Hypomagnesaemia associated with long-term use of proton pump inhibitors

Abstract

Hypomagnesaemia and associated hypocalcaemia and hypoparathyroidism have been increasingly recognised as rare long-term side-effects of proton pump inhibitors (PPIs). The PPIs may inhibit active magnesium (Mg) absorption by interfering with transcellular transient receptor potential melastatin-6 and -7 (TRPM 6 and 7) channels. More recent cell culture studies have suggested concomitant inhibition of passive Mg absorption by omeprazole. After being treated with a range of PPIs, the four patients in our case series developed hypomagnesaemia, which responded to withdrawal of therapy and initiation of Mg replacement. Their clinical course and management demonstrate key aspects of hypomagnesaemia associated with long-term use of PPIs.

Using Probiotics Instead of Pharmaceuticals to Treat Gastrointestinal Disorders

“…Negative side effects related to long-term use of proton pump inhibitors (PPIs) show that these medications, while effective, are not ideal for long-term treatment of reducing stomach acid [22]. PPIs have been associated with negative side effects such as hypomagnesemia, hypocalcemia, hypoparathyroidism, chronic kidney disease, end-stage renal disease, hip fracture, community-acquired pneumonia, Clostridium difficile infection, and increased risk of SIBO (small intestinal bacterial overgrowth) [9,[22][23][24][25].…”

“…PPIs have been associated with negative side effects such as hypomagnesemia, hypocalcemia, hypoparathyroidism, chronic kidney disease, end-stage renal disease, hip fracture, community-acquired pneumonia, Clostridium difficile infection, and increased risk of SIBO (small intestinal bacterial overgrowth) [9,[22][23][24][25]. Millions of prescriptions are written and filled each year for antacids, H2 blockers, and PPIs [6].…”

PPIs and hypomagnesaemia: more common than we thought?

“…This is despite a steadily growing number of reports, some detailing serious consequences. [15][16][17][18][19] Perhaps this is because a number of things set hypomagnesaemia apart from some of the other potential adverse effects linked to PPIs. One is that the typical symptoms of magnesium deficiency are nonspecific and may have an insidious onset.…”

Electrolyte disorders in a young female following short-term omeprazole therapy

“…1,2 Various case reports have been published in the literature implicating omeprazole as a culprit in a rare drug-induced electrolyte abnormalities notably hypomagnesaemia and hypocalcemia associated with hypoparathyroidism. [3][4][5][6][7][8] These electrolyte abnormalities have been attributed to omeprazole-induced hypomagnesaemia which leads to defective secretion of parathyroid hormone and the subsequent hypocalcemia. 9,10 However, the majority of these cases which had been noted mostly in the western world had all been reported mainly after long-term medication with omeprazole especially among the elderly.…”