Systematic review: hypomagnesaemia induced by proton pump inhibition.
Level 4 - case-series / case-control
Systematic review of case reports
PubMed 22762246 · doi:10.1111/j.1365-2036.2012.05201.x
What was done
A systematic review and statistical analysis of all available case reports on proton pump inhibitor-induced hypomagnesaemia (PPIH). The authors evaluated whether PPIH represents a drug-class effect, tracked serum magnesium dynamics during drug discontinuation and re-challenge, and analyzed comorbidities to define a potential patient risk profile.
What was found
PPIH was found to be a class effect with a median onset of 5.5 years of PPI use (range: 14 days to 13 years). Discontinuation of the PPI led to recovery from hypomagnesaemia within 4 days, while re-challenge caused recurrence within 4 days. Substitution with histamine-2-receptor antagonists prevented recurrence. No specific patient risk profile associated with hypomagnesaemia was identified. Exact participant and study counts were not reported in the abstract.
Why it matters
This review highlights that PPI-induced hypomagnesaemia is a class-wide effect reversible with drug cessation, establishing de-challenge and re-challenge dynamics and identifying H2-receptor antagonists as a viable alternative therapy.
Limits
The evidence base is restricted entirely to case reports, which inherently lack control groups, are prone to reporting bias, and cannot quantify population incidence or prevalence. The abstract does not specify the total number of reviewed cases or elucidate the underlying molecular mechanisms.
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