PPIs with diuretics boost hypomagnesemia risk

By David Douglas

NEW YORK (Reuters Health) - Giving proton pump inhibitors (PPIs) in combination with diuretics can increase the risk of hospitalization for hypomagnesemia, according to Canadian researchers.

"While rare, it's important to remember there are tens of millions of patients taking these drugs every day in North America. This is an association patents and doctors should know about," Dr. David Juurlink of Sunnybrook Research Institute, Toronto told Reuters Health by email.

As reported September 30 online in PLOS Medicine, Dr. Juurlink and colleagues used multiple healthcare databases to match 366 patients hospitalized with hypomagnesemia with 1464 controls. All were at least 66 years old.

Current PPI use was associated with an increased risk of hypomagnesemia (adjusted odds ratio, 1.43). This was particularly the case in patients also taking diuretics (adjusted OR, 1.73) but the risk was not increased significantly in those not doing so (adjusted OR, 1.25) or in those taking histamine H2 receptor antagonists (adjusted OR, 1.06).

In light of these findings, the researchers estimate that for 76,591 outpatients treated with a PPI for 90 days there will be one excess hospitalization for hypomagnesemia.

The authors note that among the limitations of the study are a lack of access to serum magnesium levels, plus uncertainties regarding the diagnostic coding of hypomagnesemia and the generalizability of the findings to younger patients.

Until more research is available, they authors suggest "that physicians recognize the potential causative role of PPIs in patients with hypomagnesemia, and reconsider PPI therapy in such patients."

SOURCE: http://bit.ly/1nXE0Fo

PLOS Med 2014.

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