Proton pump inhibitor-induced hypomagnesemia complicated with serious cardiac arrhythmias

ABSTRACT

Introduction: Magnesium is the third most common intracellular ion after potassium and calcium and is an important element in the functions of the body, since it participates in more than 300 enzyme systems. It also, plays a significant role in the transport of calcium and potassium across the cell membranes and protects against cardiac arrhythmias and is useful for their treatment due to hypomagnesemia induced from the proton pump inhibitors (PPIs).

Areas covered: PPIs are used for the treatment of peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD), but have been associated with hypomagnesemia with serious cardiac arrhythmias including torsades de pointes (TdP). To better understand the magnitude of this problem, a Medline search of the English language literature was conducted from 2010 to 2018 and 35 papers with pertinent information were selected.

Expert commentary: The review of these papers suggests that PPIs cause hypomagnesemia, which could be associated with serious cardiac arrhythmias including TdP. However, its incidence is not very common considering the millions of people taking PPIs, but the FDA has advised the physicians to be watchful about this serious adverse effect of PPIs and check the magnesium levels before initiation of PPI treatment.

KEYWORDS:

• Magnesium
• deficiency
• hypomagnesemia
• proton pump inhibitors
• cardiac arrhythmias
• torsades de points

Article highlights

• PPIs are effective drugs for the treatment of PUD and GERD and fairly safe

• Long-treatment with PPIs could be associated with lethal cardiac arrhythmias

• Vigilance is required by the caring physician to discover these complications

• PPIs appear to have a class effect regarding these complications

• Measurement of magnesium levels before initiation of PPI treatment and periodically thereafter is recommended.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

[Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.