Drug & supplement interaction

Magnesium + Rocuronium

Rocuronium brand name: Zemuron.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Magnesium has a moderate interaction with Rocuronium. Parenteral magnesium alters the pharmacokinetics of skeletal muscle relaxants, increasing their effects and accelerating the onset of effect.

Read the full interaction report
SeverityModerate
LikelihoodProbable
EvidenceA
What do Severity, Likelihood & Evidence mean?
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Interaction report

Magnesium and Rocuronium

Here is the interaction we found between these two, with the evidence behind it.

Moderate

SKELETAL MUSCLE RELAXANTS

Why this applies to Rocuronium

Rocuronium falls under SKELETAL MUSCLE RELAXANTS — the group Magnesium interacts with.

Parenteral magnesium alters the pharmacokinetics of skeletal muscle relaxants, increasing their effects and accelerating the onset of effect.
Parenteral magnesium shortens the time to onset of skeletal muscle relaxants by about 1 minute and prolongs the duration of action by about 2 minutes. Magnesium potentiates the effects of skeletal muscle relaxants by decreasing calcium-mediated release of acetylcholine from presynaptic nerve terminals, reducing postsynaptic sensitivity to acetylcholine, and having a direct effect on the membrane potential of myocytes. Magnesium also has vasodilatory actions and increases cardiac output, allowing a greater amount of muscle relaxant to reach the motor end plate. A clinical study found that low-dose rocuronium (0.45 mg/kg), when given after administration of magnesium 30 mg/kg over 10 minutes, has an accelerated onset of effect, which matches the onset of effect seen with a full-dose rocuronium regimen (0.6 mg/kg). In another clinical study, onset times for rocuronium doses of 0.3, 0.6, and 1.2 mg/kg were 86, 76, and 50 seconds, respectively, when given alone, but were reduced to 66, 44, and 38 seconds, respectively, when the doses were given after a 15-minute infusion of magnesium sulfate 60 mg/kg. Giving intraoperative intravenous magnesium sulfate, 50 mg/kg loading dose followed by 15 mg/kg/hour, reduces the onset time of rocuronium, enhances its clinical effects, reduces the dose of intraoperative opiates, and prolongs the spontaneous recovery time. It does not affect the activity of subsequently administered neostigmine.
Severity Moderate Likelihood Probable Evidence A

Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the good news first: rocuronium is one of those medicines you'll only ever get in an operating room or ICU, given through a vein by an anesthesia team to relax your muscles during surgery. So this isn't something you'd be juggling at home with a magnesium pill from the vitamin aisle.

The interaction that matters is with IV magnesium given during surgery, not your daily supplement. When magnesium is in your system, it makes rocuronium work faster and last longer. Magnesium quiets the signal between nerve and muscle, so the relaxant hits harder. In practice this means your anesthesia team may use a smaller dose and watch your recovery from the paralysis a little more closely. This is well documented, and the folks managing your anesthesia already account for it.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.
  2. Choi ES, Jeong WJ, Ahn SH, Oh AY, Jeon YT, Do SH. Magnesium sulfate accelerates the onset of low-dose rocuronium in patients undergoing laryngeal microsurgery. J Clin Anesth. 2017 Feb;36:102-106. PubMed
  3. Rodríguez-Rubio L, Solis Garcia Del Pozo J, Nava E, Jordán J. Interaction between magnesium sulfate and neuromuscular blockers during the perioperative period. A systematic review and meta-analysis. J Clin Anesth. 2016;34:524-34. PubMed
  4. Almeida CED, Carvalho LR, Andrade CVC, Nascimento PD Jr, Barros GAM, Modolo NSP. Effects of magnesium sulphate on the onset time of rocuronium at different doses: a randomized clinical trial. Braz J Anesthesiol. 2021;71(5):482-8. PubMed
  5. Su YH, Luo DC, Pang Y. Effects of intraoperative Magnesium sulfate infusion on emergency agitation during general anesthesia in patients undergoing radical mastectomy: a randomized controlled study. BMC Anesthesiol 2023;23(1):326. PubMed
  6. Han J, Park HY, Shin HJ, Chung SH, Do SH. Effects of magnesium sulphate on neostigmine-induced recovery from moderate neuromuscular blockade with rocuronium: a randomized controlled trial. Magnes Res 2023;36(2):31-39. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Magnesium Also Interacts With Other Medications

Magnesium has 6 major, 174 moderate, 114 minor known drug interactions in our database — the Rocuronium one above is one of them. If you take anything else, check it against the full list below.

Major 6 Moderate 174 Minor 114 No known interaction 2,536 (incl. Rocuronium)
Taking anything else?

Check Another of Your Medications Against Magnesium

Covers the 2,830 medications we’ve checked against Magnesium. Pick one to open its full report.

From our Q&A

Questions About Magnesium or Rocuronium

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Magnesium or Rocuronium, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Rocuronium

This page covers Magnesium only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Rocuronium page lists 3 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Procaine (major) and Lithium (moderate).

By severity: 1 major · 2 moderate.

From our pharmacist’s overview on the Rocuronium page

“Rocuronium (Zemuron) is the muscle relaxant an anesthesia team gives during surgery to keep you still while a machine breathes for you, so anything that deepens or extends its effect deserves genuine caution. Only three supplement ingredients are on file, but all three push in that same direction, prolonging the paralysis or speeding i…”

Reviewed by 2 · Jul 18, 2026

Open the Rocuronium interaction page

One more smart check

Taking Magnesium as Part of a Dietary Supplement Product? Check It for Interactions

We hold 29,717 real supplement products containing Magnesium, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Magnesium. Your product may carry other ingredients that interact with Rocuronium too, on top of Magnesium — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Magnesium and Rocuronium Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Magnesium
Top 10

#5 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Rocuronium
Top half

#1,292 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Magnesium

What is Magnesium?

Magnesium
  • Preventing or treating magnesium deficiency
  • Constipation
  • Muscle cramps
  • Sleep support
  • Anxiety and stress
  • Migraine prevention

Magnesium is an essential mineral your body needs for muscles, nerves, blood pressure, and many other functions, and supplements are useful for preventing or correcting deficiency. Some other uses, like easing constipation or preventing migraines, have reasonable support, while uses for sleep and anxiety are less proven. It is generally safe for most healthy people at recommended amounts, but talk to your pharmacist or doctor before starting, especially if you have kidney problems.

Read the full Magnesium monograph & all interactions
Keep checking

Other Drugs & Magnesium

Browse every other medication we’ve checked against Magnesium — both the ones with a known interaction and the ones without. Select any drug for the full detail.

6Major
174Moderate
114Minor
2,535No known interaction
6 Major 174 Moderate 114 Minor 2,535 No interaction
Major

6 interactions

Moderate

174 interactions

Showing 60 of 174 moderate interactions — see all 174 on the Magnesium page.

Minor

114 interactions

Showing 60 of 114 minor interactions — see all 114 on the Magnesium page.

No interaction 2,535 drugs checked — show the list

We also checked Magnesium against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,535 medications checked with no known interaction — see the full Magnesium list.

See the full Magnesium interactions page
See every supplement checked against Rocuronium, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Magnesium monograph › Uses, safety, and every drug interaction in one place Rocuronium supplement interactions › Every supplement checked against Rocuronium, ranked by severity Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Magnesium and Rocuronium Together: Common Questions

Can you take Magnesium with Rocuronium?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Magnesium and Rocuronium interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Rocuronium and Magnesium?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.