Does the use of proton pump inhibitors increase the risk of hypomagnesemia

Liao, Susan; Gan, Li; Mei, Zhechuan

doi:10.1097/md.0000000000015011

Cited by 33 publications

(26 citation statements)

References 27 publications

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“…Many studies have suggested an increased risk and that hypomagnesemia develops in a proportion of PPI users [131]. Meta-analyses have been problematic due to study heterogeneity, but a recent analysis found that PPI users had an increased risk of hypomagnesemia (RR 1.44) compared to non-users [132], whereas analysis of only high-quality studies found an RR of 1.63 [133]. Hypomagnesemia is rare and it seems that mainly patients who already use a diuretic are at risk [131].…”

Section: Resultsmentioning

confidence: 99%

Adverse Effects of Proton Pump Inhibitors—Evidence and Plausibility

Fossmark

Martinsen

Waldum

2019

IJMS

123

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Proton pump inhibitors (PPIs) have been increasingly used over the last decades and there are concerns about overuse and the numerous reported side-effects. It is uncertain whether associations between PPI use and potential side effects are causal. However, important evidence from experimental and mechanistic studies that could support a causal relationship may have been underestimated by epidemiologists and meta-analysists. In the current manuscript we review the combined epidemiological and mechanistic evidence of the adverse effects of PPI use.

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Section: Resultsmentioning

confidence: 99%

Adverse Effects of Proton Pump Inhibitors—Evidence and Plausibility

Fossmark

Martinsen

Waldum

2019

IJMS

123

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“…While the aim of this study was not to evaluate the clinical safety of pantoprazole in calves, the lack of observed adverse effects correlate with previously reported pantoprazole use in ruminants for case management of cattle (4,26), camels (27), sheep (15,28), yaks (29), and goats (30,31). Adverse effects of pantoprazole administration described people include hyponatremia (32), hypomagnesemia (33), as well as nephritis and hepatotoxicity (34). Additional adverse effects described in people from proton pump inhibitor administration include thrombocytopenia (35) and neutropenia (36).…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics and Tissue Levels of Pantoprazole in Neonatal Calves After Intravenous Administration

et al. 2020

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Background: Neonatal calves are at risk of developing abomasal ulceration, but there is a lack of pharmacokinetic data for potential anti-ulcerative therapies, such as pantoprazole, in ruminant species.Objective: The study objectives were to estimate plasma pharmacokinetic parameters for pantoprazole in neonatal dairy calves after intravenous (IV) administration. A secondary objective was to quantify the concentrations of pantoprazole in edible tissues after IV dosing.Methods: Pantoprazole was administered to 9 neonatal Holstein calves at a dose of 1 mg/kg IV. Plasma samples were collected over 24 h and analyzed via HPLC-MS for determining pantoprazole concentrations. Pharmacokinetic parameters were derived via non-compartmental analysis. Tissue samples were collected at 1, 3, and 5 days after administration and analyzed via HPLC-MS.Results: Following IV administration, plasma clearance, elimination half-life, and volume of distribution of pantoprazole were estimated at 4.46 mL/kg/min, 2.81 h, and 0.301 L/kg, respectively. The global extraction ratio was estimated at 0.053 ± 0.015. No pantoprazole was detected in the edible tissues 1, 3, or 5 days after administration. A metabolite, pantoprazole sulfone was detected in all the edible tissues 1 and 3 days after administration.Conclusion: The reported plasma clearance for pantoprazole is less than that reported for alpacas but higher than reported in foals. The elimination half-life in calves appears to be longer than observed in foals and alpacas. While pantoprazole sulfone was detected in the tissues after IV administration, further research is needed as to the metabolism and potential tissue accumulation of other pantoprazole metabolites in calves. Future pharmacodynamic studies are necessary to determine the efficacy of pantoprazole on abomasal acid suppression in calves.

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“…When used in humans for therapy, multiple adverse events have been reported from patients administered PPIs, mainly skin reactions, nephritis, pancytopenia, anaphylaxis, edema, hepatotoxicity, as well as biochemical changes such as hyponatremia and hypomagnesemia (8)(9)(10)(11)(12)(13)(14). Pantoprazole specifically has been associated with thrombocytopenia, hepatotoxicity, and pancreatitis (9,11,(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Clinical Investigation of the Safety and Adverse Effects of Pantoprazole in Hospitalized Ruminants

2020

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Clinical safety data for the use of gastroprotectants in hospitalized ruminants is lacking. In human patients, multiple adverse effects are possible from the use of pantoprazole including hematologic and electrolyte abnormalities as well as anaphylaxis and edema. The medical records of all hospitalized cattle, goats, and sheep administered pantoprazole over an ∼5-year period were retrospectively analyzed for adverse effects. Seventy-nine eligible patients were observed. Hypomagnesemia was observed after pantoprazole administration in 10 cattle; however, no significant changes were noted when compared to baseline before pantoprazole administration. Significant changes were noted in serum indicators of hepatic and renal function; however, these represented downward trends that were most likely clinically insignificant. Anaphylaxis after pantoprazole administration was not observed; however, seven cattle displayed edema after pantoprazole administration. Veterinary clinicians should be aware of the potential for hypomagnesemia in hospitalized ruminants being administered pantoprazole and monitor patients accordingly. While these preliminary retrospective results indicate that pantoprazole may be a safe adjunctive therapy in hospitalized ruminants, additional studies are necessary to further determine the safety and toxicity of pantoprazole in ruminants.

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Does the use of proton pump inhibitors increase the risk of hypomagnesemia

Cited by 33 publications

References 27 publications

Adverse Effects of Proton Pump Inhibitors—Evidence and Plausibility

Adverse Effects of Proton Pump Inhibitors—Evidence and Plausibility

Pharmacokinetics and Tissue Levels of Pantoprazole in Neonatal Calves After Intravenous Administration

A Retrospective Clinical Investigation of the Safety and Adverse Effects of Pantoprazole in Hospitalized Ruminants

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