Proton-pump inhibitor use is associated with low serum magnesium concentrations

Danziger, John; William, Jeffrey H.; Scott, Daniel; Lee, Joon; Lehman, Li-wei H.; Mark, Roger G.; Howell, Michael D.; Celi, Leo Anthony; Mukamal, Kenneth J.

doi:10.1038/ki.2012.452

Cited by 163 publications

(167 citation statements)

References 42 publications

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“…[2][3][4][5][6] Severe hypomagnesemia can present with tremor, changes in mental status, hallucinations, agitation, dizziness, tetany, seizures or cardiac arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Effect of Chronic Proton Pump Inhibitor Use on Serum Magnesium Levels in Pediatric Patients

Stanford¹,

Rahhal²

2015

Gastro Open J

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Hypomagnesemia has been reported in adult patients on Proton Pump Inhibitor (PPI) therapy. No studies have described the effect of this class on medications on Magnesium (Mg) levels in children. This was a retrospective cohort study assessing serum Mg levels in patients on PPI therapy followed by a pediatric gastroenterology service at a tertiary center. The study included 31 patients with a mean age of 7.8 years with 74 serum Mg levels. Duration of PPI therapy ranged between few days to more than 8 years. The main indication for PPI therapy was gastroesophageal reflux disease. Only 2 patients, of adult age, had Mg levels below the normal reference limit of 1.6 mg/dL. In one patient, multiple risk factors for hypomagnesemia were noted. For the entire cohort, there was no statistically significant difference in serum Mg levels over time or with chronic use (defined as more than 2 years). This study did not identify any patient less than 18 years of age with hypomagnesemia while on PPI therapy. Prospective larger long-term pediatric studies may still be needed to better assess the incidence of hypomagnesemia in children on PPI therapy.

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“…[2][3][4][5][6] Severe hypomagnesemia can present with tremor, changes in mental status, hallucinations, agitation, dizziness, tetany, seizures or cardiac arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Effect of Chronic Proton Pump Inhibitor Use on Serum Magnesium Levels in Pediatric Patients

Stanford¹,

Rahhal²

2015

Gastro Open J

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“…In the case of vitamin B 12 , most of the studies are case-control and many of them have been questioned because the method of measurement of vitamin B 12 is not taking into account the patient's diet (29,30). Furthermore, studies of low methodological consistency have associated PPI for over a year with hypomagnesaemia (31,32). The Food and Drug Administration (FDA) has issued a warning about it and recommends applying serum magnesium levels before starting longterm treatment with PPIs and monitoring magnesemia in patients with risk factors (33).…”

Section: Overuse and Its Consequencesmentioning

confidence: 99%

Practical considerations in the management of proton-pump inhibitors

Aguilera¹,

Martín-de-Argila-dePrados²,

Albillos-Martínez³

2015

Rev Esp Enferm Dig

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Proton-pump inhibitors (PPIs) are one of the most active ingredients prescribed in Spain. In recent decades there has been an overuse of these drugs in both outpatient clinics and hospitals that has lead to a significant increase in healthcare spending and to an increase in the risk of possible side effects. It is important for health professionals to know the accepted indications and the correct doses for the use of these drugs. On the market there are different types of PPI: omeprazole, pantoprazole, lansoprazole, rabeprazole and esomeprazole. Omeprazole is the oldest and most used PPI, being also the cheapest. Although there are no important differences between PPIs in curing diseases, esomeprazole, a newgeneration PPI, has proved to be more effective in eradicating H. pylori and in healing severe esophagitis compared to other PPIs. In recent years the use of generic drugs has spread; these drugs have the same bioavailability than the original drugs. In the case of PPIs, the few comparative studies available in the literature between original and generic drugs have shown no significant differences in clinical efficacy.Key words: Proton-pump inhibitor. PPI. Omeprazole. Pantoprazole. Lansoprazole. Rabeprazole. Esomeprazole. INTRODUCTIONProton-pump inhibitors (PPIs) represent a family of drugs widely used in our country. The advent in the nineties of PPIs was a great revolution in the treatment of ulcer disease and gastroesophageal reflux. The main problems of PPIs at present time are its overuse and the errors in the therapeutic indication. This fact leads to a considerable health economic cost and the risk of long-term side effects. In this review the main problems of PPIs prescription, their indications, the differences between PPIs and tips on their use are discussed. Brief historical memory: since alkaline diets until PPIsThe treatment of ulcer disease and gastroesophageal reflux disease (GERD) in the early twentieth century was the prescription of alkaline foods like milk, eggs and puree (1). Later, there were products as sodium bicarbonate that improved symptoms but did not prevent complications. Surgical treatment consisted of different types of gastric surgeries for peptic ulcer disease and Nissen fundoplication for GERD (2).In the mid twentieth century the use of muscarinic antagonists was introduced, atropine being its main active ingredient. Acids secretion was partially inhibited by blocking the muscarinic receptor of the parietal cell. However, these drugs had little effectiveness and numerous adverse effects due to the amount of muscarinic receptors distributed throughout the body. E-type prostaglandin was discovered later, but, again, the limitations of these substances were their short half life and side effects. An important progress in gastric antisecretory therapy was the appearance of H 2 receptors antagonists (H 2 blockers) (3). The most used were ranitidine and famotidine. These drugs established a substantial change by blocking the action of histamine receptor in gastric parietal ...

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“…Patients groups are often differentiated by their illness severity, and thus any observational study assessing the effects of related treatments may fail to address underlying associated factors. For example, a recent observational Big Data study attempted to examine whether exposure to proton pump inhibitors (PPI) was associated with hypomagnesemia [10]. Indeed, in many thousands of examined patients, PPI users had lower admission serum magnesium concentrations.…”

Section: Selection Biasmentioning

confidence: 99%