PPIs induce hypomagnesemia but Serum magnesium levels to be monitored regardless of PPI use
Japan: The researchers in a recent study, published in the Die Pharmazie journal suggest measuring serum magnesium levels regardless of the use of proton pump inhibitors (PPIs). The findings will be useful for health professionals in adequate PPI use.
Proton-pump inhibitor-induced hypomagnesemia (PPIH) is a well-recognized phenomenon. Several observational studies in the inpatient and outpatient populations have established the association between PPI exposure and serum magnesium concentrations. pH-dependent regulation of transient receptor potential melastatin-6 transporters in the colonic enterocyte has been proposed to explain the impact of PPIs on magnesium reabsorption.
Proton pump inhibitors are used commonly for the prevention or treatment of gastric ulcers but can induce hypomagnesemia. Not much is known about the risk factors and onset duration related to patient characteristics of this adverse event in Japanese patients. Therefore, K Yamashiro, Laboratory of Public Health, Faculty of Pharmacy, Kindai University, Osaka, Japan, and colleagues analyzed the time-to-onset of PPI-induced hypomagnesemia and investigated the association between hypomagnesemia and PPIs utilizing the Japanese Adverse Drug Event Report (JADER) database. Hypomagnesemia cases between 2004 and 2021 were analyzed.
Using the Weibull distribution, the researchers performed the time-to-onset analysis. The analysis database consisted of 236,525 cases, 188 cases were associated with hypomagnesemia. The median onset duration of PPI-induced hypomagnesemia was 99.0 days, which is considered the random failure type.
The study led to the following findings:
- The multiple logistic regression analysis revealed that hypomagnesemia is significantly associated with male sex, age < 60, estimated body-mass index (eBMI), PPIs, and the interaction of age (<60)*PPIs.
- Diuretics were not significantly associated with hypomagnesemia.
Regardless of the duration of PPI use, the researchers suggest measuring serum magnesium levels, particularly in patients with age < 60, male sex, or low BMI.
"These findings will aid health professionals in the adequate use of proton pump inhibitors," the researchers wrote in their conclusion. "There is a need for evaluating these findings by cohort studies and long-term clinical investigations."
Reference:
Yamashiro K, Hosomi K, Yokoyama S, Ogata F, Nakamura T, Kawasaki N. Adverse event profiles of hypomagnesemia caused by proton pump inhibitors using the Japanese Adverse Drug Event Report (JADER) Database. Pharmazie. 2022 Sep 1;77(7):243-247. doi: 10.1691/ph.2022.2416. PMID: 36199184
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