Exclude malignancy in the presence of any alarm symptoms (eg, significant wt loss, recurrent vomiting, dysphagia, haematemesis, anaemia or melaena). Regularly monitor liver enzymes in patients w/ severe liver impairment. Discontinue treatment if liver enzymes rise. Increased risk of Clostridium difficile
-associated diarrhoea (CDAD) especially in hospitalised patients. Slightly increased risk of GI infections caused by bacteria eg, Salmonella & Campylobacter. Hypomagnesemia which may lead to hypocalcemia &/or hypokalemia. Consider monitoring Mg levels prior to initiation of PPI treatment & periodically after, in patients expected to be on prolonged treatment or are taking PPIs w/ drugs that may cause hypomagnesemia. Increased risk for osteoporosis-related fractures of the hip, wrist or spine especially in patients receiving high-dose or long-term therapy. Concomitant use w/ methotrexate. Not recommended in co-administration w/ HIV protease inhibitors eg, atazanavir, nelfinavir. Consider cyanocobalamin deficiency in patients w/ Zollinger-Ellison syndrome & other pathological hypersecretory conditions requiring long-term treatment. Discontinue PPI treatment for 14 days prior to chromogranin A measurements. Avoid long-term treatment. Discontinue treatment if signs or symptoms consistent w/ cutaneous lupus erythematosus or SLE occur & evaluate patient. 20-mg tab: Concomitant use w/ NSAID. 40-mg tab: Do not use in combination treatment (eg, amoxicillin, clarithromycin) for eradication of H. pylori
in patients w/ moderate to severe hepatic dysfunction or impaired renal function. Regularly monitor patients when exceeding a treatment period of 1 yr. Dizziness & visual disturbances may affect ability to drive or operate machinery. Do not use during pregnancy. Lactation. Not recommended for use in childn <12 yr (tab) & <18 yr (inj).