RELATIONSHIP BETWEEN PROTON-PUMP INHIBITOR USE AND LOWER BLOOD MAGNESIUM LEVELS
DOI:
https://doi.org/10.22159/ijap.2018.v10s1.81Keywords:
Blood magnesium levels, Lansoprazole, Omeprazole, Proton-pump inhibitorsAbstract
Objective: The aim of this study was to determine whether and to what degree proton-pump inhibitor (PPI) use affects blood magnesium levels.
Methods: We performed a cross-sectional comparative study with consecutive sampling technique from June to October 2016. This study compared
blood magnesium levels of patients using PPIs (lansoprazole and omeprazole) with those of patients not taking PPIs. The total sample was 184 patients.
Data collected included questionnaires and medical records. Statistical analysis was performed with the unpaired t-test, Mann–Whitney U-test, and
one-way analysis of variance.
Results: The average magnesium level in patients using PPIs was 2.08±0.21 mg/dL, whereas the average magnesium level in patients not using PPIs
was 2.27±0.38 mg/dL, a statistically significant difference (p<0.001). Magnesium levels were significantly lower in patients using PPIs for >1 year
and in patients using omeprazole (p<0.05).
Conclusion: Blood magnesium levels of patients using PPIs were significantly lower than those who did not use PPIs. Decreased levels of magnesium
in patients using PPI are affected by PPI type and the duration of PPI use - >1 year. Thus, the long-term use of PPIs may lead to decreased levels of
magnesium. Therefore, monitoring the levels of magnesium is important in patients using PPIs for a long term to avoid the risk of hypomagnesemia.
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References
Tamura T, Sakaeda T, Kadoyama K, Okuno Y. Omeprazole- and
esomeprazole-associated hypomagnesaemia: Data mining of the public
version of the FDA adverse event reporting system. Int J Med Sci
;9:322-6.
Food and Drug Administration. Drug Safety Communication: Low
Magnesium Levels can be Associated with Long-Term use of Proton
Pump Inhibitor Drugs (PPIs). Available from: http://www.fda.gov/
drugs/drugsafety/ucm245011.html. [Last accessed on 2015 Dec 08].
Kieboom BC, Kiefte-de Jong JC, Eijgelsheim M, Franco OH, Kuipers EJ,
Hofman A, et al. Proton pump inhibitors and hypomagnesemia in the
general population: A population-based cohort study. Am J Kidney Dis
;66:775-82.
Epstein M, McGrath S, Law F. Proton-pump inhibitors and
hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834‑6.
Toh JW, Ong E, Wilson R. Case report hypomagnesaemia associated
with long-term use of proton pump inhibitors. Gastroenterol Rep
;3:243-53.
Shah DU, Sachdeva PD. Association of proton pump inhibitor with
hypomagnesaemia : A cross-sectional study at a tertiary care hospital of
Anand district. Indian J Pharm Pract 2014;25:538-43.
Hess MW, Hoenderop JG, Bindels RJ, Drenth JP. Alimentary
pharmacology and therapeutics systematic review: Hypomagnesaemia
induced by proton pump inhibition. Aliment Pharmacol Ther
;36:405-13.
Lameris AL, Monnens LA, Bindels RJ, Hoenderop JG. Drug-induced
alterations in Mg2+ homoeostasis. Clin Sci (Lond) 2012;123:1-4.
Vakil N. Prescribing proton pump inhibitors: Is it time to pause and
rethink? Drugs 2012;72:437-45.
Gau JT, Yang YX, Chen R, Kao TC. Uses of proton pump inhibitors and
hypomagnesemia. Pharmacoepidemiol Drug Saf 2012;21:553-9.
Koulouridis I, Alfayez M, Tighiouart H, Madias NE, Kent DM,
Paulus JK, et al. Out-of-hospital use of proton pump inhibitors and
hypomagnesemia at hospital admission: A nested case-control study.
Am J Kidney Dis 2013;62:730-7.
Takeda Y, Doyama H, Tsuji K, Yamada S, Takemura K. Does long-term
use of proton pump inhibitors cause hypomagnesaemia in Japanese
outpatients? BMJ Open Gastroenterol 2014;1:e000003.
Lindner G, Funk GC, Leichtle AB, Fiedler GM, Schwarz C,
Eleftheriadis T, et al. Impact of proton pump inhibitor use on
magnesium homoeostasis: A cross-sectional study in a tertiary
emergency department. Int J Clin Pract 2014;68:1352-7.
Danziger J, William JH, Scott DJ, Lee J, Lehman LW, Mark RG, et al.
Proton-pump inhibitor use is associated with low serum magnesium
concentrations. Kidney Int 2013;83:692-9.
Ghose B, Ide S. Hypomagnesaemia and Type 2 diabetes mellitus:
A review of the literature. Austin J Nutr Food Sci 2014;2:1025.
Mohanty S, Pinnelli VB, Murgod R, Raghavendra DS. Evaluation of
serum copper, magnesium and glycated haemoglobin in Type 2 diabetes
mellitus. Asian J Pharm Clin Res 2013;6:188-90.
Alex SM, Menon VP, Sabarish B, Umadevi P, Dipu TS. Clozapineinduced
diabetic ketoacidosis: A case report. Asian J Pharm Clin Res
;11:1-2.
Sheeba S, Sneha AK, Veena B. Knowledge and self-care practices
among diabetics. Asian J Pharm Clin Res 2017;10:234-7.
Quamme GA. Recent developments in intestinal magnesium absorption.
Curr Opin Gastroenterol 2008;24:230-5.
Thongon N, Krishnamra N. Omeprazole decreases magnesium transport
across Caco-2 monolayers. World J Gastroenterol 2011;17:1574-83.
Voets T, Nilius B, Hoefs S, van der Kemp AW, Droogmans G,
Bindels RJ, et al. TRPM6 forms the mg2+ influx channel involved in
intestinal and renal mg2+ absorption. J Biol Chem 2004;279:19-25.
Thébault S, Cao G, Venselaar H, Xi Q, Bindels RJ, Hoenderop JG,
et al. Role of the alpha-kinase domain in transient receptor potential
melastatin 6 channel and regulation by intracellular ATP. J Biol Chem
;283:19999-20007.
William JH, Danziger J. Proton-pump inhibitor-induced
hypomagnesemia: Current research and proposed mechanisms. World J
Nephrol 2016;5:152-7.