 40 mg leaflets are:

Method of administration: swallow the tablet whole (do not chew or break it) with a little water, 1 hour before a meal. Dosing for one strength is not transferred to the other – take exactly the strength and dose your doctor has prescribed.

Special patient groups

• Children under 12 years: not recommended.
• Severe liver impairment: as a rule no more than 20 mg pantoprazole per day; the doctor checks liver enzymes more often, and treatment is stopped if they rise. In moderate or severe liver impairment and in kidney problems Nolpaza 40 mg is not used for H. pylori eradication.
• Older people and kidney impairment: usually no dose adjustment is needed (consult your doctor).

Contraindications – when the medicine must not be used

• allergy to pantoprazole or any of the excipients;
• allergy to any other medicine from the proton pump inhibitor group.

Warnings and precautions

• Severe liver disease – more frequent liver enzyme tests, especially with longer use.
• Reduced vitamin B12 stores or risk factors – long-term use may reduce vitamin B12 absorption.
• Continuous NSAID use (20 mg) – the risk is assessed according to age (65 and over) and previous ulcer or bleeding.
• Concomitant use of HIV protease inhibitors (e.g. atazanavir) – consult your doctor.
• Use for more than a year – slightly increased risk of hip, wrist or spine fractures, especially with osteoporosis or corticosteroids.
• Use for more than 3 months – magnesium may fall (tiredness, involuntary muscle contractions, disorientation, seizures, dizziness, fast heartbeat), possibly with low potassium or calcium.
• Previous skin problems with similar medicines; rash on sun-exposed skin or joint pain – tell your doctor; severe skin reactions (SJS, TEN, DRESS, erythema multiforme) – stop the medicine.
• Planned chromogranin A test or urine test for THC – tell your doctor you take pantoprazole.
• Slightly increased risk of infectious diarrhoea.
• The medicine contains sorbitol (E420).

Interactions with other medicines, food and drink

Tell your doctor or pharmacist about all medicines you take. According to the leaflet, the following are important:

• ketoconazole, itraconazole, posaconazole and erlotinib – pantoprazole may prevent them from working properly;
• warfarin and phenprocoumon – additional blood tests may be needed;
• atazanavir (HIV medicine);
• methotrexate – the doctor may temporarily stop Nolpaza, as pantoprazole raises methotrexate levels;
• fluvoxamine – the doctor may reduce its dose;
• rifampicin;
• St John’s wort (Hypericum perforatum).

Food and drink: swallow the tablets whole with a little liquid, 1 hour before a meal.

Pregnancy and breast-feeding

• Pregnancy and breast-feeding: there are no adequate data on use in pregnancy, and pantoprazole is excreted in breast milk. The medicine is used only if the doctor considers the benefit greater than the possible risk to the foetus or newborn.

Driving and using machines

• Nolpaza has no or negligible influence on the ability to drive and use machines. If dizziness or visual disturbances occur, do not drive or use machines.

Possible side effects

Stop taking the medicine and contact your doctor or emergency services immediately in case of: a serious allergic reaction (swelling of the tongue or throat, difficulty swallowing, hives, difficulty breathing, facial swelling, severe dizziness with fast heartbeat and sweating – rare); serious skin reactions (blisters, erosions around the eyes, nose, mouth or genitals, rash on sun-exposed skin, fever, swollen glands – frequency not known); jaundice, or fever with rash and lower back pain with painful urination (kidney inflammation).

Common (up to 1 in 10): benign stomach polyps.

Uncommon (up to 1 in 100): headache, dizziness, diarrhoea, vomiting, bloating, constipation, dry mouth, abdominal pain and discomfort, rash, itching, weakness and malaise, sleep disorders, hip, wrist or spine fractures, raised liver enzymes.

Rare and very rare: altered or lost taste, blurred vision, hives, joint and muscle pain, weight change, raised temperature, leg swelling, allergic reactions, depression, breast enlargement in men, disorientation, raised bilirubin and blood fats, agranulocytosis, low platelet and white blood cell counts. Frequency not known: hallucinations, confusion, tingling and prickling of the skin, inflammation of the large bowel with watery stools, low blood sodium, magnesium, calcium or potassium.

Overdose, missed dose and stopping treatment

• Overdose: there are no known symptoms of overdose; if you have taken more than you should, consult your doctor or pharmacist immediately.
• Missed dose: do not take a double dose; take the next dose at the usual time.
• Stopping treatment: do not stop taking the medicine before consulting your doctor or pharmacist.

Related information

For additional care and support with heartburn and reflux, see also the category Heartburn (excess acid) – products in this category do not replace the medicine you have been prescribed.

Composition, pack and manufacturer

• Active substance: pantoprazole – 20 mg or 40 mg per gastro-resistant tablet (as pantoprazole sodium sesquihydrate).
• Excipients – core: mannitol (E421); crospovidone; sodium carbonate; sorbitol (E420); calcium stearate. Coating: hypromellose (E464); povidone K25; titanium dioxide (E171); yellow iron oxide (E172); propylene glycol (E1520); methacrylic acid-ethyl acrylate copolymer (1:1) dispersion 30%; sodium laurilsulfate; polysorbate 80; macrogol 6000; talc (E553b).
• Appearance: light brownish-yellow, slightly biconvex, oval film-coated tablets.
• Pack: OPA/Al/PVC//Al blisters of 14 tablets – carton with 14 or 28 tablets (20 mg and 40 mg).
• Marketing authorisation holder: Krka-Farma d.o.o. Beograd, Jurija Gagarina 26/V/II, Belgrade. Manufacturers: Krka, d.d., Novo mesto, Slovenia; TAD Pharma GmbH, Cuxhaven, Germany.
• Marketing authorisation numbers (renewals of 19.02.2024): 20 mg – 000457379 2023 (14 tablets) and 000457818 2023 (28 tablets); 40 mg – 000457809 2023 (14 tablets) and 000457810 2023 (28 tablets).

Storage

• Store in the original package to protect from moisture.
• Keep out of the sight and reach of children.
• Do not use after the expiry date; return unused medicine to a pharmacy that collects unused medicines.

Frequently asked questions

When is the best time to take Nolpaza?

According to the leaflet, swallow the tablet whole with a little water 1 hour before a meal. For H. pylori eradication Nolpaza 40 mg is taken twice daily – 1 hour before breakfast and 1 hour before dinner.

What is the difference between Nolpaza 20 mg and 40 mg?

Nolpaza 20 mg is used for reflux symptoms, long-term treatment and prevention of relapse of reflux oesophagitis, and for stomach protection during continuous NSAID use. Nolpaza 40 mg is used to treat reflux oesophagitis and ulcers, for H. pylori eradication and for Zollinger-Ellison syndrome. The doctor decides on the strength.

Is it safe to take pantoprazole for a long time?

With use for more than 3 months magnesium may fall, and with more than a year there is a slightly increased risk of fractures and reduced vitamin B12 absorption. The doctor will therefore probably monitor you regularly – report any new and unusual symptoms.

May I take St John’s wort with Nolpaza?

St John’s wort is listed in the leaflet among products you should tell your doctor about before using them with Nolpaza. Ask your doctor or pharmacist before taking herbal products.

Sources

• ALIMS – Package leaflet for Nolpaza 20 mg gastro-resistant tablets (PIL, Serbian)
• ALIMS – Summary of product characteristics for Nolpaza 20 mg (SmPC, Serbian)
• ALIMS – Package leaflet for Nolpaza 40 mg gastro-resistant tablets (PIL, Serbian)
• ALIMS – Summary of product characteristics for Nolpaza 40 mg (SmPC, Serbian)

Date sources were checked: 25.10.2026.