On March 2 the FDA issued a safety announcement to warn the public that sustained use of drugs to reduce stomach acid associated with GERD and digestive ulcers (Proton Pump Inhibitors, or PPIs) can cause deficiency of the essential mineral magnesium.
Magnesium is needed to maintain normal muscle and nerve function, keep heart rhythm steady, support a healthy immune system and keep bones strong. It is needed for 300-some processes, and incidence of deficiencies increases with age.
Symptoms of low magnesium may include fatigue & weakness, tingling, numbness, muscle spasms, tremor, irregular or racing heart beat, palpitations, convulsions, upset stomach, dizziness or light headedness, and more. Low magnesium is common in people with nutrient absorption problems (eg., Crohn’s disease), blood sugar problems/poorly controlled diabetes, and high alcohol intake.
Prescription PPIs include Nexium (esomeprazole magnesium), Dexilant (dexlansoprazole), Prilosec (omeprazole), Zegerid (omeprazole and sodium bicarbonate), Prevacid (lansoprazole), Protonix (pantoprazole sodium), and AcipHex (rabeprazole sodium). Vimovo is a prescription combination drug product that contains a PPI (esomeprazole magnesium and naproxen). Over-the-counter (OTC) PPIs include Prilosec OTC (omeprazole), Zegerid OTC (omeprazole and sodium bicarbonate), and Prevacid 24HR (lansoprazole).
Over-the-counter PPIs tend to deliver lower doses and be intended for short courses of treatment. Risk with all PPIs & antacids is reduced if taken as prescribed for a limited time.
Supplementary magnesium. Among people taking PPIs who’ve been found to be deficient, the FDA reports that about half have been able to raise and stabilize their blood magnesium by taking a magnesium supplement. But in about one-fourth of cases, the patient will need to discontinue the PPI drug to improve.
Healthcare professionals are advised to consider testing blood magnesium levels before prescribing PPI drugs for sustained periods; to determine whether patients are taking drugs such as digoxin, diuretics (water pills), certain antibiotics, or others that that can cause magnesium depletion; and to test magnesium periodically when there is sustained PPI use.
The full FDA Drug Safety Communication on this subject, with advice for patients, is HERE.