Low Magnesium Levels May Be Associated with Proton Pump Inhibitor Drugs

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Prescription PPIs include Nexium (esomeprazole magnesium), Dexilant

(dexlansoprazole), Prilosec (omeprazole), Zegerid (omeprazole and sodium

bicarbonate), Prevacid (lansoprazole), Protonix (pantoprazole sodium),

AcipHex (rabeprazole sodium), and Vimovo (a prescription combination drug

product that contains a PPI [esomeprazole magnesium and naproxen]).

Over-the-counter (OTC) PPIs include Prilosec OTC (omeprazole), Zegerid OTC

(omeprazole and sodium bicarbonate), and Prevacid 24HR (lansoprazole).

FDA notified healthcare professionals and the public that prescription

proton pump inhibitor (PPI) drugs may cause low serum magnesium levels

(hypomagnesemia) if taken for prolonged periods of time (in most cases,

longer than one year). Low serum magnesium levels can result in serious

adverse events including muscle spasm (tetany), irregular heartbeat

(arrhythmias), and convulsions (seizures); however, patients do not always

have these symptoms. Treatment of hypomagnesemia generally requires

magnesium supplements. In approximately one-quarter of the cases reviewed,

magnesium supplementation alone did not improve low serum magnesium levels

and the PPI had to be discontinued.

PPIs work by reducing the amount of acid in the stomach and are used to

treat conditions such as gastroesophageal reflux disease (GERD), stomach and

small intestine ulcers, and inflammation of the esophagus.

Healthcare professionals should consider obtaining serum magnesium levels

prior to initiation of prescription PPI treatment in patients expected to be

on these drugs for long periods of time, as well as patients who take PPIs

with medications such as digoxin, diuretics or drugs that may cause

hypomagnesemia. For patients taking digoxin, a heart medicine, this is

especially important because low magnesium can increase the likelihood of

serious side effects. Healthcare professionals should consider obtaining

magnesium levels periodically in these patients.

*The ls of Pharmacotherapy. 2011;45(1):1-8.

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