Table 8.

Magnesium and drug interactions.

Medications that reduce magnesium levels:

(i) H2 blockers: for example, cimetidine and nizatidine

(ii) Proton pump inhibitors: for example, esomeprazole, omeprazole, and pantoprazole (FDA WARNING: supplementing magnesium will not correct deficiency; you must stop the drug)

(iii) Antacids: aluminum and magnesium hydroxide and sodium bicarbonate

(iv) Antibiotics: for example, amoxicillin, azithromycin, doxycycline, minocycline, levofloxacin, ciprofloxacin, cephalexin,

sulfamethoxazole and trimethoprim, and tetracycline

(v) Antihistamines: for example, astemizole and terfenadine

(vi) Antivirals: for example, delavirdine, lamivudine, and zidovudine

(vii) Antiepileptic medications: phenytoin and phenobarbital

(viii) Blood pressure drugs: hydralazine and combination of ACE inhibitors with HCTZ (enalapril and HCTZ)

(ix) Diuretics: for example, furosemide, ethacrynic acid, chlorothiazide, chlorthalidone, metolazone, and indapamide

(x) Cardiac glycoside: digoxin

(xi) Cardiac drugs: sotalol, amiodarone, bretylium, and quinidine

(xii) CNS stimulants: methylphenidate

(xiii) Cholesterol agents: cholestyramine and colestipol

(xiv) Corticosteroids: betamethasone, dexamethasone, hydrocortisone, prednisone, and triamcinolone

(xv) Inhaled corticosteroids: fluticasone, flunisolide, and triamcinolone

(xvi) Estrogens: DES, estradiol, estring, and estrogen-containing drugs: HRT and BCP

(xvii) Immunosuppressants: cyclosporine and tacrolimus

(xviii) Nonsteroidal aromatase inhibitors for breast cancer: anastrozole

(xix) Osteoporosis: raloxifene

(a) On the other hand, magnesium decreases bisphosphonate absorption

(xx) SERMs (selective estrogen receptor modulators): raloxifene, tamoxifen, and toremifene

(xxi) Sulfonamides: antibiotics and some diabetic medications

(xxii) Nutraceuticals: for example, high-dose calcium, high-dose vitamin D, and caffeine

Medications that may increase serum magnesium:

(i) Lithium carbonate

(ii) Antidepressants: for example, sertraline and amitriptyline

(iii) Potassium sparing diuretics: amiloride and spironolactone reduce magnesium excretion