I assume pantoprazole is against acid reflux, is there a connection between how effective the metoprolol is if there is no stomach acid? Personally, I am long a time Pantoprazole user and could not handle the metoprolol or any of the others. I fainted and fell, broke several ribs, and punctured my right lung. So, after 3 cardioversions, several ablations I now have a pacemaker since this March. It is going reasonably well, no more afib but still have this tiredness. I was also put on Bisoprolol after my last ablation around my sinus node. Next appointment middle of August.