Hypomagnesemia and proton-pump inhibitors

Area of Science:

• Nephrology
• Endocrinology
• Pharmacology

Background:

• Proton pump inhibitors (PPIs) are frequently associated with clinically significant hypomagnesemia.
• Hypomagnesemia can manifest as hypoparathyroidism, though severe complications are rare.

Purpose of the Study:

• To review the association between PPI use and hypomagnesemia.
• To discuss the clinical presentation, potential mechanisms, and management strategies for PPI-induced hypomagnesemia.

Main Methods:

• A comprehensive literature search was conducted using terms related to PPIs, magnesium, and hypomagnesemia.
• Relevant articles were identified through database searches and reference list reviews.

Main Results:

• Hypomagnesemia was observed across various PPIs, suggesting a potential class effect.
• Low magnesium levels were refractory to supplementation until PPIs were discontinued.
• Recurrence of hypomagnesemia was noted upon PPI re-challenge, independent of dosage.
• Mechanisms underlying PPI-induced hypomagnesemia remain unclear, with PPI-induced hypochlorhydria not appearing to be involved.

Conclusions:

• PPIs are a likely cause of hypomagnesemia, despite unclear mechanisms and incidence rates.
• Baseline magnesium monitoring is advised for patients on long-term PPI therapy or those with other risk factors for hypomagnesemia.
• Discontinuation of PPIs or consideration of alternative treatments like H2-blockers may be necessary.