Dexilant side effects and how to avoid them

Hypomagnesemia, vitamin B12 deficiency, and fundic gland polyps are common Dexilant side effects with long-term use

By Georgia C. Yalanis, MD | Nov. 15, 2021 Medically reviewed by Anne Jacobson, MD, MPH

Dexilant is the brand name for the drug dexlansoprazole. Dexilant is in the class of medications known as proton pump inhibitors (PPIs). Proton pump inhibitors (dexlansoprazole, lansoprazole, omeprazole) block the main pump in the lining of the stomach that produces gastric acid. This reduces the amount of acid in the stomach and provides symptom relief of heartburn and stomach pain. It also allows the lining of the stomach and esophagus to heal from damage caused by too much acid. PPIs are used as prescription drugs or over-the-counter medications in the treatment of heartburn, acid reflux, gastric ulcers, and gastroesophageal reflux disease (GERD).

The Food and Drug Administration (FDA) has approved Dexilant for use in adults and children 12 years of age and older. Dexlilant is available as a 30 mg or 60 mg delayed-release capsule.

PPIs, including Dexilant, are associated with several side effects. In this article, we will discuss these side effects, warnings, potential drug interactions, and how to avoid them.

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Common side effects of Dexilant

Dexilant use is associated with some common side effects. These are usually mild and self-limiting (they go away on their own). If any of the following symptoms occur and become bothersome, notify your healthcare provider.

Abdominal pain
Diarrhea
Nausea
Vomiting
Gas
Upper respiratory tract infection
Headache
Vitamin B12 deficiency (long-term use)
Fundic gland polyps (long-term use)

Serious side effects of Dexilant

Some serious side effects can occur when using this medication, especially when taken in high doses. If any of the following serious adverse events occur, it is important to seek medical attention right away. These events can also be reported to the FDA Adverse Events Reporting System by calling 1-800-FDA-1088.

Serious allergic reactions or hypersensitivity reactions, which could lead to anaphylaxis or death
Life-threatening skin conditions, which include Stevens-Johnson syndrome and toxic epidermal necrolysis
Kidney problems including renal impairment and tubulointerstitial nephritis
Joint pain, bone fractures, and osteoporosis
Lupus erythematosus
Clostridium difficile-associated diarrhea (C.Diff)
Hypomagnesemia (long-term use)

Side effects of long-term Dexilant use

Proton pump inhibitors are the third largest selling class of medications. They are generally considered a very safe and well-tolerated class of drugs. Many people take PPIs for chronic or persistent conditions over a long period of time. This increased usage has uncovered some side effects that are more likely to occur when PPIs have been used for a long period of time (years).

The best length of time to take PPIs varies by medical condition and factors unique to each person. It is important to discuss all medical conditions and medications with a healthcare provider before taking this medication to minimize the likelihood of side effects.

Hypomagnesemia

Hypomagnesemia is a condition where there is low magnesium in the bone and blood. Current evidence suggests that PPIs like Dexilant can impair intestinal absorption of magnesium so that less is available for use in the body. Magnesium deficiency can cause a wide range of non-specific symptoms such as tiredness or weakness, specific symptoms including muscle cramps or muscle pain, and even cause life-threatening events like seizures, cardiac arrhythmias, and problems with metabolism.

PPI-induced hypomagnesemia (PPIH) is something that can occur with any PPI and can be persistent and severe. Most magnesium levels return to normal within a few weeks of stopping a PPI, but they may drop when the medication is started again.

For some people, stopping a PPI may not be an option. In these cases, oral or intravenous magnesium supplementation is often used. In extreme cases, surgery may be indicated to eliminate the need for PPI use altogether. A healthcare professional can provide specific recommendations based on the severity of low magnesium and the need to continue the PPI. Recommendations may also include checking magnesium blood levels during treatment.

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Vitamin B12 deficiency

Vitamin B12, also known as cobalamin, is required for many important processes in the body. It is one of the essential vitamins that must be acquired from a person’s diet. PPIs decrease the amount of stomach acid produced, which limits the amount of vitamin B12 the body can absorb from foods. This can happen with long-term use of any PPI, including Dexilant. Vitamin B12 levels need to be monitored especially in older patients.

Most studies note that the risk for vitamin B12 deficiency is related to the length of time PPIs are used. Low vitamin B12 can cause weakness, tiredness, difficulty breathing, anemia, and problems thinking or dementia in seniors. When considering any new symptom, it is important to discuss all medication use with a healthcare provider, especially medications that have been taken for several years.

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Fundic gland polyps

Fundic gland polyps are benign (non-cancerous) growths in the upper portion of the stomach called the fundus. They usually do not cause symptoms themselves and are typically found during endoscopic procedures performed to find the cause of stomach problems or reflux.

Incidence of PPI-induced gastric polyps significantly increases after using these medications for more than 12 months. Over longer periods of time, polyps can continue to increase in both size and number. There are case reports of these polyps disappearing when proton pump inhibitors are stopped.

Dementia

There are some questions about the link between PPI use and new-onset dementia from conditions like Alzheimer’s disease. One study found that chronic PPI use in older adults was associated with a 44% increased risk of developing dementia. This study prompted discussion in the medical community about using PPIs in seniors and caused many older individuals to stop taking their PPIs without talking to their providers about the risks and benefits.

Since then, other studies have had widely different conclusions. This has led to discussion regarding other factors that could contribute to the risk of dementia like vitamin B levels, other medication use, and health status. Current recommendations are to stop using PPIs in people who don’t need them and to use the lowest possible dose for people who do need them.

How long do Dexilant side effects last?

Symptoms should start to improve within a few days of starting a PPI. Most common side effects (gastrointestinal symptoms, headache) associated with Dexilant use are mild and will go away on their own after several days of taking the medication. Serious side effects (Stevens-Johnson syndrome, toxic epidermal necrolysis, bone fractures) require prompt discontinuation of the medication.

There are several side effects associated with the long-term use of PPIs. These include low magnesium, vitamin B12 deficiency, stomach polyps, and possibly dementia in older adults.

Dexilant contraindications and warnings

Abuse and dependence

Dexilant is not habit-forming or addictive. While there are no withdrawal symptoms associated with stopping PPIs, stopping them abruptly after a prolonged period of use could result in rebound hypergastrinemia, a condition where the stomach produces too much stomach acid. This may require users to become dependent on medications like PPIs to control the acid.

Overdose

It is very unlikely that taking too much Dexilant will cause immediate, imminent death. However, this medication should be taken exactly as is prescribed or according to the drug information in the package insert. Individuals concerned about taking too much medication or accidentally taking medication that was not prescribed to them should seek medical attention or call the Poison Control Centers at 1-800-222-1222.

Restrictions

There are no absolute restrictions for Dexilant use in adults older than 18 years of age. Caution should be used in people with liver problems or low magnesium levels.

Dexilant may be used during pregnancy as there is no known risk based on limited human data. However, no human data is available on Dexilant use during breastfeeding. Women should discuss Dexilant and safe alternatives with their healthcare providers.

Dexilant interactions

Medications that are contraindicated for use with Dexliant:

Rilpivirine

Several other medications should be used with caution if taking Dexilant:

Atazanavir, nelfinavir, and saquinavir: Lowers the concentration of these medications in the body and may result in a loss of therapeutic effects and development of HIV resistance
Warfarin: Taking PPIs with warfarin may increase bleeding or cause abnormal bleeding
Tacrolimus: Dexilant may increase blood levels of tacrolimus
Methotrexate: May increase and prolong blood levels of methotrexate
Other medications that decrease gastric acidity
Drugs with acid-dependent absorption: Many medications may be affected by the decrease in stomach acid.

How to avoid Dexilant side effects

1. It is important to follow medical advice while taking this medication

Take only the dose prescribed by a healthcare professional or recommended on the package insert medication guide. Do not take more medication and do not take less. Take all of the doses how and when they are prescribed. For a missed dose, take the next dose as soon as you remember.

2. Patients should disclose a full medication list, health history, and allergies before taking Dexilant

This includes all medications and supplements, medical conditions, and allergies.

3. Store and dispose of the medication correctly and away from children

PPIs should be stored at room temperature (68 to 77 degrees Fahrenheit). Improper storage and disposal of the medication could potentially expose children to the medication.

4. To reduce GI side effects, it may be helpful to take this medication with a small meal or snack

Capsule granules may be mixed with food such as applesauce. The granules should not be chewed or stored in food for later use.

PPIs are most effective when they are taken before a meal. If you are planning on having a large meal, taking Dexilant 30 minutes before eating will improve acid control.

PPIs should not be taken on a completely empty stomach or before bed unless indicated by a healthcare provider.