PPIs and magnesium. WAS: Rabeprazole, a.k.a. Aciphex, questions?

[Guest guest]

wrote:

> ... prescription of rebeprazole ...

>

> NIH recommends that this drug may cause low serum magnesium levels.

Rebeparzole or Aciphex is a PPI and the FDA recommendation seen on the

NIH article applies to all PPIs.

See:

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedical\

Products/ucm245275.htm

According to that safety notice hypomagnesemia in most cases does not

result in less than a year of PPI use. If you are trying a PPI to see

if it helps with spasm and NCCPs you would know if it was working in

less time than that.

Also see:

Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case

series.

http://www.ncbi.nlm.nih.gov/pubmed/20378675

and

Severe hypomagnesaemia in long-term users of proton-pump inhibitors.

http://www.ncbi.nlm.nih.gov/pubmed/18221401

For those of us that use PPIs long-term, more than a year,

hypomagnesemia should be considered. An important thing to remember if

hypomagnesemia does result is that while on PPIs standard

supplementation of magnesium does not work in many cases. Higher does

may work or one may need a time off of the PPI (PPI holiday) to restore

magnesium.

For the last half a year I have been playing with my PPI dose trying to

find out just how little I need and how long I can go without it. At

first I went to one cap every other day. I had some problems with that

so I tried one half cap every day (I open the cap and take half of the

particles and then put the cap back together, if you need details let me

know). I wondered if there was some rebound effect going off the PPI and

that the food choices I made could have been part of the problem with

the every other day plan. Also it seems that we can become

hypersensitive after a period of acid reflux so that even a little seems

worse than it would have if it had not been part of an ongoing problem.

With that in mind I tried going without the PPI unless I was planing to

eat too much of problem foods (Sweet, spicy or greasy) then I would take

a half a cap in advance and if I made a mistake to try an antacid first

before taking more. This seems to be working very well and I can go for

days without the PPI. If I start to get a long burn a day back at a full

dose seems to fix it.

I am sure this will not work for everyone. My heartburn was only mild

anyway. Some people may not be able to reduce their PPIs on as many days

as I do but perhaps a break or holiday now and then would help. Perhaps

trying alternatives one week a month, or whatever works. If anyone

thinks a PPI holiday could be a good thing for them, talk to your

doctor. My doctor knows I am doing this and we will discuss it when I

see him. Supplementation during a PPI holiday may be one way to deal

with these kind of issues.

Also consider that it may not be the low acid level that causes these

problems. It may be that PPIs block absorption of some minerals at the

intestines. See:

Omeprazole decreases magnesium transport across Caco-2 monolayers.

http://www.ncbi.nlm.nih.gov/pubmed/21472124

If that is the problem, then maybe the PPI holiday could include the use

of an alternative like an H2 blocker. They can also be effective at

reducing acid reflux. Not as effective as a PPI but something for the

holiday. Some people may want to let their acid levels return to normal

during the PPI holiday. In that case you would avoid the H2 blocker

also, if you are able to get by for that time with full acid production.

But remember you don't want high acid levels in the esophagus long

enough to cause long-term problems. Your esophagus needs to completely

recover from the holiday.

I would love to hear what other member's doctors think on this issue.

notan