Hypomagnesemia in the provision of Proton Pump Inhibitor (PPI) Long Term

Drugs included in the category of Proton Pump Inhibitor (PPI) that circulated in Indonesia, among others: Esomeprazole, Omeprazole, lansoprazole and Pantroprazole, with a working mechanism to reduce or suppress gastric acid secretion by inhibiting the enzyme activity of H / K ATPase (proton pump) in surface of gastric parietal cells at a pH less than 4. Drugs that bind to protons (H) immediately converted into a pron Sulfonamode active pump. 

PPI drugs are indicated for the treatment of patients such as: Gastro Esophageal Reflux Disease (GERD), and Small Intestine Stomach ulcer and esophageal inflammation.

From the U.S. FDA Review of Reports of Adverse Event Reporting System (AERS), Medical Literature and Periodic Safety Update Report (PSUR) for cases of hypomagnesemia in patients who are receiving an extension of PPI therapy, suggests that there is the possibility of increased risk of decreased levels of magnesium ( hypomagnesemia) if the PPI is used in the long term. Hypomagnesemia has been reported in adult patients who received PPIs at least 3 months and most occurred after 1 year of PPI. 

Hypomagnesemia cause symptoms of serious side effects in certain patients, such as muscle spasm (tetany), irregular heartbeat (arrhythmia) and convulsions (seizures), impaired parathyroid hormone secretion and hypocalcemia. The mechanism of occurrence of hypomagnesemia in the provision of long-term PPI is not known, but may be related to changes in intestinal absorption of magnesium. 

Handling patients who are experiencing is generally hypomagnesemia with magnesium supplementation and cessation of PPI. 

Suggested to the doctor to do a blood magnesium levels of patients at the time: Before the long-term PPI therapy, By periodically during treatment with PPI, what more if the PPI class of drugs given concurrently with diuretics (loop diuretics and thiazide diuretics), and digoxin. 

Sources: POM Meso News Bulletin, Vol 29, No. 1, June 2011