What are the long term side effects of rabeprazole 20 mg?

October 9, 2025 •

3 min read

Proton pump inhibitors (PPIs) like rabeprazole are widely prescribed, but long-term use is associated with potential risks. Understanding what are the long term side effects of rabeprazole 20 mg is crucial for anyone on extended therapy for conditions like GERD.

Quick Summary

Long-term use of rabeprazole 20 mg, a proton pump inhibitor, can lead to serious side effects. These include an increased risk of bone fractures, kidney problems, nutrient deficiencies like vitamin B12 and magnesium, and certain infections.

Key Points

Bone Fracture Risk: Long-term use (a year or longer) of rabeprazole increases the risk of fractures in the hip, wrist, or spine.
Kidney Disease: Prolonged rabeprazole therapy is associated with a higher risk of acute interstitial nephritis and chronic kidney disease.
Vitamin B12 Deficiency: Taking rabeprazole for over three years can interfere with vitamin B12 absorption, leading to potential neurological symptoms and anemia.
Low Magnesium (Hypomagnesemia): Use for three months or more can deplete magnesium levels, which may cause serious side effects like muscle spasms and irregular heartbeat.
Increased Infection Risk: Rabeprazole can increase the risk of gastrointestinal infections like C. difficile and potentially community-acquired pneumonia.
Stomach Polyps: A heightened risk of developing benign stomach growths called fundic gland polyps is associated with long-term use.
Medical Supervision is Key: Patients should use the lowest effective dose for the shortest time needed and should not stop the medication abruptly without consulting a doctor due to rebound acid production.

Understanding Rabeprazole and Its Use

Rabeprazole, also known by the brand name AcipHex, is a proton pump inhibitor (PPI) prescribed for conditions caused by excessive stomach acid. It functions by blocking the proton pump in stomach cells, which is the final stage of gastric acid production. This effectively reduces stomach acid and is used to treat issues like GERD, duodenal ulcers, and Zollinger-Ellison syndrome. While typically used for short periods (4 to 8 weeks), there are concerns with prolonged use.

Common vs. Serious Side Effects

Short-term side effects are usually mild, including headaches, pain, and gastrointestinal issues. However, taking rabeprazole for a year or longer can lead to more serious long-term health risks.

Major Long-Term Side Effects

Extended use of rabeprazole 20 mg has been linked to several significant health problems, with the FDA issuing warnings about the long-term risks associated with PPIs.

Bone Fractures

Long-term PPI use is associated with an increased risk of fractures, particularly in the hip, wrist, and spine, especially after a year of use or at higher doses. This may be due to reduced calcium absorption caused by lower stomach acid levels. Rabeprazole has been specifically associated with an increased risk for subsequent fractures in one study.

Kidney Problems

Prolonged PPI use is connected to a higher risk of kidney issues, including acute interstitial nephritis (sudden kidney inflammation) and chronic kidney disease (CKD). Symptoms can be subtle, such as fatigue and changes in urination. Some research indicates rabeprazole might have a lower risk of causing kidney problems compared to certain other PPIs.

Nutrient Deficiencies

By reducing stomach acid, rabeprazole can hinder the absorption of vital nutrients.

Vitamin B12 Deficiency: Using rabeprazole for more than three years can lead to low vitamin B12 levels, causing symptoms like fatigue and neurological issues.
Hypomagnesemia (Low Magnesium): Taking rabeprazole for three months or longer can result in low magnesium, which can be serious and cause muscle spasms and irregular heartbeats. Sometimes, stopping the PPI is necessary to correct low magnesium.
Iron and Calcium: PPIs can also affect the absorption of iron and calcium.

Infections and Other Risks

Clostridioides difficile (C. diff) Infection: Reduced stomach acid increases the risk of serious gut infections like C. diff-associated diarrhea.
Pneumonia: There is a suggested link between PPI use and an increased risk of community-acquired pneumonia.
Stomach Growths (Fundic Gland Polyps): Long-term PPI use, especially over a year, can increase the risk of benign stomach polyps.
Lupus: In rare cases, rabeprazole may trigger or worsen lupus.

Comparison of PPI Long-Term Effects


Feature	Rabeprazole	Omeprazole (Another Common PPI)
Mechanism	Inhibits the H+/K+ ATPase (proton pump) to reduce stomach acid.	Also inhibits the H+/K+ ATPase (proton pump).
Onset of Action	Often demonstrates a more rapid onset of acid inhibition than omeprazole.	Effective, but may have a slightly slower onset compared to rabeprazole.
Long-Term Fracture Risk	Associated with an increased risk of hip, wrist, and spine fractures.	Also associated with an increased risk of bone fractures with long-term use.
Nutrient Deficiencies	Risk of Vitamin B12 and magnesium deficiency with use >1-3 years.	Similar risk of Vitamin B12 and magnesium deficiency with long-term use.
Kidney Risk	Associated with risk of AIN and CKD, but some studies suggest a lower signal compared to other PPIs.	Associated with similar kidney risks.

Managing Risks and Discontinuation

To minimize risks, healthcare providers recommend using the lowest effective dose of rabeprazole for the shortest duration necessary. For those on long-term therapy, monitoring for nutrient deficiencies and kidney function may be advised. It's crucial to consult a doctor before stopping rabeprazole, as abrupt discontinuation can lead to rebound acid hypersecretion. A gradual tapering of the dose is often recommended.

Conclusion

While effective for acid-related issues, long-term use of rabeprazole 20 mg carries notable risks, including bone fractures, kidney disease, nutrient deficiencies, and infections. Patients should use the medication as prescribed, be aware of potential symptoms, and regularly discuss their treatment with their healthcare provider to evaluate the ongoing need for the medication.

For more information from a regulatory agency, you can visit the FDA's drug database: ACIPHEX (rabeprazole sodium) Label

Frequently Asked Questions

Rabeprazole is typically intended for short-term use, often for 4 to 8 weeks. Long-term use (more than a year) is associated with increased risks and should only be undertaken under a doctor's supervision to manage chronic conditions.

Yes, long-term use of proton pump inhibitors like rabeprazole has been linked to an increased risk of kidney problems, including acute interstitial nephritis and chronic kidney disease.

Yes, taking rabeprazole for an extended period can lead to deficiencies in Vitamin B12 (if taken for >3 years) and magnesium (if taken for >3 months) due to decreased absorption in the stomach.

Studies suggest that taking rabeprazole long-term, especially at high doses for over a year, may increase the risk of osteoporosis-related fractures of the hip, wrist, or spine.

If you have been taking rabeprazole for a long time, you should speak to your doctor before stopping. Stopping suddenly can cause rebound acid production and a return of symptoms. Your doctor may recommend a gradual dose reduction.

Some observational studies have suggested a possible increased risk of stomach cancer with long-term PPI use, especially in certain populations, but more research is needed to establish a direct causal link. It's recommended to use the lowest effective dose for the shortest possible duration.

Symptoms of low magnesium (hypomagnesemia) can include dizziness, irregular or fast heartbeat, muscle tremors or jerking movements, muscle cramps, and seizures.