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International Journal of General Medicine

Clinical Articles, Lead Article

Are PPIs arrhythmogenic?

Magnesium deficiency in patients receiving proton pump inhibitors (PPIs) may contribute to worsening arrhythmias and further complications, according to a study1 published recently in the International Journal of General Medicine.

Several case reports have been written regarding the relationship between the use of PPIs and hypomagnesaemia. Some of these reported cases have electrocardiogram abnormalities where electrolytes deficiencies were the contributing factor for these events.

Authors investigated the correlation between different arrhythmias and the use of PPI and hypomagnesaemia incidence. 421 patients admitted to the critical care unit with unstable angina, non-ST elevation myocardial infarction, and ST-elevation myocardial infarction were included in this study.

184 patients (43.8%) received PPI and 237 patients (51.16%) did not, magnesium levels were low (<1.8 mg/dL) in 95 patients (22.5%), and 167 patients (39.6%) developed arrhythmias. The P-values for the regression coefficient association for the use of PPI and the level of magnesium were P = 1.31e-29 and P = 8e-102, respectively.

The P-values indicate that there is a statistically significant association between the PPI use, magnesium levels, and the occurrence of cardiovascular events, with a strong correlation factor of 0.817.

Patients receiving PPI should be followed closely for magnesium deficiency, especially if they experience acute cardiovascular events, the authors conclude.


1. El-Charabaty E, Saifan C, Abdallah M, et al. Effects of proton pump inhibitors and electrolyte disturbances on arrhythmias. Int J Gen Med 2013:6;515–8.

Published on: August 30, 2013

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