Proton pump inhibitors and hypomagnesemia monitoring

Lemon, Thomas I

doi:10.2147/ijgm.s51547

Cited by 5 publications

(8 citation statements)

References 2 publications

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“…PPIs may decrease intestinal magnesium absorption by interfering with both active absorption via transient receptor potential melastatin (TRPM) protein channels and with passive absorption through the paracellular pores. 33 , 34 PPIs may also affect the absorption of magnesium in the colon. The pH in the cecum is usually acidic due to the fermentation of carbohydrates, so PPI inhibition of colonic proton pumps may increase the pH of the distal colon and indirectly decrease active magnesium absorption in the colon by TRPM6 and by passive paracellular transport.…”

Section: Discussionmentioning

confidence: 99%

Proton Pump Inhibitor Usage and the Risk of Mortality in Hemodialysis Patients

Francisco

Varas

Ramos

et al. 2018

Kidney International Reports

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IntroductionLong-term inappropriate proton pump inhibitors use (PPIs) is a matter of concern because of the risks associated with their long-term use in older patients with chronic conditions. The risk of PPI treatment in hemodialysis patients remains unexplored.MethodsWe assessed the relationship between the use of PPIs and the risk of death in hemodialysis patients throughout a retrospective multicenter propensity score–matched study. Information about demographic, hemodialysis treatment, laboratory data, and concomitant medication was obtained from the EuCliD database (Fresenius Medical Care). We studied 1776 hemodialysis patients on PPI therapy compared to 466 patients not receiving PPIs. The resulting population comprising 2 groups of 410 matched patients was studied.ResultsPPI use was associated with hypomagnesemia (Mg <1.8 mg/dl (0.75 mmol/l); odds ratio [OR] = 2.70, 95% confidence interval [CI] = 1.38−5.27, P < 0.01). The exposure to PPIs in the full patient cohort was identified as an independent predictor for all-cause mortality in both univariate (HR = 3.16, 95% CI = 1.69–5.90, P < 0.01) and multivariate (HR = 2.70, 95% CI = 1.38–5.27, P < 0.01) Cox regression models. Moreover PPI use was identified as a predictor of CV mortality (HR = 1.51, 95% CI = 1.05−2.20, P = 0.03) Of the 820 patients matched throughout the propensity score analysis, the hazard ratios for all-cause mortality (HR = 1.412, 95% CI = 1.04–1.93, P = 0.03) and CV mortality (HR = 1.67, 95% CI = 1.03−2.71, P = 0.04) were higher among patients on PPIs versus those not on PPIs.ConclusionThe study data suggest that the PPI treatment should be regularly monitored and prescribed only when indicated.

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Section: Discussionmentioning

confidence: 99%

Proton Pump Inhibitor Usage and the Risk of Mortality in Hemodialysis Patients

Francisco

Varas

Ramos

et al. 2018

Kidney International Reports

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“…Others reported hypomagnesemia in 13% of PPI users. Nevertheless, patients on long-term treatment with PPIs should be monitored for magnesium deficiency, especially those with diabetes and cardiovascular disease (e.g., arrhythmias, heart failure, hypertension), because the probability and the risk of disease-associated complications is increased [46,50,51]. The mechanisms by which PPIs can interfere with intestinal magnesium absorption is still being investigated.…”

Section: Drug-induced Magnesium Deficiencymentioning

confidence: 99%

Magnesium and Drugs

Gröber¹

2019

IJMS

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Several drugs including diuretics and proton-pump inhibitors can cause magnesium loss and hypomagnesemia. Magnesium and drugs use the same transport and metabolism pathways in the body for their intestinal absorption, metabolism, and elimination. This means that when one or more drug is taken, there is always a potential risk of interaction with the magnesium status. Consequently the action of a drug may be adversely affected by magnesium (e.g., magnesium, calcium, and zinc can interfere with the gastrointestinal absorption of tetracycline antibiotics) and simultaneously the physiological function of minerals such as magnesium may be impaired by a drug (e.g., diuretics induce renal magnesium loss). Given the ever-increasing number of drugs on the market and the frequency with which they are used, greater attention must be paid in daily medical and pharmaceutical practice focused in particular on the adverse effects of drug therapy on magnesium status in order to minimize the potential risk to the health of patients.

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“…Hypomagnesaemia with PPI use is uncommon, occurring in less than 1% of all PPI-induced side-effects voluntarily reported to the FDA [ 6 ]. The mechanism by which this occurs is still being investigated.…”

Section: Introductionmentioning

confidence: 99%

“…The mechanism by which this occurs is still being investigated. PPIs may decrease intestinal magnesium (Mg) absorption by interfering with both active [transient receptor potential melastatin (TRPM) protein channels] and passive (paracellular pores) absorption [ 6 , 7 ]. PPIs bind irreversibly to the parietal cell H/K adenosine triphosphate (ATP) pump and inhibit gastric acid production by 95%.…”

Section: Introductionmentioning

confidence: 99%

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Hypomagnesaemia associated with long-term use of proton pump inhibitors

Toh

Ong

Wilson

2014

Gastroenterol. Rep.

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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.

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Proton pump inhibitors and hypomagnesemia monitoring

Cited by 5 publications

References 2 publications

Proton Pump Inhibitor Usage and the Risk of Mortality in Hemodialysis Patients

Proton Pump Inhibitor Usage and the Risk of Mortality in Hemodialysis Patients

Magnesium and Drugs

Hypomagnesaemia associated with long-term use of proton pump inhibitors

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