Proton Pump Inhibitors Causes Low Magnesium

Proton Pump Inhibitor-Induced Hypomagnesemia

The Federal Drug Administration has issued a warning about proton pump inhibitors and the risk of low magnesium Proton pump inhibitors are a major cause of low magnesium. Proton pump inhibitors or PPIs were developed almost 27 years ago. 

Proton pump inhibitors are now considered the “gold standard” of treatment for the majority of gastrointestinal disorders.  There are  6 PPIs approved by the FDA. These include:

DrugDosages, mgIVLiquid or suspensionGenericOver-the-counter
Omeprazole10, 20, 40YesNoYesYes
Esomeprazole20, 40YesYesYesYes
Lansoprazole15, 30YesYesYesYes
Dexlansoprazole30, 60NoNoNoNo
Pantoprazole20, 40YesYesYesNo
Proton Pump Inhibitors and Low Magnesium

Acid Reflux and Proton Pump Inhibitors

According to the Federal Drug Administration, “ The U.S. Food and Drug Administration (FDA) is informing the public that prescription proton pump inhibitor (PPI) drugs may cause low serum magnesium levels (hypomagnesemia) if taken for prolonged periods of time (in most cases, longer than one year).

In approximately one-quarter of the cases reviewed, magnesium supplementation alone did not improve low serum magnesium levels and the PPI had to be discontinued.””

Proton Pump Inhibitors are prescribed for the following gastrointestinal conditions:

  • Peptic ulcer disease
  • GERD
  • Esophagitis
  • Prevention of NSAID ulcers
  • Functional acid reflux
  • PPIs are part of the treatment for Helicobacter pylori

How Do PPIs Work

Proton pump inhibitors work by interrupting some of the “natural” chemical processes of the body. These drugs are made up of capsules that have weak bases in order to survive the “harsh” environment of the stomach. Proton pump inhibitors are absorbed in the small bowel. Once the proton pump inhibitors are absorbed, they go into the bloodstream where they deactivate the parietal cells in the stomach. The parietal cells secrete the hydrochloric acid.
Magnesium and PPI

A Risk for Mineral Deficiencies

Over 100 million prescriptions were written for proton pump inhibitors in 2015. These prescriptions cost around 10 billion dollars per year in the United States. Almost 80% of PPIs are bought without a prescription.

Often time, people are taking proton pump inhibitors without any indications of a gastrointestinal diagnosis.

Children are also being prescribed proton pump inhibitors at an alarming pace. Four million prescriptions for proton pump inhibitors were written for children in 2015. These are in addition to the number of over the counter sales.

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Proton Pump Inhibitors Linked to Heart Disease

The use of proton pump inhibitors and low magnesium is a very serious health concern. Considering heart disease is at an all-time high, doctors need to be cautious about prescribing proton pump inhibitors. Proton pump inhibitors are designed to only be taken for 2-3 weeks. There are people who have been on PPIs for years.

Proton Pump Inhibitors and Low Magnesium

Low Magnesium Symptoms

Proton pump inhibitors inhibit magnesium absorption by interfering with certain enzymatic processes. Low magnesium used with proton pump inhibitors can cause a wide range of symptoms.

  • Muscle cramps and spasms
  • Weakness and lethargy
  • Tetany
  • Loss of consciousness
  • Anxiety and numbness
  • Agitation and hallucination
  • Low calcium and low potassium
  • Ataxia
  • EKG changes

Long-term use of proton pump inhibitors can cause severe electrolyte imbalance. When PPIs are discontinued, there is an improvement in the magnesium and calcium levels. Low magnesium has been associated with diabetes and kidney disease.

Proton pump inhibitors have also been associated with the wasting of vitamin B12, vitamin C, iron, and calcium.

  • Vitamin B12 requires gastric acid to be absorbed.  B12 deficiency affects more than 30% of the elderly.
  • Vitamin C is depleted in PPI therapy because the vitamin is diluted in gastric juices. Proton pump inhibitors also decrease the active component of Vitamin C.
  • Calcium can be depleted because calcium needs acid to distract the calcium from food.
  • Iron needs acid to be absorbed.
  • Magnesium is the main mineral that is affected. Proton pump inhibitors and low magnesium can cause a plethora of health problems. Some of these health problems can be remedied with the stoppage of PPIs and supplementing with magnesium. Even when people took magnesium with the PPIs, they still were not able to maintain their magnesium levels. Only when they were taken completely off of the PPIs did their magnesium levels start to increase.

Long-term use of PPI’s has been shown to increase your risk of esophageal cancer, according to a new study from Sweden.

Proton Pump Inhibitors and Low Magnesium


In conclusion, the use of proton pump inhibitors (PPIs) has been associated with a potential risk of low magnesium levels.

Proton pump inhibitors are commonly prescribed medications for managing conditions such as gastroesophageal reflux disease (GERD) and peptic ulcers.

While they effectively reduce stomach acid production, prolonged use of PPIs can interfere with the body’s ability to absorb magnesium, leading to low magnesium levels.

Low magnesium levels, also known as hypomagnesemia, can have significant implications for overall health.

PPI'S Cause low magnesium

Magnesium plays a crucial role in various bodily functions, including nerve function, muscle contraction, and maintaining a healthy heart rhythm.

Therefore, a deficiency in magnesium can lead to a range of symptoms such as muscle weakness, tremors, fatigue, and irregular heartbeat.

It is important for healthcare professionals to be aware of the potential risk of low magnesium associated with PPI use and monitor patients who are on long-term PPI therapy.

Regular monitoring of magnesium levels can help identify deficiencies early on and allow for appropriate interventions, such as magnesium supplementation or considering alternative treatments for acid-related conditions.

Furthermore, patients taking PPIs should be educated about the potential risks and advised to report any symptoms suggestive of low magnesium levels to their healthcare providers.

This proactive approach can help prevent complications associated with hypomagnesemia and ensure that patients receive the necessary support and interventions.


5 thoughts on “Proton Pump Inhibitors Causes Low Magnesium”

  1. Thank you for posting this, I take PPI’s, not on regular basis, but I’m going to ask my doctor about this to see if there’s any alternative to take.

  2. Didn’t know that magnesium deficiency could lead to health problems. Thanks for raising awareness to such an important issue!

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