Table 3.

Drug-induced hypomagnesemia in a patient with cancer: adjunct agents used in patients with cancer

Drug Class or NameIncidenceMechanismReference
PPIs19% of PPI usersIntestinal loss, malabsorption of magnesium. PPIs interfere with TRPM6 and TRPM7 genes, leading to intestinal malabsorption and possible renal Mg loss(105107)
Thiazide diureticsUnknownTRPM6 inhibition, leading to increase in renal Mg loss, increase in potassium excretion causes hypokalemia, leading to decrease in passive Mg reabsorption(45,52)
Loop diureticsUnknownDecrease in paracellular reabsorption in thick ascending LOH, increase renal Mg loss, hypokalemia(44,52)
PamidronateCase reportsRenal impairment, increased Mg excretion, and cellular shifting(44)
No other bisphosphate has been reported to cause hypomagnesemia
RANKL mAb (denosumab)Isolated case reportUnknown(53)
IbuprofenIsolated case reportUnknown(47)
Aminoglycosides (amikacin, gentamicin, tobramycin, neomycin, streptomycin)UnknownPositively charged antibiotics act via a polyvalent cation-sensing extracellular receptor in DCT, leading to inhibition of PTH-mediated cAMP formation and Mg uptake in the DCT(108110)
Antituberculous agents (viomycin, capreomycin)UnknownProximal tubular dysfunction, secondary hyperaldosteronism with consequent renal Mg loss(111113)
Amphotericin BUnknownThis drug is a polyene antibiotic, and Mg participates in the polyene-sterol binding process, leading to a functional Mg deficiency(114)
TheophyllineUnknownRenal Mg wasting(115)
PentamidineUnknownRenal Tubular injury(116118)
FoscarnetUp to 70%Chelates divalent ions, thereby leading to acute reduction in ionized magnesium(119,120)
  • PPI, proton-pump inhibitor; TRPM, transient receptor potential melastatin; Mg, magnesium; LOH, loop of Henle; RANKL, receptor activator of NF-κΒ ligand; DCT, distal convoluted tubule; PTH, parathyroid hormone.