Nutrition, deficiency & diseases: Magnesium interactions

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Magnesium (Mg) interactions can decrease the absorption of some medications. Magnesium can interact and bind with them, creating non-absorbable complexes in the gut.

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In some cases the efficacy of the medication may be excessively enhanced as Magnesium may have similar functions in the body. In both the interactions, the required therapeutic effect is not achieved and adds to the health problem.

There are some interactions wherein Mg2+ may compete with the medication or nutrient for the same transient receptor potential (TRP) channel for entry into the body. In almost all the above situations, by giving sufficient time gap between the intake of medicine and magnesium, the interaction can be overcome. It is generally advised to take the medicine at least two hours before Mg supplementation. Alternatively the medicine may be taken at least four hours after the supplement.

Magnesium is contraindicated in certain health conditions and also while undergoing certain therapies to stall possible severe adverse effects on the health. In such contraindicated situations, the supplements should not be taken. If at all there is a critical condition wherein magnesium supplementation is also required, close monitoring of the health of the patient in a medical facility is required.

magnesium supplement drug interactions and contraindications

magnesium supplement interactions and contraindications

Magnesium interactions

Various medications such quinolone antibiotics, aminoglycoside antibiotics, tetracycline antibiotics, bisphosphonates, calcium channel blockers, muscle relaxants, potassium-sparing diuretics and levothyroxine have been found to have interactions with magnesium salts. These medicines and Mg supplement must be administered at least two hours apart to conserve the efficacy.

Interaction with aminoglycoside antibiotics

Magnesium may interact with aminoglycoside antibiotics and cause neuromuscular weakness. Some of the aminoglycoside antibiotics are, kanamycin, tobramycin, gentamicin, and neomycin, vancomycin, erythromycin, clarithromycin, azithromycin and streptomycin.

Quinolone antibiotics

Magnesium supplements may interact and reduce the absorption of quinolone antibiotics. Taking the doses at least two hours apart may reduce the loss of efficacy of the antibiotics. Some of the quinolone antibiotics are, ciprofloxacin, clinafloxacin, enoxacin, gatifloxacin, norfloxacin, gemifloxacin, sparfloxacin, moxifloxacin, trovafloxacin, levofloxacin and grepafloxacin.

Tetracycline antibiotics

Magnesium may interact and bind to tetracycline antibiotics in the gut and reduces their efficacy. The doses may be taken at least two hours apart to improve efficacy. Some of the tetracycline antibiotics are tetracycline, demeclocycline, oxytetracycline, doxycycline and minocycline.

Antifungal medications

Ketoconazole is an antifungal medication and using ketoconazole together with magnesium oxide is found to decrease the effects of ketoconazole. Separation of the doses by at least two hours is recommended to avoid interaction.

Interaction with bisphosphonates

Bisphosphonates prevent the loss of bone mass and are prescribed to treat osteoporosis and similar diseases. Magnesium supplements interact and decrease the absorption of bisphosphonates. Taking doses at least two hours apart can prevent loss of efficacy. Some of the bisphosphonates are, pamidronate, alendronate, neridronate, etidronate, olpadronate, risedronate, zoledronate and tiludronate.

Calcium channel blockers

Calcium channel blockers are medications to lower blood pressure (hypertension). Magnesium salts also lower the blood pressure. Taking magnesium with the high blood pressure medication can cause the blood pressure to go too low. Some medications for high blood pressure are aranidipine, nifedipine, azelnidipine, verapamil, lacidipine, diltiazem, manidipine, isradipine, pranidipine, felodipine, efonidipine and amlodipine.

Interaction with muscle relaxants

Magnesium salts are known to relax muscles. Taking Mg supplements along with muscle relaxants can make the side effects of these relaxants to come to fore. Some of the relaxants are, carisoprodol, metaxalone, pipecuronium, methocarbamol, orphenadrine, cyclobenzaprine, gallamine, atracurium, pancuronium and succinylcholine.

Potassium-sparing diuretics

Potassium-sparing diuretics promote the retention of both potassium and magnesium in the body. If magnesium supplements are also taken hypermagnesemia may be caused.

Tiludronate & Alendronate

Tiludronate and alendronate are medicines prescribed for osteoporosis. Mg salts interact and interfere with their absorption in the intestines. Staggering the doses by two hours or more can improve the efficacy.

Interaction with levothyroxine

Levothyroxine is a medication prescribed for underactive thyroid. Magnesium salts interact with the medication and render it ineffective.

Diabetes medicines

Magnesium salts can interact and increase the efficacy of tolazamide, an oral blood glucose lowering drug prescribed for patients with Type 2 diabetes. There is a possibility of hypoglycemia (low blood sugar) and the patient must be counseled to monitor his blood sugar and handle the situation. Similarly taking Mg salts either with glipizide or with glyburide may cause blood sugar to go too low due to interaction.

Quinidine

Quinidine is an antiarrhythmic agent and it works by blocking the fast inward sodium current (INa). Magnesium is found to interact and increase the blood levels and efficacy of quinidine with symptoms of excessive effects like ringing in the ears, hearing loss, visual problems, loose stools, headache, dizziness etc. A dose adjustment may have to be done by the health care provider.

HIV medications

Abacavir/dolutegravir/lamivudine are prescribed for HIV infection. The concomitant administration of magnesium supplement is found to decrease the effectiveness of these antiviral drugs.

Acetaminophen (paracetamol)

Magnesium salts have been found to interact and reduce the efficacy of paracetamol. If both are prescribed, give sufficient gap of time for the medications.

Acetylsalicylic acid (aspirin)

Acetylsalicylic acid efficacy is reduced when it is taken along with Mg. Mg salts may be taken two hours before aspirin or four hours after the mineral intake.

Penicillamine

Penicillamine is prescribed to treat rheumatoid arthritis. Mg salts interact and decrease its effectiveness. The doses may staggered to reduce the interaction.

Magnesium contraindications

In certain diseases and health conditions, magnesium is contraindicated. Taking the mineral salts in such contraindicated conditions can adversely affect the health, sometimes become life threatening.

Contraindicated in myasthenia gravis

Myasthenia gravis is either an autoimmune or congenital neuromuscular disorder wherein there is progressive muscle weakness and fatigue. The neuromuscular transmission is decreased in such patients. Magnesium being a neuromuscular relaxant, is contraindicated as it may further depress the condition leading to cardiac or pulmonary arrest.

Contraindicated heart problems

Magnesium supplementation is contraindicated in several heart problems. Heart problems like atrial fibrillation (irregular heart beat), atrioventricular block (or AV block) or myocardial infarction (heart attack) may get worsened in case of Mg supplementation. Magnesium sulfate injection is contraindicated and should not be administered parenterally in patients with heart block or myocardial damage.

Contraindicated renal impairment

In patients with renal impairment magnesium salts are contraindicated. As there is subnormal urine output, the Mg2+ may get accumulated in the blood serum giving rise the hypermagnesemia and related health problem.

Contraindicated with anticoagulants (Warfarin)

In patients under treatment with warfarin, magnesium supplementation is contraindicated. Mg also has the effect of thinning blood and taking it along with warfarin may lead to bleeding and haemorrhage.

Contraindicated in bradycardia (slow heart rate)

Magnesium supplementation is contraindicated in person with hypotension or slow heart rate. Consuming Mg tablets by such persons can lead to acute severe hypotension and the heart may stop for good.

Contraindicated in bowel hypomotility or intestinal blockage

Magnesium supplementation is contraindicated in persons with chronic, acute constipation or intestinal blockage. As the route to remove excess of ingested magnesium is blocked, the serum levels may shoot up causing severe hypermagnesemia.

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