Using a proton-pump inhibitor for extended periods may cause low serum magnesium levels, the FDA cautioned yesterday. The agency issued the alert after reviewing more than 50 cases of hypomagnesemia in patients taking PPIs over long periods, usually a year or more.
Possible adverse effects of hypomagnesemia include tetany, arrhythmias, and seizures. The alert primarily applies to prescription PPIs, which are indicated for long-term use. The FDA says there is little risk from over-the-counter PPIs when taken as directed for 14 days.
Before prescribing a PPI for a long period, clinicians should consider baseline magnesium testing as well as occasional testing throughout treatment. Periodic magnesium testing is also advised in patients concurrently taking digoxin, because low magnesium in these patients carries a greater risk for serious side effects.
The FDA said that long-term PPI use may affect intestinal absorption of magnesium, although the mechanism is unknown.
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