Proton pump inhibitors (PPIs) and hypomagnesaemia

• prolonged use of proton pump inhibitors (PPIs) has been associated with case reports of hypomagnesaemia
  
  
  • some cases occurred after 3 months of PPI therapy, but most occurred after 1 year of treatment
    • serious manifestations of hypomagnesaemia - fatigue, tetany, delirium, convulsions, dizziness, and ventricular arrhythmia - can occur, but they may begin insidiously and be overlooked. In most case reports, hypomagnesaemia improved after magnesium replacement and discontinuation of the PPI
      
      
• healthcare professionals should consider measuring magnesium levels before starting PPI treatment and repeat measurements periodically during prolonged treatment, especially in those who will take a PPI concomitantly with digoxin or drugs that may cause hypomagnesaemia (eg, diuretics)

The MHRA advise that healthcare professionals should:

• consider measurement of magnesium levels before starting PPI treatment and periodically during prolonged treatment, especially in those who will take a PPI concomitantly with digoxin or drugs that may cause hypomagnesaemia (eg, diuretics)
• take into account any use of PPIs obtained over-the-counter

Reference:

• MHRA (April2012). Drug and Safety Update; 5 (9).