Hypomagnesemia and Hypocalcemia Caused by Proton-Pump Inhibitors Long-Term Therapy

Cabras, Paola; Anedda, Michele; Caddeo, Laura; Marongiu, Francesco; Mameli, Antonella

doi:10.1097/mjt.0000000000001041

Cited by 5 publications

(4 citation statements)

References 29 publications

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“…Similarly, in a recent literature review published in 2019 by P. Cabras et al , which included 58 patients and 40 studies, hypocalcemia and hypomagnesemia were observed in patients who were consulting for neurological, muscular and/or cardiac rhythm disorders and had been on PPIs therapy for more than a year without any other identifiable causes explaining the clinical symptoms [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of long-term proton pump inhibitors on phosphocalcium metabolism and bone mineral density

Smaoui,

Chtourou,

Jallouli

et al. 2024

Future Science OA

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Aim: Although Proton pump inhibitors (PPIs) are well-tolerated, their long-term use may be associated with decreased bone mass. Methods: This is a case-control study including patients treated with PPIs (>1 year) and control subjects who have not received PPIs treatment. Results: A total of 90 patients and 90 matched controls were included. PPIs use was associated with hypocalcemia and hypomagnesemia. Vitamin D3 deficiency and hyperparathyroidism were associated with PPIs use. Long-term PPIs use was significantly associated with decreased bone density. Risk factors of decreased bone mineral density (BMD) included age >50 years, menopause, lack of sun exposure, double PPIs dose, daily intake, post-meal intake and association with a mucoprotective agent. Conclusion: Our results highlight the risk of decreased BMD in patients on long-term PPIs treatment.

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Section: Discussionmentioning

confidence: 99%

Effect of long-term proton pump inhibitors on phosphocalcium metabolism and bone mineral density

Smaoui,

Chtourou,

Jallouli

et al. 2024

Future Science OA

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“…The mechanistic aspects described in this paper are in part based on animal research. In humans, the relationships between PPI use and magnesium levels or between magnesium and inflammation were investigated only in epidemiological studies or described in case reports [52,54,116]. For our hypothesis of PPI use leading to muscle function loss, most support from literature is available.…”

Section: Discussionmentioning

confidence: 99%

The Use of Proton Pump Inhibitors May Increase Symptoms of Muscle Function Loss in Patients with Chronic Illnesses

Vinke

Wesselink

Orten-Luiten

et al. 2020

IJMS

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Long-term use of proton pump inhibitors (PPIs) is common in patients with muscle wasting-related chronic diseases. We explored the hypothesis that the use of PPIs may contribute to a reduction in muscle mass and function in these patients. Literature indicates that a PPI-induced reduction in acidity of the gastrointestinal tract can decrease the absorption of, amongst others, magnesium. Low levels of magnesium are associated with impaired muscle function. This unwanted side-effect of PPIs on muscle function has been described in different disease backgrounds. Furthermore, magnesium is necessary for activation of vitamin D. Low vitamin D and magnesium levels together can lead to increased inflammation involved in muscle wasting. In addition, PPI use has been described to alter the microbiota’s composition in the gut, which might lead to increased inflammation. However, PPIs are often provided together with nonsteroidal anti-inflammatory drugs (NSAIDs), which are anti-inflammatory. In the presence of obesity, additional mechanisms could further contribute to muscle alterations. In conclusion, use of PPIs has been reported to contribute to muscle function loss. Whether this will add to the risk factor for development of muscle function loss in patients with chronic disease needs further investigation.

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“…This type of extended exposure to PPIs can increase the risk for serious adverse effects [ 3 ]. Long-term exposure to PPIs as a form of medication therapy can potentially impact numerous organ systems in the body, resulting in electrolyte disturbances, such as hypomagnesemia and hypocalcemia, which could cause tetany, convulsions, and cardiac arrhythmias [ 5 ]. Kidney disease, increased risk of infection, and pneumonia, especially in the elderly, along with many other abnormalities, are other documented possible adverse effects.…”

Section: Introductionmentioning

confidence: 99%

Proton Pump Inhibitors, Kidney Damage, and Mortality: An Updated Narrative Review

Edinoff

Parker

et al. 2023

Adv Ther

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Since their approval by the Food and Drug Administration (FDA) in 1989, proton pump inhibitors (PPIs) have become one of the most highly utilized drugs in the United States, assuming a position as one of the top 10 most prescribed medications in the country. The purpose of PPIs is to limit the amount of gastric acid secreted by the parietal cells via irreversible inhibition of the H+/K+-ATPase pump, therefore maintaining an elevated gastric acid pH of greater than 4 for 15–21 h. Even though PPIs have many clinical uses, they are not without their adverse effects, mimicking achlorhydria. Besides electrolyte abnormalities and vitamin deficiencies, long-term use of PPIs has been linked to acute interstitial nephritis, bone fractures, poor COVID-19 infection outcomes, pneumonia, and possibly an increase in all-cause mortality. The causality between PPI use and increased mortality and disease risk can be questioned since most studies are observational. Confounding variables can greatly affect an observational study and explain the wide-ranging associations with the use of PPIs. Patients on PPIs are generally older, obese, sicker with a higher number of baseline morbidities, and on more medications than the compared PPI non-users. These findings suggest that PPI users are at a higher risk of mortality and complications based on pre-existing conditions. This narrative review aims to update readers on the concerning effects that proton pump inhibitor use can have on patients and give providers a resource to create informed decisions on appropriate PPI use.

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Hypomagnesemia and Hypocalcemia Caused by Proton-Pump Inhibitors Long-Term Therapy

Cited by 5 publications

References 29 publications

Effect of long-term proton pump inhibitors on phosphocalcium metabolism and bone mineral density

Effect of long-term proton pump inhibitors on phosphocalcium metabolism and bone mineral density

The Use of Proton Pump Inhibitors May Increase Symptoms of Muscle Function Loss in Patients with Chronic Illnesses

Proton Pump Inhibitors, Kidney Damage, and Mortality: An Updated Narrative Review

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