The headline “NEVER use magnesium if you are taking any of the following medications” is too strong. Most people taking these medicines don’t have to avoid magnesium completely; the issue is usually timing, dose, or monitoring. Magnesium supplements can interfere with absorption of some drugs, while other medications can change magnesium levels.
O
ODs
+1
Medications that deserve particular attention
1. Certain antibiotics
Magnesium can bind to some antibiotics—especially doxycycline and ciprofloxacin/levofloxacin—and reduce how much medicine your body absorbs. They generally need to be separated from magnesium rather than magnesium being permanently avoided. NIH guidance recommends taking these antibiotics at least 2 hours before or 4–6 hours after a magnesium supplement.
O
ODs
2. Bisphosphonates for osteoporosis
Medicines such as alendronate can have reduced absorption when taken too close to magnesium. NIH recommends separating magnesium from an oral bisphosphonate by at least 2 hours.
O
ODs
3. Diuretics (“water pills”)
Drugs such as furosemide, bumetanide and hydrochlorothiazide can alter how much magnesium is lost in urine. Some other diuretics have the opposite effect. This is generally a reason to monitor magnesium status—not automatically avoid magnesium.
O
ODs
4. Proton-pump inhibitors (PPIs)
Long-term use of drugs such as omeprazole, esomeprazole or lansoprazole can sometimes cause low blood magnesium. In this situation, a clinician may actually recommend magnesium supplementation or investigate whether the PPI needs to be changed.
O
ODs
5. Levothyroxine and some other medicines
Magnesium-containing products can reduce absorption of several medications. A medication review with a pharmacist is the safest way to determine the appropriate separation interval for your particular drug.
R
Remedy
Another important issue: kidney disease
If your kidneys don’t function properly, magnesium can accumulate because the kidneys normally remove excess magnesium. High magnesium levels can become dangerous, potentially causing low blood pressure, muscle weakness, breathing problems, abnormal heart rhythms and, at very high levels, cardiac arrest.
O
ODs
How much magnesium is too much?
For adults, the U.S. NIH sets an upper limit of 350 mg/day of magnesium from supplements and medications (not magnesium naturally present in food), unless a healthcare professional recommends otherwise. High supplemental doses commonly cause diarrhea, nausea and abdominal cramping.
O
ODs
Bottom line: Don’t automatically stop magnesium because you’re taking medication. Instead, check the exact medication, magnesium product and dose, because the correct solution may simply be separating the doses or monitoring your magnesium level.
If you give me the names of the medications you take, I can check each one and tell you whether magnesium should be avoided, separated by a few hours, or monitored.
O
R
Sources
