Long-term PPI: is laboratory monitoring needed?
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Prolonged treatment: targeted monitoring
Before prolonged treatment, then regularly
- Serum magnesium (if prolonged treatment, digoxin or diuretic)if neededThe SmPC asks to consider this test for prolonged treatment, or in combination with digoxin or a diuretic, before starting and then regularly, without specifying a frequency [2]. The AGA advises against measuring it routinely [3].
- Vitamin B12 (if reduced stores or malabsorption factor)if neededLong-term treatment in a patient with reduced stores or at risk of vitamin B12 malabsorption [2]. See also the page "Vitamin B12 deficiency".
- Serum creatinine with GFR (if interstitial nephritis suspected)if neededAcute tubulointerstitial nephritis can occur at any time on a PPI and progress to renal failure; stop the PPI if it is suspected [2].
Also consider
Do not order
- Vitamin B12 in every patient on a PPI: the SmPC covers only patients with reduced stores or at risk of malabsorption [2]
- Chromogranin A on a PPI: falsely elevated; stop the PPI at least 5 days before the measurement [2]
- Renewing a PPI without reassessing the indication: long-term treatment is very rarely justified [1]
- Serum creatinine, vitamin B12 or bone mineral density as routine monitoring of every patient on long-term PPI: not recommended by the AGA [3]
Hypomagnesaemia found on a PPI
Laboratory tests
- Serum magnesium (follow-up)
- Serum calcium
- Serum albumin
- Serum potassium
Sources (8)
- Haute Autorité de santé. Bon usage des inhibiteurs de la pompe à protons (IPP). Fiche Bon usage du médicament, validée par le Collège le 8 septembre 2022.
- Résumé des caractéristiques du produit MOPRAL 20 mg, gélule gastro-résistante (oméprazole), rubriques 4.4 et 4.8. Base de données publique des médicaments (code CIS 64103828), consultée le 11 octobre 2026. Mises en garde de classe communes aux IPP.
- Freedberg DE, Kim LS, Yang YX. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology 2017;152:706-15.
- Haute Autorité de santé. Choix et durées d'antibiothérapies : traitement probabiliste de l'infection par Helicobacter pylori chez l'adulte. Fiche mémo validée le 15 juillet 2021, mise à jour le 13 mai 2025.
- Medicines and Healthcare products Regulatory Agency (MHRA, Royaume-Uni). Proton pump inhibitors in long-term use: reports of hypomagnesaemia. Drug Safety Update, avril 2012, vol. 5, n° 9 : A1 (page gov.uk publiée le 11 décembre 2014).
- National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. Clinical guideline CG184, 3 septembre 2014, mise à jour le 18 octobre 2019 : recommandation 1.5.1.
- Iwakiri K, Fujiwara Y, Manabe N, et al. Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021 (Japanese Society of Gastroenterology). J Gastroenterol 2022;57(4):267-285.
- Targownik LE, Fisher DA, Saini SD. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology 2022;162(4):1334-1342.