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The mechanism of action, involving natural beta-3 adrenergic receptors and lipolytic pathways, suggests that chronic use is unlikely to produce novel safety concerns beyond what was observed in clinical trials

Physiol Rep

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Hypomagnesemia recurred if PPI therapy was re-introduced[226] Another recent review of 4 cases examined the clinical consequences and mechanisms of electrolyte disorders that resulted from the elderly patients taking a PPI for a period of 1 to 13 years.[227] They developed severe low magnesium levels with low calcium levels, hypoparathyroidism (low parathyroid hormone), and extremely low urinary calcium and magnesium excretion