PPI e ipomagnesemia: allarmismo ingiustificato o reale problema? PPI and hypomagnesemia: unjustified alarmism or actual problem?

Introduction. Elderly subjects are at high risk for side effects of drugs, this is mainly due to agerelated differences in the pharmacokinetics and pharmacodynamics of the administered drugs and to polypharmacotherapy that is common in elderly patients. The appropriateness of drug prescription is a relevant issue. In the last decade, the use of Proton Pump Inhibitors (PPI) is increased but inappropriate prescribing (IP) in older patients is highly prevalent (40-80% of patients). Despite PPIs are fairly safe drugs, these medications can induce some adverse effects. Since 2006, several clinical reports have indicated that hypomagnesaemia is associated with long-term PPI therapy. Thus, we conducted an observational study to assess the incidence of hypomagnesaemia in hospitalized elderly patients, in order to find a relationship between prevalence of hypomagnesaemia and long-term PPI therapy. Moreover, we evaluated the appropriateness of PPI prescription. Methods. At the time of the enrollment clinical history, functional assessment, list of medications and comorbidity index were collected in 68 patients. Hypomagnesaemia was defined as levels of magnesium lower than 1.7 mg/dL (or 0.70 mmol/L). Results. In our population, 35 patients (51.47%) were treated with PPIs and, among them, 12 patients (34.29%) have an inappropriate PPI prescription. We found no differences in magnesium serum levels between patients treated and not-treated with PPIs. Discussion. In order to define a potential relationship between hypomagnesaemia and long-term PPI therapy more patients have to be enrolled, however, it is evident that elderly people are at high risk for inappropriate drug prescriptions.