Magnesium Drug Interactions

Many prescription drugs are known to deplete magnesium in the human body, yet none of them are as critical to your health as magnesium. The reason is simple: every organ, nerve, tissue, muscle and cell depends on magnesium for energy and physical maintenance.  Learn all the drugs that deplete and interfere with your magnesium status below:

Some of the most deceiving sources of magnesium depletion are prescription drugs. Not only do they deplete magnesium, but their long term use may also lead to serious, potentially debilitating side effects. These effects lead to a destructive cycle which further increases our body’s need for magnesium due to its central role in healing.

To the right are the 14 different classes of drugs which are known to deplete magnesium:

Below is a list of the magnesium-depleting drugs found within these 14 classes, followed by magnesium’s common drug interactions. 

+ Acid Blockers
+ Antacids
+ Antibiotics
+ Antiviral Agents
+ Blood Pressure Drugs
+ Central Nervous System Stimulants
+ Cholesterol Agents
+ Corticosteroids
+ Hormone Replacement Therapy/Oral Contraceptives
+ Immunosuppressants
+ Nonsteroidal Aromatase Inhibitors for Breast Cancer
+ Osteoporosis Drugs
+ SERMS (Selective Estrogen Receptor Modulators – for breast cancer)
+ Sulfonamides

Some of the most deceiving sources of magnesium depletion are prescription drugs. Not only do they deplete magnesium, but their long term use also causes serious, potentially debilitating side effects. Often these effects lead to a destructive cycle which further increases our body’s need for magnesium due to its central role in healing.

Below are the 14 different classes of drugs which are known to deplete magnesium:

+ Acid Blockers
+ Antacids
+ Antibiotics
+ Antiviral Agents
+ Blood Pressure Drugs
+ Central Nervous System Stimulants
+ Cholesterol Agents
+ Corticosteroids
+ Hormone Replacement Therapy/Oral Contraceptives
+ Immunosuppressants
+ Nonsteroidal Aromatase Inhibitors for Breast Cancer
+ Osteoporosis Drugs
+ SERMS (Selective Estrogen Receptor Modulators – for breast cancer)
+Sulfonamides

Below is a list of the magnesium-depleting drugs found within these 14 classes.  Further down are the common drugs that magnesium may have interactions with.

++ IMPORTANT: Prevention vs. Treatment

If you take any of these drugs, please understand their full effects on your health. They often remove “symptoms” (which are signals that your body is fighting disease) of problems often rooted in magnesium deficiency in the first place, without actually solving the problem.

Remember, magnesium is needed for every vital function in our body. Prescription drugs deplete your magnesium.

Please use the supervision of a knowledgeable health professional when taking magnesium while on medications. Its healing effects may remove the need for some medications, and continued use of these medications may then cause additional harm.

1. Magnesium-Draining Drugs:

ACID BLOCKERS

Cimetidine (Tagamet)
Esomeprazole (Nexium)
Famotidine (Pepcid and Pepcid Complete)
Nizatidine (Axid)
Omeprazole (Prilosec OTC)
Pantoprazole (Protonix)
Ranitidine (Zantac)
Rabeprazole (Aciphex)

ANTACIDS

Aluminum and magnesium hydroxide (Maalox, Mylanta)
Aluminum carbonate gel (Basaljel)
Aluminum hydroxide (Amphojel, AlternaGEL)
Calcium carbonate (Tums, Titralac, Rolaids)
Magnesium hydroxide (Phillips’ Milk of Magnesia)
Sodium bicarbonate (Alka-Seltzer, baking soda)

ANTIBIOTICS (A few examples)

Amoxicillin (Amoxil)
Azithromycin (Z-Pak)
Cefaclor (Ceclor)
Cefdinir (Omnicef)
Cephalexin (Keflex)
Ciprofloxacin (Cipro)
Clarithromycin (Biaxin)
Doxycycline (Doryx)
Erythromycin (E.E.S.)
Levofloxacin (Levaquin)
Minocycline (Minocin)
Sulfamethoxazole and trimethoprim (Bactrim, Septra)
Tetracycline (Sumycin)

ANTIVIRAL AGENTS

Delavirdine (Rescriptor)
Foscarnet (Foscavir)
Lamivudine (Epivir)
Nevirapine (Viramune)
Zidovudine, AZT (Retrovir)
Zidovudine and Lamivudine (Combivir)

BLOOD PRESSURE DRUGS

Hydralazine (Apresoline)

ACE inhibitors:

Enalapril and HCTZ (Vaseretic)
Angiotensin II receptor blockers:
Valsartan and HCTZ (Diovan HCT)

Diuretics, loop:

Bumetanide (Bumex)
Ethacrynic acid (Edecrin)
Furosemide (Lasix)
Torsemide (Demadex)

Diuretics, thiazide (and any combination drug that contains HCTZ or hydrochlorothiazide—dozens of drugs contain this)

Candesartan and HCTZ (Atacand HCT)
Chlorothiazide (Diuril)
Chlorthalidone (Hygroton)
Hydrochlorothiazide or HCTZ (Hydrodiuril)
Methyclothiazide (Enduron)
Metolazone (Zaroxolyn)

Diuretics, potassium-sparing:

Possibly the potassium-sparing diuretics, however this is not conclusive
Diuretics, sulfonamide:
Indapamide (Lozol)
Cardiac Glycoside
Digoxin (Digitek, Lanoxicaps, Lanoxin)

CENTRAL NERVOUS SYSTEM (CNS) STIMULANTS

Methylphenidate (Metadate, Ritalin)

CHOLESTEROL AGENTS

Cholestyramine (Questran)
Colestipol (Colestid)

CORTICOSTEROIDS

Betamethasone (Diprolene, Luxiq)
Dexamethasone (Decadron)
Hydrocortisone (Cortef)
Methylprednisolone (Medrol)
Mometasone (Elocon)
Prednisolone (Pediapred Liquid)
Prednisone (Deltasone, Liquid Pred, Sterapred)
Triamcinolone (Aristocort cream)

Inhaled corticosteroids:

Flunisolide (Nasarel, Nasalide)
Futicasone (Flonase)
Triamcinolone (Azmacort inhaler)

HORMONE REPLACEMENT THERAPY / ORAL CONTRACEPTIVES

Diethylstilbestrol (DES)
Estradiol (Activella, Climara, Combipatch, Estrace, Estraderm, Estring, EstroGel, Femring, Menostar, and many others)
Estrogen-containing drugs (hormone replacement therapy and birth control)
Estrogens, conjugated (Premphase, Prempro)
Estrogens, esterified (Estratab)
Estropipate (Ogen)
Ethinyl estradiol (found in many birth control pills)
Levonorgstrel (found in many birth control pills)

IMMUNOSUPPRESSANTS

Cyclosporine (Sandimmune, Neoral)
Tacrolimus (Prograf)

NONSTEROIDAL AROMATASE INHIBITORS FOR BREAST CANCER

Anastrozole (Arimidex)

OSTEOPOROSIS

Raloxifene (Evista)

S.E.R.M.S (SELECTIVE ESTROGEN RECEPTOR MODULATORS—USED FOR BREAST CANCER)

Raloxifene (Evista)
Tamoxifen (Nolvadex)
Toremifene (Fareston)

SULFONAMIDES

Sulfa antibiotics, some diabetic medications

2. Magnesium Drug Interactions:

ANTACIDS

People taking magnesium supplements to resolve constipation and temporary digestive problems should beware of antacids because these drugs can reduce the desired laxative effect of the specific magnesium supplement being used.

Some antacids include: calcium carbonate (Tums, others), dihydroxyaluminum sodium carbonate (Rolaids, others), magaldrate (Riopan), magnesium sulfate (Bilagog), aluminum hydroxide (Amphojel), and others.

ANTICOAGULANT & ANTIPLATELET MEDICATIONS

These drugs are meant to slow down the body’s blood clotting, and magnesium has similar effects. Caution should be advised and a health provider should be consulted about taking magnesium with these medications.

Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, indomethacin (Indocin), ticlopidine (Ticlid), warfarin (Coumadin), and others.

ANTIBIOTICS

Aminoglycoside antibiotics exert their effects on our muscles, and magnesium plays an essential role in our muscles, hence it is wise to consult a practitioner about how to best combine the two. Some aminoglycoside antibiotics include amikacin (Amikin), gentamicin (Garamycin), kanamycin (Kantrex), streptomycin, tobramycin (Nebcin), and others.

Quinone antibiotics are another type of antibiotics whose absorption can be hindered by magnesium. These antibiotics should be taken 2 hours before, or 4-6 hours after magnesium supplementation.Some of these antibiotics that might interact with magnesium include ciprofloxacin (Cipro), enoxacin (Penetrex), norfloxacin (Chibroxin, Noroxin), sparfloxacin (Zagam), trovafloxacin (Trovan), and grepafloxacin (Raxar).

Tatracycline antiniotics are vulnerable to magnesium interaction in the stomach, where magnesium can bind them, and prevent their absorption. Taking calcium 2 hours before or 4 hours after these antibiotics can help reduce this effect. Some tetracyclines include demeclocycline (Declomycin), minocycline (Minocin), and tetracycline (Achromycin).

BISPHOSPHONATES

Taking magnesium with bisphosphonates can decrease how much of them the body absorbs, thus decreasing their effectiveness. Taking bisphosphonate at least 2 hours before magnesium helps. Some bisphosphonates include alendronate (Fosamax), etidronate (Didronel), risedronate (Actonel), tiludronate (Skelid), and others.

BLOOD PRESSURE MEDICATIONS: Calcium Channel Blockers

Supplementing with magnesium while taking calcium channel blockers may increase the dizziness, nausea, and fluid retention from these drugs, (particularly nifedipine or Procardia) in pregnant women. Other calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem), felodipine (Plendil), and verapamil (Calan).

DIABETIC MEDICATIONS

Glipizide and glyburide are two medications used to control blood sugar levels. Magnesium hydroxide commonly found in antacids may increase the absorption of these drugs. Caution should be advised when supplementing these drugs with magnesium so as to avoid larger swings in blood sugar. The dosages of these drugs may potentially be lowered if combined with magnesium.

Sulfonylureas are another type of medication for diabetics which lower blood pressure, and whose absorption may be increased with magnesium supplementation. Similar caution should also be taken to avoid drastic swings in blood pressure.

DIGOXIN

This drug has adverse potential side-effects, which are similar to the side-effects of low magnesium in the blood. Extra caution should be taken when using this drug, to ensure blood magnesium levels stay in a healthy range. A safe magnesium supplement should be used to ensure blood magnesium does not drop to dangerous levels especially while taking digoxin.

DIURETICS

Two different kinds of diuretics are known to deplete magnesium to potentially dangerous levels: Loop (includes furosemide or Lasix) and thiazide (includes hydrochlorothiazide). A safe magnesium supplement should be used to ensure magnesium levels do not drop to dangerous levels especially while taking these diuretics.

GABAPENTIN (Neurontin)

Gabapentin (Neurontin) absorption may be decreased by simultaneous magnesium supplementation. To reduce this effect, it may help taking gabapentin (Neurontin) at least 2 hours before, or 4 to 6 hours after taking magnesium supplements.

HORMONE REPLACEMENT THERAPY (for menopause)

Magnesium levels often drop during menopause and hormone replacement therapy may help prevent these losses. Postmenopausal women or those taking hormone replacement therapy should consult a health professional about supplementing magnesium along with these medications to prevent and major imbalances.

LEVOTHYROXINE

Although not magnesium specifically, several antacids containing magnesium, have been shown to reduce the effectiveness of this drug which is taken for hypothyroid conditions. Caution should be taken with laxatives and antacids while taking levothyroxine.

MUSCLE RELAXANTS

Magnesium plays a central biological role in magnesium relaxation and thus can noticeably increase the desired effects and side-effects of muscle relaxants. Caution should be taken with the timing and dosages of these two.
Some muscle relaxants include carisoprodol (Soma), pipecuronium (Arduan), orphenadrine (Banflex, Disipal), cyclobenzaprine, gallamine (Flaxedil), atracurium (Tracrium), pancuronium (Pavulon), succinylcholine (Anectine), and others.

OSTEOPOROSIS MEDICATIONS

Tiludronate and Alendronate(Fosamax) are two of these medications whose absorption may be reduced by magnesium. Avoiding magnesium supplements for at least 1 hour before or 2 hours after these medications may help avoid these reductions in absorption.

PENICILLAMINE

Penicillamine – used for the treatment of Wilson’s disease and rheumatoid arthritis – can inactivate magnesium, particularly with long-term use of high doses. Magnesium supplementation has however been shown to reduce penicillamine’s side effects. Consulting a health professional is advised when looking to used magnesium to alleviate these side effects.

WATER PILLS

These potassium-sparing diuretics may have the effect of increasing magnesium in the body. Caution is advised when using these drugs with magnesium supplements in people with kidney problems who lack the ability to regulate blood magnesium levels.

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