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Proton pump inhibitors (PPIs) and hypomagnesaemia

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • prolonged use of proton pump inhibitors (PPIs) has been associated with case reports of hypomagnesaemia

    • some cases occurred after 3 months of PPI therapy, but most occurred after 1 year of treatment
      • serious manifestations of hypomagnesaemia - fatigue, tetany, delirium, convulsions, dizziness, and ventricular arrhythmia - can occur, but they may begin insidiously and be overlooked. In most case reports, hypomagnesaemia improved after magnesium replacement and discontinuation of the PPI

  • healthcare professionals should consider measuring magnesium levels before starting PPI treatment and repeat measurements periodically during prolonged treatment, especially in those who will take a PPI concomitantly with digoxin or drugs that may cause hypomagnesaemia (eg, diuretics)

The MHRA advise that healthcare professionals should:

  • consider measurement of magnesium levels before starting PPI treatment and periodically during prolonged treatment, especially in those who will take a PPI concomitantly with digoxin or drugs that may cause hypomagnesaemia (eg, diuretics)
  • take into account any use of PPIs obtained over-the-counter

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