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Contact your healthcare provider promptly if you experience: Severe or persistent heartburn unresponsive to over-the-counter antacids or lifestyle modifications Difficulty swallowing (dysphagia) or painful swallowing (odynophagia), which may indicate esophageal inflammation or stricture Persistent nausea and vomiting that prevents adequate oral intake or leads to dehydration Vomiting blood (hematemesis) or material resembling coffee grounds Black, tarry stools (melena) or visible blood in stool Severe abdominal pain, particularly if localized to the upper abdomen or radiating to the back (stop medication immediately if pancreatitis is suspected) Right upper quadrant pain, fever, or yellowing of skin/eyes, which may indicate gallbladder disease Unintentional weight loss beyond expected therapeutic effects New or worsening chest pain (call 911 if concerning for heart attack), especially if accompanied by shortness of breath These symptoms may indicate complications such as erosive esophagitis, gastrointestinal bleeding, pancreatitis, or gastroparesis

These side effects are typically mild to moderate and often decrease over time

10.4161/cbt.26428 46 GaoL.LiuM.-M.ZangH.MaQ.-Y.YangQ.JiangL.et al (2018)

A single 20mg vial draws from one batch with one certificate of analysis, whereas the same total mass split across two 10mg vials may span two batches and two purity figures