Version May 2024
Antacid, various GI symptoms (eg, acid indigestion), including gastroesophageal reflux disease, intermittent symptom relief: Magnesium hydroxide 400 mg per 5 mL: Oral: 5 to 15 mL up to 4 times/day as needed for periodic episodes (≤1 episode per week) (ACG [Katz 2022]; Kahrilas 2022; manufacturer’s labeling); maximum dose: 60 mL per 24 hours; if needed for >1 episode per week or symptoms persist beyond 2 weeks, evaluate need for alternative treatment (Kahrilas 2022; WGO [Hunt 2017]; manufacturer’s labeling).
Note: OTC dosing recommendations vary by product and/or manufacturer; consult specific product labeling.
Laxative (occasional constipation): OTC labeling:
Chewable tablet: Magnesium hydroxide 1,200 mg/tablet: Oral: 2 to 4 tablets once daily or in divided doses; do not exceed 4 tablets in 24 hours.
Liquid:
Magnesium hydroxide 400 mg per 5 mL: Oral: 30 to 60 mL/day once daily at bedtime or in divided doses.
Magnesium hydroxide 800 mg per 5 mL: Oral: 15 to 30 mL/day once daily at bedtime or in divided doses.
Magnesium hydroxide 1,200 mg per 5 mL: Oral: 10 to 20 mL/day once daily at bedtime or in divided doses.
There are no dosage adjustments provided in the manufacturer's labeling; however, patients in severe kidney failure should not receive magnesium due to toxicity from accumulation. Patients with a CrCl <30 mL/minute should be monitored by serum magnesium levels.
There are no dosage adjustments provided in manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Magnesium hydroxide: Pediatric drug information")
Note: Dose expressed as mg of magnesium hydroxide.
Antacid: Magnesium hydroxide 400 mg/5 mL: Children ≥12 years and Adolescents: Oral: 5 to 15 mL 4 times per day as needed; maximum dose: 60 mL per 24 hours.
Constipation:
Note: Other agents (eg, polyethylene glycol 3350) are preferred for pharmacologic constipation therapy; magnesium hydroxide may be used as additional or second-line therapy (NASPGHAN [Tabbers 2014]).
Weight-directed dosing:
Infants, Children, and Adolescents: Limited data available: Oral: 80 to 240 mg/kg/day (1 to 3 mL/kg/day of 400 mg/5 mL product) divided once or twice daily. Maximum daily dose: 4,800 mg/day (60 mL/day of 400 mg/5 mL product) (Blackmer 2010; CPS [Rowan-Legg 2011]).
Fixed dosing (NASPGHAN [Tabbers 2014]; manufacturer's labeling):
Oral liquid (magnesium hydroxide 400 mg/5 mL):
Children 2 to <6 years: Oral: 5 to 15 mL/day in single or divided doses. Maximum daily dose: 15 mL/day (1,200 mg/day).
Children 6 to <12 years: Oral: 15 to 30 mL/day in single or divided doses. Maximum daily dose: 30 mL/day (2,400 mg/day).
Children ≥12 years and Adolescents: Oral: 15 to 60 mL/day in single or divided doses. Maximum daily dose: 60 mL/day (4,800 mg/day).
Tablets:
Children 2 to <6 years: Oral: 400 to 1,200 mg/day in single or divided doses. Maximum daily dose: 1,200 mg/day.
Children 6 to <12 years: Oral: 1,200 to 2,400 mg/day in single or divided doses. Maximum daily dose: 2,400 mg/day.
Children ≥12 years and Adolescents: Oral: 2,400 to 4,800 mg/day in single or divided doses. Maximum daily dose: 4,800 mg/day.
Patients in severe renal failure should not receive magnesium due to toxicity from accumulation. Patients with a CrCl <30 mL/minute receiving magnesium should have serum magnesium levels monitored.
There are no dosage adjustments provided in manufacturer's labeling.
There are no adverse reactions listed in the manufacturer's labeling.
Disease-related concerns:
• Neuromuscular disease: Use with extreme caution in patients with myasthenia gravis or other neuromuscular disease.
• Kidney impairment: Use with caution in patients with kidney impairment; accumulation of magnesium may lead to magnesium intoxication.
Other warnings/precautions:
• Self-medication (OTC use): Prior to self-medication, patients should contact health care provider if they have kidney dysfunction, are on a magnesium-restricted diet, have stomach pain/nausea/vomiting, or have had a sudden change in bowel habits that persist for >2 weeks. Patients should use this product ≥2 hours prior to taking other medications. Patients should stop use as a laxative and notify health care provider of any rectal bleeding, if bowel movement does not occur after using product, or if use is needed for >1 week. Stop use as an antacid and notify health care provider if you have taken the maximum dose for >2 weeks.
Multiple salt forms of magnesium exist; close attention must be paid to the salt form when ordering and administering magnesium; incorrect selection or substitution of one salt for another without proper dosage adjustment may result in serious over- or underdosing.
Some dosage forms may contain propylene glycol; in neonates, large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Suspension, Oral:
FT Milk of Magnesia: 1200 mg/15 mL (355 mL) [cramp free, stimulant free, sugar free; cherry flavor]
FT Milk of Magnesia: 1200 mg/15 mL (355 mL, 473 mL) [cramp free, stimulant free, sugar free; original flavor]
FT Milk of Magnesia: 1200 mg/15 mL (355 mL) [cramp free, stimulant free, sugar free; contains saccharin sodium; mint flavor]
GoodSense Milk of Magnesia: 1200 mg/15 mL (355 mL) [cramp free, gluten free, stimulant free, sugar free]
GoodSense Milk of Magnesia: 1200 mg/15 mL (355 mL) [cramp free, stimulant free, sugar free; contains saccharin sodium]
Milk of Magnesia: 400 mg/5 mL (355 mL, 480 mL [DSC])
Milk of Magnesia: 400 mg/5 mL (30 mL) [contains methylparaben, propylene glycol, propylparaben]
Milk of Magnesia: 2400 mg/30 mL (30 mL)
Milk of Magnesia: 2400 mg/30 mL (30 mL) [contains methylparaben, propylene glycol, propylparaben, saccharin sodium]
Milk of Magnesia: 7.75% (360 mL, 480 mL)
Milk of Magnesia: 7.75% (473 mL) [mint flavor]
Milk of Magnesia: 7.75% (30 mL) [spearmint flavor]
Milk of Magnesia: 2400 mg/30 mL (30 mL) [alcohol free, dye free, gluten free, sugar free]
Milk of Magnesia: 2400 mg/30 mL (30 mL [DSC]) [alcohol free, dye free, sugar free]
Milk of Magnesia: 1200 mg/15 mL (355 mL [DSC]) [cramp free, gluten free, stimulant free, sugar free]
Milk of Magnesia: 1200 mg/15 mL (355 mL [DSC]) [cramp free, gluten free, stimulant free, sugar free; contains saccharin sodium]
Milk of Magnesia: 400 mg/5 mL (355 mL) [cramp free, stimulant free; cherry flavor]
Milk of Magnesia: 1200 mg/15 mL (355 mL) [cramp free, stimulant free, sugar free]
Milk of Magnesia: 1200 mg/15 mL (355 mL) [cramp free, stimulant free, sugar free; contains saccharin sodium; mint flavor]
Milk of Magnesia: 1200 mg/15 mL (355 mL) [gluten free, stimulant free, sugar free; unflavored flavor]
Milk of Magnesia: 1200 mg/15 mL (355 mL) [gluten free, stimulant free, sugar free; contains saccharin sodium]
Milk of Magnesia: 400 mg/5 mL (473 mL) [low sodium, sugar free]
Milk of Magnesia: 1200 mg/15 mL (355 mL) [stimulant free]
Milk of Magnesia: 400 mg/5 mL (355 mL, 473 mL, 3780 mL) [stimulant free, sugar free]
Milk of Magnesia Concentrate: 2400 mg/10 mL (10 mL) [contains methylparaben, propylene glycol, propylparaben, saccharin sodium]
Milk of Magnesia Concentrate: 2400 mg/10 mL (10 mL [DSC]) [contains methylparaben, propylene glycol, propylparaben, saccharin sodium; lemon flavor]
Milk of Magnesia Concentrate: 2400 mg/10 mL (10 mL [DSC]) [alcohol free, dye free, sugar free]
Phillips Milk of Magnesia: 400 mg/5 mL (355 mL [DSC]) [cramp free, stimulant free, sugar free]
Tablet Chewable, Oral:
Pedia-Lax: 400 mg [contains fd&c red #40(allura red ac)aluminum lake]
May be product dependent
Chewable (Pedia-Lax Oral)
400 mg (per each): $0.27
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral: Shake liquids well before using. Use dose cup provided or other appropriately labeled measuring device to ensure accurate dosing. Follow all doses of liquid and chewable tablet formulations with 8 ounces of water.
Oral: All doses should be followed by 8 ounces of water in patients ≥2 years of age.
Antacid, various GI symptoms (eg, acid indigestion), including gastroesophageal reflux disease, intermittent symptom relief: For the relief of acid indigestion, heartburn, sour stomach, and GI upset associated with these symptoms (ACG [Katz 2022]).
Laxative (occasional constipation): For relief of occasional constipation. This product generally produces bowel movement in 30 minutes to 6 hours.
None known.
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 Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Acalabrutinib: Antacids may decrease the 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 the 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 the absorption of Alpha-Lipoic Acid. Alpha-Lipoic Acid may decrease the 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
Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor therapy
Atazanavir: Antacids may decrease the 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 the serum concentration of Baloxavir Marboxil. Risk X: Avoid combination
Belumosudil: Antacids may decrease the 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 the serum concentration of Bictegravir. Management: Administer bictegravir under fasting conditions 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 diminish the therapeutic effect 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 diminish the therapeutic effect 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 the 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 the serum concentration of Bosutinib. Management: Administer antacids more than 2 hours before or after bosutinib. Risk D: Consider therapy modification
Bromperidol: Antacids may decrease the absorption of Bromperidol. Risk C: Monitor therapy
Cabotegravir: Polyvalent Cation Containing Products may decrease the 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 the 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: Laxatives (Magnesium Containing) may enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. More specifically, concomitant use of calcium polystyrene sulfonate with magnesium-containing laxatives may result in metabolic alkalosis or with sorbitol may result in intestinal necrosis. Management: Avoid concomitant use of calcium polystyrene sulfonate (rectal or oral) and magnesium-containing laxatives. Risk X: Avoid combination
Captopril: Antacids may decrease the serum concentration of Captopril. Risk C: Monitor therapy
Cefdinir: Antacids may decrease the 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 the serum concentration of Cefditoren. Risk X: Avoid combination
Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy
Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Management: Administer cefuroxime axetil at least 1 hour before or 2 hours after the administration of short-acting antacids. Risk D: Consider therapy modification
Chloroquine: Antacids may decrease the 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 the 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 diminish the therapeutic effect of Cysteamine (Systemic). Risk C: Monitor therapy
Dabigatran Etexilate: Antacids may decrease the 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 the serum concentration of Dasatinib. Management: Simultaneous administration of dasatinib and antacids should be avoided. Administer antacids 2 hours before or 2 hours after dasatinib. Risk D: Consider therapy modification
Deferiprone: Polyvalent Cation Containing Products may decrease the 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
Delavirdine: Antacids may decrease the serum concentration of Delavirdine. Management: Separate doses of delavirdine and antacids by at least 1 hour. Monitor for decreased delavirdine therapeutic effects with this combination. Risk D: Consider therapy modification
Diacerein: Antacids may decrease the absorption of Diacerein. Risk C: Monitor therapy
Dichlorphenamide: Laxatives may enhance the hypokalemic effect of Dichlorphenamide. Risk C: Monitor therapy
Dolutegravir: Magnesium Salts may decrease the 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 enhance the hypermagnesemic effect 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 the 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: Antacids may decrease the serum concentration of Elvitegravir. Management: Separate administration of aluminum and magnesium containing antacids and elvitegravir-containing products by at least 2 hours in order to minimize the risk for an interaction. Risk D: Consider therapy modification
Erdafitinib: Serum Phosphate Level-Altering Agents may diminish the therapeutic effect 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 the 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 the 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 the serum concentration of Fosinopril. Management: The US and Canadian fosinopril manufacturer labels recommend separating the doses of antacids and fosinopril by 2 hours. Risk D: Consider therapy modification
Gabapentin: Magnesium Salts may enhance the CNS depressant effect of Gabapentin. Specifically, high dose intravenous/epidural magnesium sulfate may enhance the CNS depressant effects of gabapentin. Magnesium Salts may decrease the 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 the 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 the 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
Infigratinib: Antacids may decrease serum concentrations of the active metabolite(s) of Infigratinib. Antacids may decrease the serum concentration of Infigratinib. Management: Avoid coadministration of infigratinib with antacids or other gastric acid-lowering agents. If antacids cannot be avoided, administer infigratinib 2 hours before or after administration of antacids. Risk D: Consider therapy modification
Iron Preparations: Antacids may decrease the 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 the absorption of Isoniazid. Risk C: Monitor therapy
Itraconazole: Antacids may decrease the serum concentration of Itraconazole. Antacids may increase the 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 the 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 diminish the therapeutic effect of Lanthanum. Management: Administer antacid products at least 2 hours before or after lanthanum. Risk D: Consider therapy modification
Ledipasvir: Antacids may decrease the serum concentration of Ledipasvir. Management: Separate the administration of ledipasvir and antacids by 4 hours. Risk D: Consider therapy modification
Levoketoconazole: Antacids may decrease the absorption of Levoketoconazole. Management: Advise patients to take antacids at least 2 hours after taking levoketoconazole. Risk D: Consider therapy modification
Levonadifloxacin: Magnesium Salts may decrease the serum concentration of Levonadifloxacin. Risk X: Avoid combination
Levonadifloxacin: Antacids may decrease the serum concentration of Levonadifloxacin. Risk X: Avoid combination
Levothyroxine: Magnesium Salts may decrease the 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 diminish the therapeutic effect 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 diminish the therapeutic effect 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 enhance the adverse/toxic effect 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 combination
Multivitamins/Fluoride (with ADE): Magnesium Salts may decrease the 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 the 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
Mycophenolate: Magnesium Hydroxide may decrease the serum concentration of Mycophenolate. Management: Simultaneous administration of magnesium hydroxide antacids with the Myfortic brand of mycophenolic acid is specifically not recommended. Administer magnesium hydroxide at least 2 hours after a dose of the Cellcept brand of mycophenolate mofetil. Risk D: Consider therapy modification
Neratinib: Antacids may decrease the 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 enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy
Nilotinib: Antacids may decrease the 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 the 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 the serum concentration of Octreotide. Risk C: Monitor therapy
PAZOPanib: Antacids may decrease the 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 the 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 the 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 the 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 the 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 the 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 the serum concentration of QuiNINE. Risk X: Avoid combination
Quinolones: Antacids may decrease the 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 the 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 the 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 combination
Rilpivirine: Antacids may decrease the 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 the 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 the serum concentration of Rosuvastatin. Risk C: Monitor therapy
Roxadustat: Polyvalent Cation Containing Products may decrease the 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 the 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: Laxatives (Magnesium Containing) may enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. More specifically, concomitant use of sodium polystyrene sulfonate with magnesium-containing laxatives may result in metabolic alkalosis or with sorbitol may result in intestinal necrosis. Management: Avoid concomitant use of sodium polystyrene sulfonate (rectal or oral) and magnesium-containing laxatives. Risk X: Avoid combination
Sotalol: Antacids may decrease the 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 the serum concentration of Sotorasib. Management: Avoid coadministration of sotorasib and antacids. If use of a gastric acid suppressing medication cannot be avoided, administer sotorasib 4 hours before or 10 hours after oral antacid administration. Risk D: Consider therapy modification
Sparsentan: Antacids may decrease the serum concentration of Sparsentan. Management: Administer sparsentan 2 hours before or 2 hours after antacids. Risk D: Consider therapy modification
Strontium Ranelate: Magnesium Hydroxide may decrease the serum concentration of Strontium Ranelate. Management: Separate administration of strontium ranelate and magnesium hydroxide by at least 2 hours when possible, in order to minimize this interaction. Risk D: Consider therapy modification
Sucralfate: Antacids may diminish the therapeutic effect 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 the 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
Tacrolimus (Systemic): Magnesium Hydroxide may increase the serum concentration of Tacrolimus (Systemic). Magnesium Hydroxide may decrease the serum concentration of Tacrolimus (Systemic). Specifically, maximum concentration may decrease. Risk C: Monitor therapy
Tetracyclines: Antacids may decrease the 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 the 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 the absorption of Thyroid Products. Risk C: Monitor therapy
Trientine: Polyvalent Cation Containing Products may decrease the 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 diminish the therapeutic effect of Polyvalent Cation Containing Products. Risk X: Avoid combination
Velpatasvir: Antacids may decrease the serum concentration of Velpatasvir. Management: Separate administration of velpatasvir and antacids by at least 4 hours. Risk D: Consider therapy modification
Magnesium crosses the placenta; serum concentrations in the fetus are similar to those in the mother (Idama 1998; Osada 2002).
When dietary changes and lifestyle modifications are insufficient, magnesium hydroxide may be used for the treatment of heartburn or gastroesophageal reflux in pregnant women when used in usual recommended doses (Body 2016; Dağlı 2017; Gomes 2018; Thélin 2020).
Magnesium is endogenous to breast milk; concentrations remain constant during the first year of lactation and are not influenced by dietary intake under normal conditions (IOM 1997). Information specific to the quantification of magnesium in breast milk following the administration of magnesium hydroxide-containing antacids in breastfeeding females has not been located.
Magnesium hydroxide is considered compatible with breastfeeding when used in usual recommended doses; monitor the breastfeeding infant for adverse effects (WHO 2002).
Some products may contain sodium.
Promotes bowel evacuation by causing osmotic retention of fluid which distends the colon with increased peristaltic activity; reacts with hydrochloric acid in stomach to form magnesium chloride
Onset of action: Laxative: 30 minutes to 6 hours.
Distribution: Vd: 60.2 L (Dolberg 2017).
Bioavailability: ~15% (Dolberg 2017).
Half-life elimination: 8.3 hours (Dolberg 2017).
Excretion: Urine (up to ~20%) (Dolberg 2017); feces (as unabsorbed drug).
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