Can mask symptoms & delay diagnosis of malignant gastric tumour. Slightly increased risk of GI infections eg, Salmonella, Campylobacter & possibly Clostridium difficile
. Limited safety data for patients on maintenance treatment for >1 yr. Reports of colitis (very rare); consider discontinuation in case of severe &/or persistent diarrhoea. Treatment for prevention of peptic ulceration in patients requiring continuous NSAID treatment should be restricted to high-risk patients (eg, previous GI bleeding, perforation or ulcer, advanced age, concomitant use of medication known to increase likelihood of upper GI adverse events [eg, corticosteroids or anticoagulants], presence of serious co-morbidity factor or prolonged use of NSAID max recommended doses). May modestly increase risk of hip, wrist & spine fracture, predominantly in the elderly or in presence of other recognised risk factors, especially if used in high doses & over long durations (>1 yr). Risk of severe hypomagnesaemia w/ serious manifestations eg, fatigue, tetany, delirium, convulsions, dizziness & ventricular arrhythmia. Consider measuring Mg levels before starting & periodically during treatment if expected to be on prolonged treatment or if concomitantly taking digoxin or drugs that may cause hypomagnesaemia (eg, diuretics). Associated w/ very infrequent cases of subacute cutaneous lupus erythematosus; consider discontinuation if lesions occur, especially in sun-exposed areas of the skin, & if accompanied by arthralgia. Stop treatment for at least 5 days before chromogranin A (CgA) measurements. Co-administration of proton pump inhibitors & high-dose methotrexate may elevate & prolong serum levels of methotrexate &/or its metabolite hydroxymethotrexate. Should not be taken by patients w/ rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency. May impair ability to drive or operate machinery. Should be used w/ caution in patients w/ moderate & severe hepatic dysfunction. Not recommended during pregnancy. Lactation. Not recommended in childn.