The Food and Drug Administration (FDA) just issued a safety alert about the risk of magnesium loss due to stomach ulcer and heartburn medications called proton pump inhibitors (PPIs). Prescription PPIs include the following medications:
- Nexium (esomeprazole magnesium)
- Dexilant (dexlansoprazole)
- Prilosec (omeprazole)
- Zegerid (omeprazole and sodium bicarbonate)
- Prevacid (lansoprazole)
- Protonix (pantoprazole sodium)
- AcipHex (rabeprazole sodium)
- Vimovo (a prescription combination drug product that contains a PPI (esomeprazole magnesium and naproxen)
Over-the-counter (OTC) PPIs include Prilosec OTC (omeprazole), Zegerid OTC (omeprazole and sodium bicarbonate), and Prevacid 24HR (lansoprazole).
Potentially Dangerous Prilosec Side Effects (and Other PPIs)
The FDA goes on to say that “Low serum magnesium levels can result in serious adverse events including muscle spasm (tetany), irregular heartbeat (arrhythmias), and convulsions (seizures); however, patients do not always have these symptoms”. A very large proportion of migraine and cluster headache sufferers have low magnesium levels, and magnesium supplementation and injections have been shown to relieve migraine and cluster headaches. Ironically, many headache sufferers take OTC pain killers which can cause heartburn, reflux and ulcers and are prescribed PPIs which by depleting magnesium can make headaches worse.
FDA Recommendations for Prilosec and Other PPIs
The safety alert also provides this recommendation: “Healthcare professionals should consider obtaining serum magnesium levels prior to initiation of prescription PPI treatment in patients expected to be on these drugs for long periods of time, as well as patients who take PPIs with medications such as digoxin, diuretics or drugs that may cause hypomagnesemia. For patients taking digoxin, a heart medicine, this is especially important because low magnesium can increase the likelihood of serious side effects. Healthcare professionals should consider obtaining magnesium levels periodically in these patients”. But our research at the New York Headache Center and SUNY-Downstate Medical School showed that unfortunately the serum levels that the FDA recommends measuring are highly inaccurate. If the level is low then a deficiency is clearly present, but many people with normal serum levels can in fact be very deficient. This is due to the fact that only 1% of total body’s magnesium is in the serum, while the rest is in the bones and inside cells.
PPIs also interfere with the absorption of several vitamins, such as B12 and D, which can cause a variety of neurological and other symptoms. Measurement of vitamin B12 is also problematic because just like with magnesium the test is not accurate, although for a different reason. And just like with magnesium, some people do not absorb oral vitamin B12 and need to have regular injections. Vegetarians are at an increased risk of vitamin B12 deficiency. Last year, the FDA issued a warning about PPIs causing increased risk of bone fractures.
Safe PPI Alternatives
If you are currently taking a PPI, ask your doctor if you can stop and avoid taking PPIs unless there is no other choice. In addition to taking antacids and following a diet, meditation, biofeedback, or progressive relaxation can also help reduce heartburn.
For headache sufferers looking for the most effective, strongest, and safest pain relief available, especially of the pain that normally accompanies severe headaches, the best OTC choice is Migralex. Migralex addresses both the symptoms of severe headaches as well as associated symptoms. Migralex is also free from caffeine and other ingredients that can lead to rebound headaches and other medical complications.
For a list of the headache types that can be effectively treated by taking Migralex, click here.