How often does long-term PPI therapy cause clinically significant hypomagnesemia?

Q: How often does long-term PPI therapy cause clinically significant hypomagnesemia? EVIDENCE-BASED ANSWER: Rarely. Proton pump inhibitors (PPIs) may be associated with decreases in serum magnesium laboratory values to below 1.6 to 1.8 mg/dL, especially when used concurrently with diuretics and loop diuretics (strength of recommendation [SOR]: C, disease-oriented outcomes based on cohort, case-control, and cross-sectional studies). Clinically significant or symptomatic hypomagnesemia (below 1.2 mg/dL) appears to be quite rare, however.Timothy Plaut, MD; Katelyn Graeme, DO; Sue Stigleman, MLS; Stephen Hulkower, MD, Mountain Area Health Education Center, Asheville, NC ; Tasha Woodall, PharmD, Mountain Area Health Education Center, Asheville, NC; Eshelman School of Pharmacy, University of North Carolina, Chapel Hill