Hypomagnesemia: Reported rarely with prolonged treatment with PPIs.
Cyanocobalamin (Vitamin B-12) Deficiency: Daily long-term use (e.g., longer than 3 years) may lead to malabsorption or a deficiency of cyanocobalamin.
Cutaneous and Systemic Lupus Erythematosus: Mostly cutaneous new onset or exacerbation of existing disease discontinue pantoprazole sodium delayed-release tablets and refer to specialist for evaluation.
Bone Fracture: Long-term and multiple daily dose PPI therapy may be associated with an increased risk for osteoporosis-related fractures of the hip, wrist or spine.
Clostridium difficile-Associated Diarrhea: PPI therapy may be associated with increased risk ofĬlostridium difficile -associated diarrhea.
Acute Tubulointerstitial Nephritis: Discontinue treatment and evaluate patients.
Consider additional follow-up and diagnostic testing.
Gastric Malignancy: In adults, symptomatic response does not preclude presence of gastric malignancy.