Therapeutic amounts of intravenous salbutamol (albuterol) in four healthy people were associated with decreased plasma levels of calcium, magnesium, phosphate, and potassium.¹³ Decreased potassium levels have been reported with oral,¹⁴ intramuscular, and subcutaneous albuterol administration.¹⁵ How frequently this effect occurs is not known; whether these changes are preventable through diet or supplementation is also unknown.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Amphotericin B has been reported to increase urinary excretion of magnesium.¹⁶ It remains unclear whether it is important for people taking this drug to supplement magnesium.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,¹⁷ although this deficiency may not be reflected by a low blood level of magnesium.¹⁸ Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.¹⁹

People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.²⁰ A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.²¹ Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.²² Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.²³

Potassium-depleting diuretics, including loop diuretics, cause the body to lose potassium. Loop diuretics may also cause cellular magnesium depletion,²⁴ although this deficiency may not be reflected by a low blood level of magnesium.²⁵ Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including loop diuretics, should supplement both potassium and magnesium.²⁶

People taking loop diuretics should be monitored by their doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.²⁷ Fruit is high in potassium, and increasing fruit intake is another way of supplementing potassium. Magnesium supplementation is typically 300–400 mg per day.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{28 , 29} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{30 , 31} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.³² Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{33 , 34} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{35 , 36} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.³⁷ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{38 , 39} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{40 , 41} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.⁴² Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{43 , 44} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{45 , 46} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.⁴⁷ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{48 , 49} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{50 , 51} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.⁵² Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,⁵³ although this deficiency may not be reflected by a low blood level of magnesium.⁵⁴ Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.⁵⁵

People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.⁵⁶ A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.⁵⁷ Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.⁵⁸ Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.⁵⁹

Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,⁶⁰ although this deficiency may not be reflected by a low blood level of magnesium.⁶¹ Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.⁶²

People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.⁶³ A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.⁶⁴ Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.⁶⁵ Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.⁶⁶

>

Cisplatin may cause excessive loss of magnesium and potassium in the urine.^{67 , 68} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{69 , 70} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.⁷¹ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{72 , 73} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{74 , 75} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.⁷⁶ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

Cycloserine may interfere with calcium and magnesium absorption.⁷⁷ The clinical significance of these interactions is unclear.

Cycloserine may interfere with the absorption and/or activity of folic acid, vitamin B6, and vitamin B12.^{78 , 79} The clinical importance of this interaction is unclear.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Cyclosporine has been associated with low blood magnesium levels and undesirable side effects.^{80 , 81 , 82} Some doctors suggest monitoring the level of magnesium in red blood cells, rather than in serum, as the red blood cell test may be more sensitive for evaluating magnesium status.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{83 , 84} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{85 , 86} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.⁸⁷ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.⁸⁸ In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.⁸⁹ Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

In a case report, a man developed severe magnesium deficiency after long-term treatment with a proton pump inhibitor (pantoprazole or lansoprazole).^[REF] Severe magnesium deficiency as a result of the use of proton pump inhibitors appears to be rare among people who have no other risk factors for magnesium deficiency. However, in a study of hospitalized patients, the prevalence of low serum magnesium levels was significantly greater among users of proton pump inhibitors than among nonusers (23% vs. 11%).⁹⁰ People taking proton pump inhibitors (PPIs) should ask their doctor whether to take a magnesium supplement or whether to have their magnesium levels monitored.⁹¹

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{92 , 93} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{94 , 95} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.⁹⁶ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

Glutathione , the main antioxidant found within cells, is frequently depleted in individuals on chemotherapy and/or radiation. Preliminary studies have found that intravenously injected glutathione may decrease some of the adverse effects of chemotherapy and radiation, such as diarrhea.⁹⁷

A woman and her newborn infant experienced low blood levels of magnesium, which was possibly due to chronic use of docusate throughout and after pregnancy.⁹⁸ Controlled research is necessary to determine whether people taking docusate for long periods of time need to supplement magnesium.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{99 , 100} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{101 , 102} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.¹⁰³ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

Erythromycin may interfere with the absorption and/or activity of calcium, folic acid, magnesium, vitamin B6 and vitamin B12,¹⁰⁴ which may cause problems, especially with long-term erythromycin treatment. Until more is known, it makes sense for people taking erythromycin for longer than two weeks to supplement with a daily multivitamin-multimineral.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

In a case report, a man developed severe magnesium deficiency after long-term treatment with a proton pump inhibitor (pantoprazole or lansoprazole).^[REF] Severe magnesium deficiency as a result of the use of proton pump inhibitors appears to be rare among people who have no other risk factors for magnesium deficiency. However, in a study of hospitalized patients, the prevalence of low serum magnesium levels was significantly greater among users of proton pump inhibitors than among nonusers (23% vs. 11%).¹⁰⁵ People taking proton pump inhibitors (PPIs) should ask their doctor whether to take a magnesium supplement or whether to have their magnesium levels monitored.¹⁰⁶

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.¹⁰⁷ In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.¹⁰⁸ Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.¹⁰⁹ In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.¹¹⁰ Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.¹¹¹ In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.¹¹² Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.¹¹³ In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.¹¹⁴ Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{115 , 116} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{117 , 118} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.¹¹⁹ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

Increased magnesium excretion has been observed in studies of individuals taking felodipine.¹²⁰ Therefore, some physicians may recommend magnesium supplementation to their patients taking felodipine.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{122 , 123} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{124 , 125} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.¹²⁶ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{127 , 128} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{129 , 130} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.¹³¹ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

Potassium-depleting diuretics, including loop diuretics, cause the body to lose potassium. Loop diuretics may also cause cellular magnesium depletion,¹³² although this deficiency may not be reflected by a low blood level of magnesium.¹³³ Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including loop diuretics, should supplement both potassium and magnesium.¹³⁴

People taking loop diuretics should be monitored by their doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.¹³⁵ Fruit is high in potassium, and increasing fruit intake is another way of supplementing potassium. Magnesium supplementation is typically 300–400 mg per day.

Gentamicin has been associated with urinary loss of magnesium, resulting in hypomagnesemia (low magnesium levels) in humans.^{136 , 137}

Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,¹³⁹ although this deficiency may not be reflected by a low blood level of magnesium.¹⁴⁰ Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.¹⁴¹

People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.¹⁴² A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.¹⁴³ Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.¹⁴⁴ Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.¹⁴⁵

Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,¹⁴⁶ although this deficiency may not be reflected by a low blood level of magnesium.¹⁴⁷ Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.¹⁴⁸

People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.¹⁴⁹ A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.¹⁵⁰ Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.¹⁵¹ Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.¹⁵²

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{153 , 154} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{155 , 156} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.¹⁵⁷ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{158 , 159} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{160 , 161} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.¹⁶² Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,¹⁶³ although this deficiency may not be reflected by a low blood level of magnesium.¹⁶⁴ Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.¹⁶⁵

People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.¹⁶⁶ A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.¹⁶⁷ Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.¹⁶⁸ Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.¹⁶⁹

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{170 , 171} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{172 , 173} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.¹⁷⁴ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

Isoniazid may interfere with the activity of other nutrients, including vitamin B3 (niacin), vitamin B12, vitamin D, and vitamin E, folic acid, calcium, and magnesium.^{175 , 176} Supplementation with vitamin B6 is thought to help prevent isoniazid-induced niacin deficiency; however, small amounts of vitamin B6 (e.g. 10 mg per day) appear to be inadequate in some cases.¹⁷⁷ People should consider using a daily multivitamin-mineral supplement during isoniazid therapy.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

In a case report, a man developed severe magnesium deficiency after long-term treatment with a proton pump inhibitor (pantoprazole or lansoprazole).¹⁷⁸ Severe magnesium deficiency as a result of the use of proton pump inhibitors appears to be rare. However, people taking proton pump inhibitors (PPIs) should ask their doctor whether to take a magnesium supplement or whether to have their magnesium levels monitored.¹⁷⁹

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.¹⁸⁰ In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.¹⁸¹ Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.¹⁸² In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.¹⁸³ Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{184 , 185} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{186 , 187} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.¹⁸⁸ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{189 , 190} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{191 , 192} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.¹⁹³ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{194 , 195} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{196 , 197} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.¹⁹⁸ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{199 , 200} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{201 , 202} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.²⁰³ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

Many chemotherapy drugs can cause diarrhea, lack of appetite, vomiting, and damage to the gastrointestinal tract. Recent anti-nausea prescription medications are often effective. Nonetheless, nutritional deficiencies still occur.²⁰⁴ People undergoing chemotherapy should talk to their doctor about whether supplementing with a multivitamin-mineral will protect them against deficiencies.

Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.²⁰⁵ In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.²⁰⁶ Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{207 , 208} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{209 , 210} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.²¹¹ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,²¹² although this deficiency may not be reflected by a low blood level of magnesium.²¹³ Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.²¹⁴

People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.²¹⁵ A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.²¹⁶ Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.²¹⁷ Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.²¹⁸

Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,³ although this deficiency may not be reflected by a low blood level of magnesium.⁴ Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.⁵

People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.⁶ A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.⁷ Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.⁸ Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.⁹

Neomycin can decrease absorption or increase elimination of many nutrients, including calcium, carbohydrates, beta-carotene, fats, folic acid, iron, magnesium, potassium, sodium, and vitamin A, vitamin B12, vitamin D, and vitamin K.^{219 , 220} Surgery preparation with oral neomycin is unlikely to lead to deficiencies. It makes sense for people taking neomycin for more than a few days to also take a multivitamin-mineral supplement.

Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.²²¹ In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.²²² Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

In a case report, a man developed severe magnesium deficiency after long-term treatment with a proton pump inhibitor (pantoprazole or lansoprazole).^[REF] Severe magnesium deficiency as a result of the use of proton pump inhibitors appears to be rare among people who have no other risk factors for magnesium deficiency. However, in a study of hospitalized patients, the prevalence of low serum magnesium levels was significantly greater among users of proton pump inhibitors than among nonusers (23% vs. 11%).²²³ People taking proton pump inhibitors (PPIs) should ask their doctor whether to take a magnesium supplement or whether to have their magnesium levels monitored.²²⁴

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

In a case report, a man developed severe magnesium deficiency after long-term treatment with a proton pump inhibitor (pantoprazole or lansoprazole).^[REF] Severe magnesium deficiency as a result of the use of proton pump inhibitors appears to be rare among people who have no other risk factors for magnesium deficiency. However, in a study of hospitalized patients, the prevalence of low serum magnesium levels was significantly greater among users of proton pump inhibitors than among nonusers (23% vs. 11%).²²⁵ People taking proton pump inhibitors (PPIs) should ask their doctor whether to take a magnesium supplement or whether to have their magnesium levels monitored.²²⁶

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{227 , 228} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{229 , 230} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.²³¹ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,²³² although this deficiency may not be reflected by a low blood level of magnesium.²³³ Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.²³⁴

People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.²³⁵ A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.²³⁶ Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.²³⁷ Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.²³⁸

In a case report, a man developed severe magnesium deficiency after long-term treatment with a proton pump inhibitor (pantoprazole or lansoprazole).^[REF] Severe magnesium deficiency as a result of the use of proton pump inhibitors appears to be rare among people who have no other risk factors for magnesium deficiency. However, in a study of hospitalized patients, the prevalence of low serum magnesium levels was significantly greater among users of proton pump inhibitors than among nonusers (23% vs. 11%).²⁴⁰ People taking proton pump inhibitors (PPIs) should ask their doctor whether to take a magnesium supplement or whether to have their magnesium levels monitored.²⁴¹

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Sulfonamides, including sulfamethoxazole, can decrease absorption of calcium, magnesium, and vitamin B12.²⁴⁴ This is generally not a problem when taking sulfamethoxazole for two weeks or less. People taking sulfamethoxazole for longer than two weeks should ask their doctor about nutrient monitoring and supplementation.

Note: Since sulfamethoxazole is often prescribed in combination with trimethoprim (for example, in Bactrim or Septra), it may be easy to associate this interaction with trimethoprim. However, this interaction is not known to occur with trimethoprim alone.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Preliminary evidence indicates that theophylline can promote potassium and magnesium deficiency.^{245 , 246} Some doctors have noted a tendency for persons on theophylline to become deficient in these minerals. Therefore, supplementing with these minerals may be necessary during theophylline therapy. Consult with a doctor to make this determination.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{247 , 248} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{249 , 250} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.²⁵¹ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

Cisplatin may cause excessive loss of magnesium and potassium in the urine.^{252 , 253} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{254 , 255} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.²⁵⁶ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

Calcium , magnesium, and potassium depletion requiring prolonged replacement were reported in a child with tetany who had just completed a three-week course of i.v. tobramycin.²⁵⁷ The authors suggest this may have been due to kidney damage related to the drug. Seventeen patients with cancer developed calcium, magnesium, and potassium depletion after treatment with aminoglycoside antibiotics, including tobramycin.²⁵⁸ The authors suggested a possible potentiating action of tobramycin-induced mineral depletion by chemotherapy drugs, especially doxorubicin (Adriamycin®).

Until more is known, people receiving i.v. tobramycin should ask their doctor about monitoring calcium, magnesium, and potassium levels and the possibility of mineral replacement.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Potassium-depleting diuretics, including loop diuretics, cause the body to lose potassium. Loop diuretics may also cause cellular magnesium depletion,²⁵⁹ although this deficiency may not be reflected by a low blood level of magnesium.²⁶⁰ Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including loop diuretics, should supplement both potassium and magnesium.²⁶¹

People taking loop diuretics should be monitored by their doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.²⁶² Fruit is high in potassium, and increasing fruit intake is another way of supplementing potassium. Magnesium supplementation is typically 300–400 mg per day.

Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,²⁶³ although this deficiency may not be reflected by a low blood level of magnesium.²⁶⁴ Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.²⁶⁵

People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.²⁶⁶ A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.²⁶⁷ Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.²⁶⁸ Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.²⁶⁹

Sulfonamides, including sulfamethoxazole, can decrease absorption of calcium, magnesium, and vitamin B12.²⁷⁰ This is generally not a problem when taking sulfamethoxazole for two weeks or less. People taking sulfamethoxazole for longer than two weeks should ask their doctor about nutrient monitoring and supplementation.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{271 , 272} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{273 , 274} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.²⁷⁵ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.²⁷⁶

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{277 , 278} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{279 , 280} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.²⁸¹ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.^{282 , 283} Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.^{284 , 285} Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.²⁸⁶ Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

Many chemotherapy drugs can cause diarrhea, lack of appetite, vomiting, and damage to the gastrointestinal tract. Recent anti-nausea prescription medications are often effective. Nonetheless, nutritional deficiencies still occur.²⁸⁷ People undergoing chemotherapy should talk to their doctor about whether supplementing with a multivitamin-mineral will protect them against deficiencies.

People taking potassium-depleting diuretics may develop low potassium and magnesium blood levels. Prolonged diarrhea and vomiting might also result in low blood potassium levels. People with low potassium or magnesium blood levels who take quinidine might develop serious drug side effects.²³⁹ Therefore, people taking quinidine should have their blood potassium and magnesium levels checked regularly and might need to supplement with both minerals, especially when taking potassium-depleting diuretics.

Two individuals taking sotalol developed a side effect of the drug (a heart arrhythmia known as torsades de pointes) which was effectively treated with intravenous magnesium.^{242 , 243} Additional research is needed to determine whether people taking sotalol might be able to prevent this side effect by taking supplemental magnesium.

One double-blind study showed that giving magnesium intravenously before surgery dramatically reduced the amount of fentanyl needed to control pain during and after an operation.¹²¹ Further research is needed to determine whether people using fentanyl patches might benefit from supplementing with oral magnesium.

Supplementing magnesium may enhance the blood-sugar-lowering effects of sulfonylurea drugs.¹³⁸ Though no current studies have investigated whether glimepiride increases the risk of developing hypoglycemia, individuals should closely monitor their blood glucose while taking glimepiride together with magnesium supplements.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

In healthy volunteers, a magnesium hydroxide/aluminum hydroxide antacid, taken with cimetidine, decreased cimetidine absorption by 20 to 25%.²⁹⁰ People can avoid this interaction by taking cimetidine two hours before or after any aluminum/magnesium-containing antacids, including magnesium hydroxide found in some vitamin/mineral supplements. However, the available studies do not clearly indicate if magnesium hydroxide was the problem and may not need to be avoided.

Minerals such as aluminum, calcium, copper, iron, magnesium, manganese, and zinc can bind to ciprofloxacin, greatly reducing the absorption of the drug.^{291 , 292 , 293 , 294} Because of the mineral content, people are advised to take ciprofloxacin two hours after consuming dairy products (milk, cheese, yogurt, ice cream, and others), antacids (Maalox®, Mylanta®, Tums®, Rolaids®, and others), and mineral-containing supplements.²⁹⁵

Taking mineral supplements or antacids that contain aluminum, calcium, iron, magnesium, or zinc at the same time as tetracyclines inhibits the absorption of the drug.²⁹⁶ Therefore, individuals should take tetracyclines at least two hours before or after products containing minerals.

Many minerals can decrease the absorption and reduce effectiveness of doxycycline, including calcium, magnesium, iron, zinc, and others.²⁹⁹ To avoid these interactions, doxycycline should be taken two hours before or two hours after dairy products (high in calcium) and mineral-containing antacids or supplements.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

One controlled study showed that taking folic acid together with an antacid containing aluminum and magnesium hydroxide reduced the absorption of the vitamin.³⁰⁰ Therefore, individuals should take folic acid one hour before or two hours after taking antacids containing aluminum and magnesium hydroxide.

One study showed that taking an antacid containing magnesium and aluminum ten minutes before gemifloxacin results in an 85% reduction in the absorption of the drug.³⁰¹ Consequently, gemifloxacin and supplements containing magnesium should not be taken at the same time.

Magnesium supplementation may reduce blood levels of chloroquine, a compound similar to hydroxychloroquine, and decrease its effectiveness.³⁰² Until more is known, people taking hydroxychloroquine for arthritis who are also using magnesium supplements and are not experiencing relief might try avoiding the supplements or taking them at separate times.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Taking magnesium supplements at the same time as levofloxacin can reduce the intestinal absorption—and thus the effectiveness—of the drug.³⁰³ Consequently, nutritional supplements or antacids containing magnesium, if used, should be taken two hours before or after taking levofloxacin.

In six healthy men, nitrofurantoin absorption was reduced by also taking magnesium trisilicate.³⁰⁵ Another magnesium compound, magnesium oxide (commonly found in supplements) was shown to bind with nitrofurantoin in a test tube.³⁰⁶

In a study of 11 people, the rate of nitrofurantoin absorption was delayed despite the fact that the amount of nitrofurantoin ultimately absorbed remained the same when the drug was administered in a colloidal magnesium aluminum silicate suspension.³⁰⁷ It remains unclear whether this interaction is clinically important or if typical magnesium supplements would have the same effect.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Minerals including calcium, iron, magnesium, and zinc can bind to fluoroquinolones, including ofloxacin, greatly reducing drug absorption.³⁰⁸ Ofloxacin should be taken four hours before or two hours after consuming antacids (Maalox®, Mylanta®, Tumms®, Rolaids® and others) that may contain these minerals and mineral-containing supplements.³⁰⁹

Many minerals can decrease the absorption of tetracycline, thus reducing its effectiveness. These minerals include aluminum (in antacids), calcium (in antacids, dairy products, and supplements), magnesium (in antacids and supplements), iron (in food and supplements), zinc (in food and supplements), and others.

Iron , magnesium, and zinc may bind with warfarin, potentially decreasing their absorption and activity.³¹² People on warfarin therapy should take warfarin and iron/magnesium/zinc-containing products at least two hours apart.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Preliminary research in animals suggests that amiloride may reduce the urinary excretion of magnesium.²⁸⁸ It is unknown if this same effect would occur in humans. Nevertheless, persons taking more than 300 mg of magnesium per day and amiloride should consult with a doctor, as this combination may lead to potentially dangerous elevations in levels of magnesium in the body. The combination of amiloride and hydrochlorothiazide would likely eliminate this problem, as hydrochlorothiazide may deplete magnesium.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Calcium-containing antacids, when taken together with calcium acetate, may result in abnormally high blood levels of calcium.²⁸⁹ Consequently, people taking calcium acetate should avoid taking calcium-containing antacids.

Corticosteroids may increase the body’s loss of magnesium.²⁹⁷ Some doctors recommend that people taking corticosteroids for more than two weeks supplement with 300–400 mg of magnesium per day. Magnesium has also been reported to interfere with the absorption of dexamethasone.²⁹⁸

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

A common side effect of misoprostol is diarrhea, which is aggravated by taking magnesium.³⁰⁴ Consequently, individuals who experience diarrhea while taking misoprostol should avoid magnesium supplementation.

Preliminary research in animals suggests that amiloride, a drug similar to spironolactone, may inhibit the urinary excretion of magnesium.³¹⁰ It is unknown if this same effect would occur in humans or with spironolactone. Persons taking more than 300 mg of magnesium per day and spironolactone should consult with a doctor as this combination may lead to potentially dangerous increases in the level of magnesium in the body. The combination of spironolactone and hydrochlorothiazide would likely eliminate this problem, as hydrochlorothiazide may deplete magnesium.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Preliminary research in animals suggests that triamterene may inhibit the urinary excretion of magnesium.³¹¹ It is unknown if this same effect would occur in humans. Persons taking more than 300 mg of magnesium per day and triamterene should consult with a doctor as this combination may lead to potentially dangerous increases in the level of magnesium in the body. The combination of triamterene and hydrochlorothiazide would likely eliminate this problem, as hydrochlorothiazide may deplete magnesium.

Absorption of tiludronate, a drug related to alendronate, is reduced when taken with magnesium and/or aluminum-containing antacids.³¹³ This interaction has not yet been reported with alendronate. Until more is known, alendronate should be taken two hours before or after magnesium and/or aluminum-containing antacids.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

A magnesium- and aluminum-containing antacid was reported to interfere with atorvastatin absorption.³¹⁴ People can avoid this interaction by taking atorvastatin two hours before or after any aluminum/magnesium-containing antacids. Some magnesium supplements such as magnesium hydroxide are also antacids.

A magnesium- and aluminum-containing antacid was reported to interfere with azithromycin absorption in a study of ten healthy people.³¹⁵ People can avoid this interaction by taking azithromycin two hours before or after any aluminum/magnesium-containing products. It has not yet been shown that magnesium compounds typically found in supplements affect absorption of this drug.

Corticosteroids may increase the body’s loss of magnesium.³¹⁶ Some doctors recommend that people taking corticosteroids for more than two weeks supplement with 300–400 mg of magnesium per day. Magnesium has also been reported to interfere with the absorption of dexamethasone.³¹⁷

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

People needing digoxin may have low levels of potassium or magnesium,³¹⁸ increasing the risk for digoxin toxicity. Digoxin therapy may increase magnesium elimination from the body.³¹⁹ People taking digoxin may benefit from magnesium supplementation.³²⁰ Medical doctors do not commonly check magnesium status, and when they do, they typically use an insensitive indicator of magnesium status (serum or plasma levels). The red blood cell magnesium level may be a more sensitive indicator of magnesium status, although evidence is conflicting. It has been suggested that 300–500 mg of magnesium per day is a reasonable amount to supplement.³²¹

Intravenous administration of epinephrine to human volunteers reduced plasma concentrations of vitamin C.³²² Epinephrine and other “stress hormones” may reduce intracellular concentrations of potassium and magnesium.³²³ Although there are no clinical studies in humans, it seems reasonable that individuals using epinephrine should consume a diet high in vitamin C, potassium, and magnesium, or should consider supplementing with these nutrients.

Absorption of tiludronate, a drug related to alendronate, is reduced when taken with magnesium and/or aluminum-containing antacids.³²⁴ This interaction has not yet been reported with alendronate. Until more is known, alendronate should be taken two hours before or after magnesium and/or aluminum-containing antacids.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

In healthy people, a magnesium hydroxide/aluminum hydroxide antacid, taken with famotidine, decreased famotidine absorption by 20–25%.³²⁵ People can avoid this interaction by taking famotidine two hours before or after any aluminum/magnesium-containing antacids. Some magnesium supplements such as magnesium hydroxide are also antacids.

In a study of people with poorly controlled type 2 diabetes and low blood levels of magnesium, treatment with glipizide was associated with a significant rise in magnesium levels.³²⁶ In a randomized trial with eight healthy people, 850 mg magnesium hydroxide increased glipizide absorption and activity.³²⁷ In theory, such changes could be therapeutic or detrimental under varying circumstances. Therefore, people taking glipizide should consult with their doctor before taking magnesium supplements.

In a group of 37 postmenopausal women treated with conjugated estrogens and medroxyprogesterone for 12 months, urinary zinc and magnesium loss was reduced in those women who began the study with signs of osteoporosis and elevated zinc and magnesium excretion.³²⁸ The clinical significance of this interaction remains unclear.

In a study of patients with poorly controlled type 2 diabetes, low blood levels of magnesium, and high urine magnesium loss, metformin therapy was associated with reduced urinary magnesium losses but no change in low blood levels of magnesium.³²⁹ Whether this interaction has clinical importance remains unclear.

Corticosteroids may increase the body’s loss of magnesium.³³⁰ Some doctors recommend that people taking corticosteroids for more than two weeks supplement with 300–400 mg of magnesium per day. Magnesium has also been reported to interfere with the absorption of dexamethasone.³³¹

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Taking calcium, iron, magnesium, or zinc at the same time as minocycline can decrease the absorption of both the drug^{332 , 333} and the mineral. Therefore, calcium, iron, magnesium, or zinc supplements, if used, should be taken an hour before or after the drug.

In healthy people, a magnesium hydroxide/aluminum hydroxide antacid, taken with nizatidine, decreased nizatidine absorption by 12%.³³⁴ People can avoid this interaction by taking nizatidine two hours before or after any aluminum/magnesium-containing antacids. Some magnesium supplements such as magnesium hydroxide are also antacids.

In a case report, a man developed severe magnesium deficiency after long-term treatment with a proton pump inhibitor (pantoprazole or lansoprazole).^[REF] Severe magnesium deficiency as a result of the use of proton pump inhibitors appears to be rare. However, people taking proton pump inhibitors (PPIs) should ask their doctor whether to take a magnesium supplement or whether to have their magnesium levels monitored.³³⁵

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Absorption of tiludronate, a drug related to alendronate, is reduced when taken with magnesium and/or aluminum-containing antacids.³³⁶ This interaction has not yet been reported with alendronate. Until more is known, alendronate should be taken two hours before or after magnesium and/or aluminum-containing antacids.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Corticosteroids may increase the body’s loss of magnesium.³³⁷ Some doctors recommend that people taking corticosteroids for more than two weeks supplement with 300–400 mg of magnesium per day. Magnesium has also been reported to interfere with the absorption of dexamethasone.^[REF]

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Corticosteroids may increase the body’s loss of magnesium.³³⁸ Some doctors recommend that people taking corticosteroids for more than two weeks supplement with 300–400 mg of magnesium per day. Magnesium has also been reported to interfere with the absorption of dexamethasone.³³⁹

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Taking risedronate at the same time as iron, zinc, or magnesium may reduce the amount of drug absorbed.³⁴⁰ Therefore, people taking risedronate who wish to supplement with these minerals should take them an hour before or two hours after the drug.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

A magnesium- and aluminum-containing antacid was reported to interfere with absorption of azithromycin, another macrolide drug, in a study of ten healthy people.³⁴¹ People can avoid this interaction by taking azithromycin two hours before or after any aluminum/magnesium-containing products. It has not yet been shown that magnesium compounds typically found in supplements affect absorption of azithromycin or other similar drugs.