Published: December 2012


Hypomagnesaemia - a Risk Associated with All Proton Pump Inhibitors

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Prescriber Update 33(4): 32
December 2012

Hypomagnesaemia has now been linked to the long-term use of all proton pump inhibitors (PPIs).

The risk of hypomagnesaemia associated with long-term omeprazole use has been highlighted previously1. Medsafe's monitoring scheme M² logo sought further information regarding the risk of hypomagnesaemia for the other PPIs following a CARM report of hypomagnesaemia in a patient taking pantoprazole. The results obtained from M² logo and a review of additional data were considered by the Medicines Adverse Reactions Committee (MARC) at the September 2012 meeting2.

In most cases, hypomagnesaemia was identified in patients who had taken a PPI for longer than a year. However, in some cases the onset time was only three months.

Low serum magnesium levels can result in serious events such as fatigue, tetany, delirium, convulsions and arrhythmias. The symptoms may be insidious and easily overlooked. In some patients, magnesium supplementation may be sufficient to improve serum magnesium levels but others may need to cease PPI treatment.

CARM have also received a case report which highlights that restarting a PPI (even a different PPI) may result in a recurrence of hypomagnesaemia, within a much shorter time period than previously experienced. The outcome of the review can be found on the Medsafe website

Key Messages

  • Hypomagnesaemia is associated with long-term use of all PPIs.
  • Monitoring of serum magnesium levels prior to and during treatment should be considered for:
    • patients expected to require long-term PPI treatment.
    • patients who take other medicines such as digoxin or medicines that may cause hypomagnesaemia (such as diuretics).
  • Restoration of magnesium levels may require magnesium supplementation and cessation of PPI treatment.
  • In patients who have experienced PPI associated hypomagnesaemia, retreatment with any PPI may result in hypomagnesaemia within a short time frame.
  1. Medsafe. 2010. Omeprazole and risk of hypomagnesaemia. Prescriber Update 31(2): 13-4. URL: (accessed 22 November 2012).
  2. Medsafe. 2012. Minutes of the 151st MARC meeting 13 September 2012. URL: (accessed 15 November 2012).


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