Version July 2025
Prevention of calcifications of indwelling urethral catheters and cystostomy tubes: Irrigation: Instill 30 mL; clamp for 10 minutes, then remove clamp and drain the bladder; repeat 3 times daily.
Bladder calculi dissolution: Irrigation (via indwelling urethral catheter or cystostomy tube): Instill 30 mL; clamp for 30 to 60 minutes, then remove clamp and drain the bladder; repeat 4 to 6 times daily.
There are no dosage adjustments provided in the manufacturer’s labeling; use with caution.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%: Genitourinary: Cystitis (chemical), detrusor hyperreflexia of bladder
<1%: Genitourinary: Burning sensation on urination (burning sensation in bladder; transient)
Urinary tract extravasation
Disease-related concerns:
• Renal impairment: Use with caution in patients with impaired renal function; discontinue use if elevated serum creatinine occurs.
• Vesicoureteral reflux: Use with caution in patients with vesicoureteral reflux.
Other warnings/precautions:
• Appropriate use: Prior to initiating therapy, urine specimens should be obtained for culture; a sterile urine must be present prior to initiating therapy. An infected stone can serve as a continual source for infection. Appropriate antibiotic therapy should be instituted to treat any detected infection and should be continued throughout the course of dissolution therapy. Use should be stopped immediately if the patient develops fever, signs and symptoms consistent with urinary tract infection, or persistent flank pain. Maintain patency of the irrigating catheter. At the first sign of obstruction, irrigation should be discontinued. Not indicated for continuous irrigation of the upper urinary tract; serious adverse reactions, including sepsis and hypermagnesemia, have been reported with continuous irrigation of the upper urinary tract.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Irrigation:
Renacidin: Citric acid 1980.6 mg, magnesium carbonate 980.4 mg, glucono-delta-lactone 59.4 mg per 30 mL (30 mL) [contains benzoic acid]
No
For local irrigation within the lower urinary tract. Discontinue irrigation immediately if fever, urinary tract infection (UTI), signs and symptoms of UTI, or persistent flank pain occurs. Maintain patency of urethral catheter or cystostomy tube; discontinue if obstructed. Consult the prescribing information for additional detailed administration instructions.
Dissolution or prevention of calcifications: Dissolution of struvite or apatite type bladder calculi; to prevent encrustations of indwelling urethral catheters and cystostomy tubes.
Renacidin may be confused with Remicade
Refer to individual components.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Acalabrutinib: Antacids may decrease serum concentration of Acalabrutinib. Management: Separate administration of acalabrutinib capsules from the administration of any antacid by at least 2 hours in order to minimize the potential for a significant interaction. Acalabrutinib tablets are not expected to interact with antacids. Risk D: Consider Therapy Modification
Alfacalcidol: May increase serum concentration of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving alfacalcidol. If magnesium-containing products must be used with alfacalcidol, serum magnesium concentrations should be monitored closely. Risk D: Consider Therapy Modification
Alpha-Lipoic Acid: Magnesium Salts may decrease absorption of Alpha-Lipoic Acid. Alpha-Lipoic Acid may decrease absorption of Magnesium Salts. Management: Separate administration of alpha-lipoic acid from that of any magnesium-containing compounds by several hours. If alpha-lipoic acid is given 30 minutes before breakfast, then administer oral magnesium-containing products at lunch or dinner. Risk D: Consider Therapy Modification
Aluminum Hydroxide: Citric Acid Derivatives may increase absorption of Aluminum Hydroxide. Risk C: Monitor
Antipsychotic Agents (Phenothiazines): Antacids may decrease absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor
Atazanavir: Antacids may decrease absorption of Atazanavir. Management: Administer antacids 1 to 2 hours before or 2 hours after atazanavir to minimize the risk of a clinically significant interaction. Risk D: Consider Therapy Modification
Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease serum concentration of Baloxavir Marboxil. Risk X: Avoid
Belumosudil: Antacids may decrease serum concentration of Belumosudil. Management: Consider separating administration of belumosudil and antacids by 2 hours and monitor for reduced belumosudil efficacy. Risk D: Consider Therapy Modification
Bictegravir: Polyvalent Cation Containing Products may decrease serum concentration of Bictegravir. Management: Administer bictegravir at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended. Risk D: Consider Therapy Modification
Bisacodyl: Antacids may decrease therapeutic effects of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Management: Antacids should not be used within 1 hour before bisacodyl administration. Risk D: Consider Therapy Modification
Bismuth Subcitrate: Antacids may decrease therapeutic effects of Bismuth Subcitrate. Management: Avoid administration of antacids within 30 minutes of bismuth subcitrate (tripotassium bismuth dicitrate) administration. Risk D: Consider Therapy Modification
Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Risk D: Consider Therapy Modification
Bosutinib: Antacids may decrease serum concentration of Bosutinib. Management: Administer antacids more than 2 hours before or after bosutinib. Risk D: Consider Therapy Modification
Bromperidol: Antacids may decrease absorption of Bromperidol. Risk C: Monitor
Cabotegravir: Polyvalent Cation Containing Products may decrease serum concentration of Cabotegravir. Management: Administer polyvalent cation containing products at least 2 hours before or 4 hours after oral cabotegravir. Risk D: Consider Therapy Modification
Calcitriol (Systemic): May increase serum concentration of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving calcitriol. If magnesium-containing products must be used with calcitriol, serum magnesium concentrations should be monitored closely. Risk D: Consider Therapy Modification
Calcium Polystyrene Sulfonate: Antacids may increase adverse/toxic effects of Calcium Polystyrene Sulfonate. The combined use of these two agents may result in metabolic alkalosis. Risk C: Monitor
Captopril: Antacids may decrease serum concentration of Captopril. Risk C: Monitor
Cefdinir: Antacids may decrease absorption of Cefdinir. Management: Administer cefdinir 2 hours before or 2 hours after aluminum- or magnesium-containing antacids. Risk D: Consider Therapy Modification
Cefditoren: Antacids may decrease serum concentration of Cefditoren. Risk X: Avoid
Cefpodoxime: Antacids may decrease serum concentration of Cefpodoxime. Risk C: Monitor
Cefuroxime: Antacids may decrease serum concentration of Cefuroxime. Management: Administer cefuroxime axetil at least 1 hour before or 2 hours after the administration of short-acting antacids. Taking cefuroxime with food may lessen the magnitude of this interaction. Risk D: Consider Therapy Modification
Chloroquine: Antacids may decrease serum concentration of Chloroquine. Management: Separate the administration of antacids and chloroquine by at least 4 hours to minimize any potential negative impact of antacids on chloroquine bioavailability. Risk D: Consider Therapy Modification
Corticosteroids (Oral): Antacids may decrease bioavailability of Corticosteroids (Oral). Management: Consider separating doses by 2 or more hours. Budesonide enteric coated tablets could dissolve prematurely if given with drugs that lower gastric acid, with unknown impact on budesonide therapeutic effects. Risk D: Consider Therapy Modification
Cysteamine (Systemic): Antacids may decrease therapeutic effects of Cysteamine (Systemic). Risk C: Monitor
Dabigatran Etexilate: Antacids may decrease serum concentration of Dabigatran Etexilate. Management: Dabigatran etexilate Canadian product labeling recommends avoiding concomitant use with antacids for 24 hours after surgery. In other situations, administer dabigatran etexilate 2 hours prior to antacids. Monitor clinical response to dabigatran therapy. Risk D: Consider Therapy Modification
Dasatinib: Antacids may decrease serum concentration of Dasatinib. Management: Simultaneous administration of dasatinib and antacids should be avoided. If combined, administer antacids 2 hours before or 2 hours after dasatinib. Risk D: Consider Therapy Modification
Deferiprone: Polyvalent Cation Containing Products may decrease serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Risk D: Consider Therapy Modification
Diacerein: Antacids may decrease absorption of Diacerein. Risk C: Monitor
Dolutegravir: Magnesium Salts may decrease serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral magnesium salts. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral magnesium salts. Risk D: Consider Therapy Modification
Doxercalciferol: May increase hypermagnesemic effects of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving doxercalciferol. If magnesium-containing products must be used with doxercalciferol, serum magnesium concentrations should be monitored closely. Risk D: Consider Therapy Modification
Eltrombopag: Polyvalent Cation Containing Products may decrease serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Risk D: Consider Therapy Modification
Elvitegravir: Polyvalent Cation Containing Products may decrease serum concentration of Elvitegravir. Management: Administer elvitegravir-containing products 2 hours before, or 2 to 6 hours after, the administration of polyvalent cation containing products. Risk D: Consider Therapy Modification
Erdafitinib: Serum Phosphate Level-Altering Agents may decrease therapeutic effects of Erdafitinib. Management: Avoid coadministration of serum phosphate level-altering agents with erdafitinib before initial dose increase period based on serum phosphate levels (Days 14 to 21). Risk D: Consider Therapy Modification
Erlotinib: Antacids may decrease serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction. Risk D: Consider Therapy Modification
Fexofenadine: Antacids may decrease serum concentration of Fexofenadine. Management: Separate the administration of fexofenadine and aluminum- or magnesium-containing antacids. Risk D: Consider Therapy Modification
Fosinopril: Antacids may decrease serum concentration of Fosinopril. Management: Separate administration of antacids and fosinopril by 2 hours. Risk D: Consider Therapy Modification
Gabapentin: Magnesium Salts may increase CNS depressant effects of Gabapentin. Specifically, high dose intravenous/epidural magnesium sulfate may enhance the CNS depressant effects of gabapentin. Magnesium Salts may decrease serum concentration of Gabapentin. Management: Administer gabapentin at least 2 hours after use of a magnesium-containing antacid. Monitor patients closely for evidence of reduced response to gabapentin therapy. Monitor for CNS depression if high dose IV/epidural magnesium sulfate is used. Risk D: Consider Therapy Modification
Gefitinib: Antacids may decrease serum concentration of Gefitinib. Management: Administer gefitinib at least 6 hours before or 6 hours after administration of an antacid, and closely monitor clinical response to gefitinib. Risk D: Consider Therapy Modification
Hyoscyamine: Antacids may decrease serum concentration of Hyoscyamine. Management: Administer immediate release and sublingual oral hyoscyamine before meals, and antacids after meals, when these agents are given in combination. Risk D: Consider Therapy Modification
Iron Preparations: Antacids may decrease absorption of Iron Preparations. Management: No action is likely necessary for the majority of patients who only use antacids intermittently or occasionally. Consider separating doses of oral iron and antacids in patients who require chronic use of both agents and monitor for reduced iron efficacy. Risk D: Consider Therapy Modification
Isoniazid: Antacids may decrease absorption of Isoniazid. Risk C: Monitor
Itraconazole: Antacids may decrease serum concentration of Itraconazole. Antacids may increase serum concentration of Itraconazole. Management: Administer Sporanox brand itraconazole at least 2 hours before or 2 hours after administration of any antacids. Exposure to Tolsura brand itraconazole may be increased by antacids; consider itraconazole dose reduction. Risk D: Consider Therapy Modification
Ketoconazole (Systemic): Antacids may decrease serum concentration of Ketoconazole (Systemic). Management: Administer antacids at least 1 hour prior to, or 2 hours after, ketoconazole. Additionally, administer ketoconazole with an acidic beverage (eg, non-diet cola) and monitor patients closely for signs of inadequate clinical response to ketoconazole. Risk D: Consider Therapy Modification
Lanthanum: Antacids may decrease therapeutic effects of Lanthanum. Management: Administer antacid products at least 2 hours before or after lanthanum. Risk D: Consider Therapy Modification
Ledipasvir: Antacids may decrease serum concentration of Ledipasvir. Management: Separate the administration of ledipasvir and antacids by 4 hours. Risk D: Consider Therapy Modification
Levoketoconazole: Antacids may decrease absorption of Levoketoconazole. Management: Advise patients to take antacids at least 2 hours after taking levoketoconazole. Risk D: Consider Therapy Modification
Levonadifloxacin: Antacids may decrease serum concentration of Levonadifloxacin. Risk X: Avoid
Levonadifloxacin: Magnesium Salts may decrease serum concentration of Levonadifloxacin. Risk X: Avoid
Levothyroxine: Magnesium Salts may decrease serum concentration of Levothyroxine. Management: Separate administration of oral levothyroxine and oral magnesium salts by at least 4 hours. Risk D: Consider Therapy Modification
Mesalamine: Antacids may decrease therapeutic effects of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with the Apriso brand of mesalamine extended-release capsules. The optimal duration of dose separation is unknown. Other mesalamine products do not contain this interaction warning. Risk D: Consider Therapy Modification
Methenamine: Antacids may decrease therapeutic effects of Methenamine. Management: Consider avoiding the concomitant use of medications that alkalinize the urine, such as antacids, and methenamine. Monitor for decreased therapeutic effects of methenamine if used concomitant with antacids. Risk D: Consider Therapy Modification
MiSOPROStol: Antacids may increase adverse/toxic effects of MiSOPROStol. More specifically, concomitant use with magnesium-containing antacids may increase the risk of diarrhea. Management: Avoid concomitant use of misoprostol and magnesium-containing antacids. In patients requiring antacid therapy, employ magnesium-free preparations. Monitor for increased adverse effects (e.g., diarrhea, dehydration). Risk X: Avoid
Multivitamins/Fluoride (with ADE): Magnesium Salts may decrease serum concentration of Multivitamins/Fluoride (with ADE). Specifically, magnesium salts may decrease fluoride absorption. Management: To avoid this potential interaction separate the administration of magnesium salts from administration of a fluoride-containing product by at least 1 hour. Risk D: Consider Therapy Modification
Multivitamins/Minerals (with ADEK, Folate, Iron): Antacids may decrease serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Specifically, antacids may decrease the absorption of orally administered iron. Management: Separate dosing of oral iron-containing multivitamins and antacids by as much time as possible to minimize impact of this interaction. Monitor for decreased therapeutic efficacy of oral iron preparations during coadministration. Risk D: Consider Therapy Modification
Neratinib: Antacids may decrease serum concentration of Neratinib. Specifically, antacids may reduce neratinib absorption. Management: Separate the administration of neratinib and antacids by giving neratinib at least 3 hours after the antacid. Risk D: Consider Therapy Modification
Neuromuscular-Blocking Agents: Magnesium Salts may increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor
Nilotinib: Antacids may decrease serum concentration of Nilotinib. Management: Separate the administration of nilotinib and any antacid by at least 2 hours whenever possible in order to minimize the risk of a significant interaction. Risk D: Consider Therapy Modification
Nirogacestat: Antacids may decrease serum concentration of Nirogacestat. Management: If acid-reducing therapy is required, separate nirogacestat administration from antacids by 2 hours. Risk D: Consider Therapy Modification
Octreotide: Antacids may decrease serum concentration of Octreotide. Risk C: Monitor
PAZOPanib: Antacids may decrease serum concentration of PAZOPanib. Management: Avoid the use of antacids in combination with pazopanib whenever possible. Separate doses by several hours if antacid treatment is considered necessary. The impact of dose separation has not been investigated. Risk D: Consider Therapy Modification
PenicillAMINE: Polyvalent Cation Containing Products may decrease serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Risk D: Consider Therapy Modification
Pexidartinib: Antacids may decrease serum concentration of Pexidartinib. Management: Administer pexidartinib at least 2 hours before or 2 hours after antacids. Risk D: Consider Therapy Modification
Phosphate Supplements: Antacids may decrease absorption of Phosphate Supplements. Management: This applies only to oral phosphate administration. Separating administration of oral phosphate supplements from antacid administration by as long as possible may minimize the interaction. Risk D: Consider Therapy Modification
Phosphate Supplements: Magnesium Salts may decrease serum concentration of Phosphate Supplements. Management: Administer oral phosphate supplements as far apart from the administration of an oral magnesium salt as possible to minimize the significance of this interaction. Risk D: Consider Therapy Modification
Potassium Phosphate: Antacids may decrease serum concentration of Potassium Phosphate. Management: Consider separating administration of antacids and oral potassium phosphate by at least 2 hours to decrease risk of a significant interaction. Risk D: Consider Therapy Modification
QuiNINE: Antacids may decrease serum concentration of QuiNINE. Risk X: Avoid
Quinolones: Antacids may decrease absorption of Quinolones. Of concern only with oral administration of quinolones. Management: Avoid concurrent administration of quinolones and antacids to minimize the impact of this interaction. Recommendations for optimal dose separation vary by specific quinolone; see full monograph for details. Risk D: Consider Therapy Modification
Quinolones: Magnesium Salts may decrease serum concentration of Quinolones. Management: Administer oral quinolones several hours before (4 h for moxi/pe/spar/enox-, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome/pe/enox-, 3 h for gemi-, and 2 h for levo-, nor-, or ofloxacin or nalidixic acid) oral magnesium salts. Risk D: Consider Therapy Modification
Raltegravir: Magnesium Salts may decrease serum concentration of Raltegravir. Management: Avoid the use of oral / enteral magnesium salts with raltegravir. No dose separation schedule has been established that adequately reduces the magnitude of interaction. Risk X: Avoid
Rilpivirine: Antacids may decrease serum concentration of Rilpivirine. Management: Administer antacids at least 2 hours before or 4 hours after oral rilpivirine when used with most rilpivirine products. However, administer antacids at least 6 hours before or 4 hours after the rilpivirine/dolutegravir combination product. Risk D: Consider Therapy Modification
Riociguat: Antacids may decrease serum concentration of Riociguat. Management: Separate the administration of antacids and riociguat by at least 1 hour in order to minimize any potential interaction. Monitor clinical response to riociguat more closely in patients using this combination. Risk D: Consider Therapy Modification
Rosuvastatin: Antacids may decrease serum concentration of Rosuvastatin. Risk C: Monitor
Roxadustat: Polyvalent Cation Containing Products may decrease serum concentration of Roxadustat. Management: Administer roxadustat at least 1 hour after the administration of oral polyvalent cation containing products. Risk D: Consider Therapy Modification
Selpercatinib: Antacids may decrease serum concentration of Selpercatinib. Management: Coadministration of selpercatinib and antacids should be avoided. If coadministration cannot be avoided, selpercatinib should be administered 2 hours before or 2 hours after antacids. Risk D: Consider Therapy Modification
Sodium Polystyrene Sulfonate: Antacids may increase adverse/toxic effects of Sodium Polystyrene Sulfonate. Specifically, the risk of metabolic alkalosis may be increased. Antacids may decrease therapeutic effects of Sodium Polystyrene Sulfonate. Risk C: Monitor
Sotalol: Antacids may decrease serum concentration of Sotalol. Management: Avoid simultaneous administration of sotalol and antacids. Administer antacids 2 hours after sotalol. Risk D: Consider Therapy Modification
Sotorasib: Antacids may decrease serum concentration of Sotorasib. Management: Avoid use with PPIs, PCABs, or H2RAs. If use of a gastric acid suppressing medication is needed, use antacids and administer sotorasib 4 hours before or 10 hours after oral antacid administration. Risk D: Consider Therapy Modification
Sparsentan: Antacids may decrease serum concentration of Sparsentan. Management: Administer sparsentan 2 hours before or 2 hours after antacids. Risk D: Consider Therapy Modification
Sucralfate: Antacids may decrease therapeutic effects of Sucralfate. Management: Consider separating the administration of antacids and sucralfate by at least 30 minutes. Risk D: Consider Therapy Modification
Sulpiride: Antacids may decrease serum concentration of Sulpiride. Management: Separate administration of antacids and sulpiride by at least 2 hours in order to minimize the impact of antacids on sulpiride absorption. Risk D: Consider Therapy Modification
Tetracyclines: Antacids may decrease absorption of Tetracyclines. Management: Separate administration of antacids and oral tetracycline derivatives by several hours when possible to minimize the extent of this potential interaction. Monitor for decreased therapeutic effects of tetracyclines. Risk D: Consider Therapy Modification
Tetracyclines: Magnesium Salts may decrease absorption of Tetracyclines. Only applicable to oral preparations of each agent. Management: Avoid coadministration of oral magnesium salts and oral tetracyclines. If coadministration cannot be avoided, administer oral magnesium at least 2 hours before, or 4 hours after, oral tetracyclines. Monitor for decreased tetracycline therapeutic effects. Risk D: Consider Therapy Modification
Thyroid Products: Antacids may decrease absorption of Thyroid Products. Risk C: Monitor
Trientine: Polyvalent Cation Containing Products may decrease serum concentration of Trientine. Management: Avoid concomitant use of trientine and polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. For other oral polyvalent cations, give trientine 1 hour before, or 1 to 2 hours after the polyvalent cation. Risk D: Consider Therapy Modification
Unithiol: May decrease therapeutic effects of Polyvalent Cation Containing Products. Risk X: Avoid
Velpatasvir: Antacids may decrease serum concentration of Velpatasvir. Management: Separate administration of velpatasvir and antacids by at least 4 hours. Risk D: Consider Therapy Modification
Animal reproduction studies have not been conducted.
Magnesium is excreted in human milk; it is not known if the combination of ingredients used by irrigation are excreted in breast milk. The manufacturer recommends that caution be exercised when administering this drug to nursing women.
Serum creatinine, phosphate, and magnesium every few days during therapy. Urine culture and sensitivity every three days (or more frequently) and at the first sign of fever. Monitor for dissolution of calculi.
Magnesium from the irrigating solution is exchanged for calcium in the stone matrix. The magnesium stones are soluble and are able to dissolve in the acidic pH of the solution.
