Proton-pump inhibitor-induced hypomagnesemia: Current research and proposed mechanisms

Abstract

Since the early reports nearly a decade ago, proton-pump inhibitor-induced hypomagnesemia (PPIH) has become a well-recognized phenomenon. While many observational studies in the inpatient and outpatient populations have confirmed the association of PPI exposure and serum magnesium concentrations, there are no prospective, controlled studies to support causation. Molecular mechanisms of magnesium transporters, including the pH-dependent regulation of transient receptor potential melastatin-6 transporters in the colonic enterocyte, have been proposed to explain the effect of PPIs on magnesium reabsorption, but may be a small part of a more complicated interplay of molecular biology, pharmacology, and genetic predisposition. This review explores the current state of research in the field of PPIH and the proposed mechanisms of this effect.

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

“…Although the reduced gastric acidity associated with omeprazole medication has been linked to reduced intestinal calcium absorption also and subsequent hypocalcemia, hypomagnesaemia is accepted as the likely trigger for the other associated electrolyte disorders and hypoparathyroidism. 9,10 In the index case, we had only withdrawn omeprazole and supplemented the patient with only oral magnesium and the patient made a satisfactory recovery which supports the role of hypomagnesaemia in omeprazole-induced electrolyte derangements.…”

“…[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. Omeprazole-induced electrolyte disorders are rare following short-term omeprazole medication and among the younger age groups.…”

Prescription of Proton Pump Inhibitors in Elderly Subjects in Real Life: A Retrospective Study in a Gastroenterology Department

“…• The consequences of the malabsorption: hyponatremia [17,18], deficiency in vitamin B12 [19] and hypomagnesemia [20,21] (which could have serious consequences such as confusion [22,23])…”

Magnesiummangel og protonpumpehemmere

“…Mekanismene for protonpumpehemmerindusert magnesiummangel er sannsynligvis hemming av den intestinale absorpsjonen gjennom molekylaere mekanismer av magnesiumtransportører i et samspill med farmakologiske forhold og genetisk predisposisjon (7). Likevel regnes nok denne medikamentgruppen som «ufarlig» av norske leger og er hyppig forskrevet.…”