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pDaily treatment with any acid-suppressing medications over a long period of timee.glonger than 3 yearsmay lead to malabsorption of cyanocobalaminvitamin B-12caused by hypoor achlorhydriaRare reports of cyanocobalamin deficiency occurring with acid-suppressing therapy have been reported in the literatureThis diagnosis should be considered if clinical symptoms consistent with cyanocobalamin deficiency are observed./ppYou may be more likely to have a broken bone while taking this medicine long term or more than once per day./ppIn adultssymptomatic response to therapy with NEXIUM does not preclude the presence of gastric malignancyConsider additional follow-up and diagnostic testing in adult patients who have a suboptimal response or an early symptomatic relapse after completing treatment with a PPIIn older patientsalso consider an endoscopy./ppHypomagnesemiasymptomatic and asymptomatichas been reported rarely in patients treated with PPIs for at least three monthsin most cases after a year of therapySerious adverse events include tetanyarrhythmiasand seizuresIn most patientstreatment of hypomagnesemia required magnesium replacement and discontinuation of the PPI./p

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