Am J Clin Pathol ; 79 : — Serum hypomagnesaemia in an elderly day-hospital population. Association of hypomagnesemia and mortality in acutely ill medical patients.
Crit Care Med ; 21 : — 9. Proton pump inhibitor therapy and potential long-term harm. Curr Opin Endocrinol Diabetes Obes ; 21 : 3 — 8. Hypomagnesemia induced by long-term treatment with proton-pump inhibitors. Gastroenterol Res Pract ; : William JH , Danziger J. Magnesium deficiency and proton-pump inhibitor use: a clinical review. J Clin Pharmacol ; William JH , Danzinger J.
Proton-pump inhibitor-induced hypomagnesemia: current research and proposed mechanisms. World J Nephrol ; 5 : — 7. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation.
Volume Article Contents Abstract. Hypomagnesemia as a potentially life-threatening adverse effect of omeprazole. Oxford Academic. Revision received:. Select Format Select format.
Permissions Icon Permissions. Abstract Hypomagnesemia can be caused by a wide range of diseases e. Google Scholar Crossref. Search ADS. Google Scholar PubMed.
For commercial re-use, please contact journals. Issue Section:. Download all slides. Today's communication is in keeping with FDA's commitment to inform the public about its ongoing safety review of drugs. Additional Information for Patients. Additional Information for Healthcare Professionals.
The cases from the literature included patients on diuretics when either a change in diuretic was not associated with an improvement in serum magnesium level, or b when increase in serum magnesium level occurred with documented PPI discontinuation.
However, because hypomagnesemia is likely under-recognized and under-reported, the available data are insufficient to quantify an incidence rate for hypomagnesemia with PPI therapy.
Hypomagnesemia has been reported in adult patients taking PPIs for at least three months, but most cases occurred after a year of treatment.
Approximately one-quarter of these cases required discontinuation of PPI treatment in addition to magnesium supplementation. Some cases cited both positive dechallenge as well as positive rechallenge i. After discontinuing the PPI, the median time required for the magnesium to normalize was one week.
After restarting the PPI, the median time to develop hypomagnesemia again was two weeks. In most cases reviewed the patients did not continue on PPIs after the hypomagnesemia was treated. Examples of positive dechallenge in two patients include a year-old woman and a year-old man who were both treated with PPIs for 6 and 11 years, respectively. Both patients presented with seizures and hypomagnesemia.
Although both patients' hypomagnesemia partially resolved with intravenous replacement, in both cases discontinuation of PPI treatment was necessary to stop ongoing symptoms and to stop magnesium loss. Clinically serious adverse events were consistent with commonly reported signs and symptoms of hypomagnesemia, which are similar to the signs and symptoms reported with hypocalcemia. The serious events included tetany, seizures, tremors, carpo-pedal spasm, atrial fibrillation, supraventricular tachycardia, and abnormal QT interval.
Hypomagnesemia also produces impaired parathyroid hormone secretion which may lead to hypocalcemia. In cases where comprehensive clinical laboratory data were available, most patients had concomitant hypocalcemia and normal parathyroid hormone levels. Therefore, these findings confirm hypomagnesemia as the primary deficit. The mechanism responsible for hypomagnesemia associated with long term PPI use is unknown; however, long term use of PPIs may be associated with changes in intestinal absorption of magnesium.
OTC PPIs are labeled for 14 days of use, and this treatment course may be repeated every 4 months, up to 3 times per year. FDA acknowledges that consumers, either on their own, or based on a healthcare professional's recommendation, may take these products for periods of time that exceed the directions on the OTC label. In children, abnormal heart rates may cause fatigue, upset stomach, dizziness and lightheadedness. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication.
If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention. Stop taking the medication and seek immediate medical attention if any of the following occur:. Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication. Diarrhea: When gastric acid is decreased, the number of bacteria normally in the digestive system increases. Occasionally, this can cause serious infection in the digestive tract.
If you experience watery, foul-smelling bowel movements after starting to take omeprazole, contact your doctor as soon as possible. Fluid and electrolyte balance: Omeprazole, like other PPIs, may cause the levels of electrolytes such as potassium, sodium, magnesium, chloride, and calcium in the blood to change while taking this medication. If you experience symptoms of fluid and electrolyte imbalance such as muscle pains or cramps; dry mouth; numb hands, feet, or lips; or racing heartbeat, contact your doctor as soon as possible.
Your doctor will do blood tests regularly to monitor the levels of these electrolytes in your blood while you are taking this medication. Liver function: Liver disease or reduced liver function may cause this medication to build up in the body. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Your doctor may want to test your liver function regularly with blood tests while you are taking this medication. People with severe liver disease should generally not take more than 20 mg of omeprazole daily. Methotrexate interaction: Omeprazole, like other medications in this group, may interact with methotrexate when the two medications are used at the same time.
This combination may lead to higher than expected amounts of methotrexate in the body and can cause serious side effects, including kidney damage, irregular heartbeat, anemia, or infection. If you take omeprazole and are also going to receive a dose of methotrexate, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Osteoporosis-related fractures: Studies suggest that the use of omeprazole, like other PPIs, may be related to an increase risk of fractures, particularly for people who take this medication for a year or longer.
The lowest dose of this medication to control the symptoms, taken for the shortest period of time is less likely to cause these problems. Severe stomach problems: If you have recurrent vomiting, difficulty swallowing, blood in the stool, coughing up of blood, or significant unintentional weight loss, check with your doctor immediately.
These symptoms may be signs of a more serious stomach problem. If you develop any skin lesions, especially in sun-exposed skin areas, and if accompanied by muscle aches or pains, contact your doctor immediately. Vitamin B Long-term use of omeprazole may lead to vitamin B12 deficiency.
0コメント