Malic Acid Ingredients & Drug Interactions
by Genestra Brands
What is this page for?
First and foremost: checking Malic Acid against your medications. The heart of this page is the interaction checker and the full interaction report — how this product’s ingredients may interact with prescription and over-the-counter medicines you may be taking.
Around that, we add a pharmacist’s high-level view of the product as a whole — what’s inside, the evidence for its stated use, how transparent the label is, and what safety data exists — so you can see the full picture in one place. It’s educational information from our licensed clinical databases and the clinical staff at HelloPharmacist — not medical advice — and we don’t sell or endorse products. Our editorial policy
Malic Acid is a dietary supplement by Genestra Brands with 2 active ingredients. Its ingredients are commonly taken for fibromyalgia symptoms, muscle pain and fatigue, dry mouth (used in some lozenges).Based on those ingredients, 435 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Magnesium, L-Malic Acid. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Malic Acid by Genestra Brands
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AI summaries are generated from our interaction database for education only — always confirm with your pharmacist. How we use AI
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HelloPharmacist Scorecard of Malic Acid by Genestra Brands
Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.
What’s inside
Full disclosure
This product has 2 active ingredients: L-malic acid and magnesium. L-malic acid is an organic acid found in fruits and sour foods; magnesium is a mineral your body needs for muscle and nerve function and energy production.
The capsules also contain inactive ingredients—hypromellose, cellulose, ascorbyl palmitate, and silica—which serve as binders, fillers, and stabilizers.
Does it work?
Strong evidence
L-malic acid is possibly effective for dry mouth, but the evidence for acne, GERD, fatigue, fibromyalgia, and psoriasis is insufficient. Magnesium is effective for heartburn (dyspepsia), constipation, low magnesium levels (hypomagnesemia), and pre-eclampsia in pregnancy.
That said, the evidence we have is specific to each condition—this product's combination isn't tested for a single stated purpose, so talk with your doctor about whether it's right for what you're treating.
How safe is it?
Well-documented data
Both ingredients are generally well tolerated at typical doses. L-malic acid is safe in food amounts, but safety data for supplement doses is limited—avoid higher doses unless your doctor advises it.
Magnesium is generally safe for healthy adults at recommended amounts; it's likely safe in pregnancy and possibly safe while breastfeeding, though you should check with your doctor before using a supplement. The most common side effects are diarrhea, nausea, and gastrointestinal upset, and magnesium may cause skin irritation if applied topically.
In rare cases, very high magnesium doses may contribute to weak bones.
Meds to double-check
Major interaction found
Before taking this product, double-check with your doctor or pharmacist if you take levodopa/carbidopa (Sinemet)—magnesium can significantly reduce how well it works. Also flag skeletal muscle relaxants, potassium-sparing diuretics, calcium channel blockers, antacids or acid reflux drugs, sulfonylureas (diabetes pills), quinolone antibiotics, or bisphosphonates—magnesium interacts with all of these.
And let them know if you're on any blood pressure medication, since both ingredients may lower blood pressure further.
The bottom line
Scorecard at a glanceFully disclosed formula with strong clinical evidence behind its ingredients' uses. Major medication interactions have been identified, and safety information is well characterized.
This product may help with constipation or heartburn if magnesium is what you're after, though the evidence for L-malic acid alone is thin. If you take Parkinson's medication, muscle relaxants, water pills, blood pressure drugs, diabetes pills, antibiotics, or osteoporosis drugs, you'll need to check with your doctor or pharmacist first—the magnesium in here can interfere.
Talk it over with your own healthcare provider before you start.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 2 of 2 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Jan 22, 2021.
This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed
General information
Key facts about Malic Acid, straight from the product label.
| Brand | Genestra Brands |
|---|---|
| Barcode (UPC) | 883196130412 |
| Net contents | 90 Vegetarian Capsule(s) |
| Market status | On market |
| Date entered into DSLD | Jan 22, 2021 |
| DSLD ID | 241136 |
| Product type | Other Combinations |
| Supplement form | Capsule |
| Dietary claims / uses | Nutrient, All Other, Structure/Function |
| Intended target group(s) | Adult (18 - 50 Years) |
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.
Supplement Facts
The label details for Malic Acid by Genestra Brands, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| L-Malic Acid | 500 mg | -- |
| Magnesium | 20 mg | 5% |
Other ingredients: Hypromellose, Cellulose, Ascorbyl Palmitate, Silica
Tap any ingredient to jump to its full detail below.
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
Suggested/Recommended/Usage/Directions
Recommended Dose: Take 1 capsule 3 times daily with meals or as recommended by your health professional.
Precautions
Warning: If you are pregnant or lactating, have any health condition or are taking any medication, consult your health professional before use.
Keep out of the reach of children.
Use only if safety seal is intact.
Storage
Store in a cool, dry place.
FDA Disclaimer Statement
This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
General Statements
Contents may not fill package in order to accommodate required labeling. Please rely on stated quantity. Scan to learn about our quality excellence
FDA Statement of Identity
Dietary Supplement
Formula
With magnesium
Formulation
Supports proper muscle function
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Malic Acid by Genestra Brands label
The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.
Label images are published by the NIH Dietary Supplement Label Database for the version of this product on file. Always read your actual product label.
View the full label (PDF)The Ingredients in Malic Acid by Genestra Brands
These are the 2 active ingredients this product is made of. Select any to open its full monograph.
Serving size1 Capsule(s) Dosage formCapsule Servings per container90 Amounts shown are per serving.
Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.
L-Malic Acid
Interacts with172 drugs
Malic acid is a natural acid found in apples and other fruits, often combined with magnesium in supplements marketed for fibromyalgia and muscle pain....
L-Malic Acid monograph & interactionsMagnesium
Interacts with295 drugs
Magnesium is an essential mineral your body needs for muscles, nerves, blood pressure, and many other functions, and supplements are useful for preven...
Magnesium monograph & interactionsOther (inactive) ingredients: Hypromellose, Cellulose, Ascorbyl Palmitate, Silica. These complete the product’s ingredient list but are not active constituents.
Malic Acid by Genestra Brands Drug Interactions
HelloPharmacist Interaction Report
Malic Acid by Genestra Brands contains two active ingredients—L-malic acid and magnesium—and magnesium carries a Major interaction with levodopa/carbidopa (Sinemet), a Parkinson's medication.
Magnesium can cut the drug's effectiveness significantly; clinical data show it reduces levodopa levels by 35% and carbidopa levels by 81%.
Read the full breakdown — every affected drug type, severity by severity
Magnesium also has Moderate interactions with skeletal muscle relaxants (which it may strengthen and speed up), potassium-sparing water pills, calcium channel blockers for blood pressure, antacids and acid reflux drugs, diabetes pills (sulfonylureas), quinolone antibiotics, and bisphosphonates for bone health. The effects range from additive blood-pressure lowering to reduced absorption of the other drug.
L-malic acid carries a Moderate interaction with blood pressure medications (antihypertensives)—it may theoretically increase the blood-pressure-lowering effect, raising the risk of low blood pressure (hypotension).
Altogether, these interactions span 435 individual medications. If you take any of these drug types, run your exact medications through the interaction checker on this page before you start.
Check your own medications below · Editorial policy · How we use AI
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Ask about interactions with your drugs in plain English — “Can I take it with lisinopril?” — and we find you the answer in seconds, ingredient by ingredient.
Go to the checkerIngredients driving the most interactions
Individual Drug Interactions
The ingredients in Malic Acid interact with 435 drugs. Click any drug to see the details.
2 of the 2 ingredients in Malic Acid interact with drugs. Each result below shows which ingredient is responsible. Magnesium L-Malic Acid
Benserazide, LevodopaMadopar, Prolopa
How Benserazide, Levodopa interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Benserazide, Levodopa interactionCarbidopaLodosyn
How Carbidopa interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Carbidopa interactionCarbidopa, LevodopaDhivy, Rytary, Sinemet, Sinemet CR
How Carbidopa, Levodopa interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Carbidopa, Levodopa interactionCarbidopa, Levodopa, EntacaponeStalevo
How Carbidopa, Levodopa, Entacapone interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Carbidopa, Levodopa, Entacapone interactionLevodopaInbrija, Larodopa
How Levodopa interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Levodopa interactionLevodopa, CarbidopaDuodopa
How Levodopa, Carbidopa interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Levodopa, Carbidopa interactionAcebutololRhotral, Sectral
How Acebutolol interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
L-malic AcidAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, malic acid might increase the risk of hypotension when taken with antihypertensive drugs.
Read the full L-malic Acid + Acebutolol interactionAcetaminophen, ChlorzoxazoneAcetazone Forte, Extra Strength Tylenol Aches & Strains, Parafon Forte
How Acetaminophen, Chlorzoxazone interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumSkeletal Muscle Relaxants Moderate
Interaction Summary
Parenteral magnesium alters the pharmacokinetics of skeletal muscle relaxants, increasing their effects and accelerating the onset of effect.
Read the full Magnesium + Acetaminophen, Chlorzoxazone interactionAcetaminophen, Chlorzoxazone, CodeineAcetazone Forte C8, Parafon Forte C8
How Acetaminophen, Chlorzoxazone, Codeine interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumSkeletal Muscle Relaxants Moderate
Interaction Summary
Parenteral magnesium alters the pharmacokinetics of skeletal muscle relaxants, increasing their effects and accelerating the onset of effect.
Read the full Magnesium + Acetaminophen, Chlorzoxazone, Codeine interactionAcetaminophen, Codeine, MethocarbamolAcetaminophen, Codeine, Methocarbamol, Robaxacet 8
How Acetaminophen, Codeine, Methocarbamol interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumSkeletal Muscle Relaxants Moderate
Interaction Summary
Parenteral magnesium alters the pharmacokinetics of skeletal muscle relaxants, increasing their effects and accelerating the onset of effect.
Read the full Magnesium + Acetaminophen, Codeine, Methocarbamol interactionAcetaminophen, MethocarbamolRobaxacet
How Acetaminophen, Methocarbamol interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumSkeletal Muscle Relaxants Moderate
Interaction Summary
Parenteral magnesium alters the pharmacokinetics of skeletal muscle relaxants, increasing their effects and accelerating the onset of effect.
Read the full Magnesium + Acetaminophen, Methocarbamol interactionAcetaminophen, OrphenadrineOrfenagesic
How Acetaminophen, Orphenadrine interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumSkeletal Muscle Relaxants Moderate
Interaction Summary
Parenteral magnesium alters the pharmacokinetics of skeletal muscle relaxants, increasing their effects and accelerating the onset of effect.
Read the full Magnesium + Acetaminophen, Orphenadrine interactionAcetazolamideAk-Zol, Diamox
How Acetazolamide interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
L-malic AcidAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, malic acid might increase the risk of hypotension when taken with antihypertensive drugs.
Read the full L-malic Acid + Acetazolamide interactionAcetohexamideDymelor
How Acetohexamide interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumSulfonylureas Moderate
Interaction Summary
Magnesium increases the systemic absorption of sulfonylureas, increasing their effects and side effects.
Read the full Magnesium + Acetohexamide interactionAlcuroniumAlcuronium
How Alcuronium interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumSkeletal Muscle Relaxants Moderate
Interaction Summary
Parenteral magnesium alters the pharmacokinetics of skeletal muscle relaxants, increasing their effects and accelerating the onset of effect.
Read the full Magnesium + Alcuronium interactionAlendronateBinosto, Fosamax
How Alendronate interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumBisphosphonates Moderate
Interaction Summary
Magnesium can decrease absorption of bisphosphonates.
Read the full Magnesium + Alendronate interactionAlendronate Sodium
How Alendronate Sodium interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumBisphosphonates Moderate
Interaction Summary
Magnesium can decrease absorption of bisphosphonates.
Read the full Magnesium + Alendronate Sodium interactionAlendronate Sodium, CholecalciferolFosamax Plus D
How Alendronate Sodium, Cholecalciferol interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumBisphosphonates Moderate
Interaction Summary
Magnesium can decrease absorption of bisphosphonates.
Read the full Magnesium + Alendronate Sodium, Cholecalciferol interactionAlginic Acid, Aluminum HydroxideRafton
How Alginic Acid, Aluminum Hydroxide interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumAntacids Moderate
Interaction Summary
Use of acid reducers may reduce the laxative effect of magnesium oxide.
Read the full Magnesium + Alginic Acid, Aluminum Hydroxide interactionAliskirenTekturna
How Aliskiren interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
L-malic AcidAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, malic acid might increase the risk of hypotension when taken with antihypertensive drugs.
Read the full L-malic Acid + Aliskiren interactionAluminum HydroxideAlu-Cap, Amphojel, Gaviscon
How Aluminum Hydroxide interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumAntacids Moderate
Interaction Summary
Use of acid reducers may reduce the laxative effect of magnesium oxide.
Read the full Magnesium + Aluminum Hydroxide interactionAluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium HydroxideAscriptin Codeine #2
How Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumAnticoagulant/antiplatelet Drugs, Antacids Moderate
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium + Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide interactionAluminum Hydroxide, Aspirin, Magnesium HydroxideAscriptin
How Aluminum Hydroxide, Aspirin, Magnesium Hydroxide interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumAnticoagulant/antiplatelet Drugs, Antacids Moderate
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium + Aluminum Hydroxide, Aspirin, Magnesium Hydroxide interactionAluminum Hydroxide, Magnesium Hydroxide (otc Drug)Maalox, Mucogel
How Aluminum Hydroxide, Magnesium Hydroxide (otc Drug) interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumAntacids Moderate
Interaction Summary
Use of acid reducers may reduce the laxative effect of magnesium oxide.
Read the full Magnesium + Aluminum Hydroxide, Magnesium Hydroxide (otc Drug) interactionAluminum Hydroxide, Magnesium Hydroxide, Simethicone (otc Drug)Mylanta
How Aluminum Hydroxide, Magnesium Hydroxide, Simethicone (otc Drug) interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumAntacids Moderate
Interaction Summary
Use of acid reducers may reduce the laxative effect of magnesium oxide.
Read the full Magnesium + Aluminum Hydroxide, Magnesium Hydroxide, Simethicone (otc Drug) interactionAluminum, Magnesium (otc Drug)Almagel
How Aluminum, Magnesium (otc Drug) interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumAntacids Moderate
Interaction Summary
Use of acid reducers may reduce the laxative effect of magnesium oxide.
Read the full Magnesium + Aluminum, Magnesium (otc Drug) interactionAmbrisentanLetairis, Volibris
How Ambrisentan interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
L-malic AcidAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, malic acid might increase the risk of hypotension when taken with antihypertensive drugs.
Read the full L-malic Acid + Ambrisentan interactionAmikacinAmikin, Arikayce
How Amikacin interacts with Malic Acid — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumAminoglycoside Antibiotics Moderate
Interaction Summary
Concomitant use of aminoglycoside antibiotics and magnesium can increase the risk for neuromuscular weakness.
Read the full Magnesium + Amikacin interactionAmilorideAmilamont, Midamor
How Amiloride interacts with Malic Acid — through 2 ingredients. Tap an ingredient for the detail:
L-malic AcidAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, malic acid might increase the risk of hypotension when taken with antihypertensive drugs.
Read the full L-malic Acid + Amiloride interactionMagnesiumPotassium-sparing Diuretics Moderate
Interaction Summary
Potassium-sparing diuretics decrease excretion of magnesium, possibly increasing magnesium levels.
Read the full Magnesium + Amiloride interactionAmiloride, HydrochlorothiazideAmil-Co, Amilzide, Moduret 25, Moduretic
How Amiloride, Hydrochlorothiazide interacts with Malic Acid — through 2 ingredients. Tap an ingredient for the detail:
MagnesiumPotassium-sparing Diuretics Moderate
Interaction Summary
Potassium-sparing diuretics decrease excretion of magnesium, possibly increasing magnesium levels.
Read the full Magnesium + Amiloride, Hydrochlorothiazide interactionL-malic AcidAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, malic acid might increase the risk of hypotension when taken with antihypertensive drugs.
Read the full L-malic Acid + Amiloride, Hydrochlorothiazide interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Malic Acid with known interactions, here are the types of medications they can affect. Open any type for the detail — or search your exact drug in the checker above.
Magnesium
Levodopa/Carbidopa (Sinemet)
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Clinical research in healthy volunteers shows that taking magnesium oxide 1000 mg with levodopa 100 mg/carbidopa 10 mg reduces the area under the curve (AUC) of levodopa by 35% and of carbidopa by 81%. In vitro and animal research shows that magnesium produces an alkaline environment in the digestive tract, which might lead to degradation and reduced bioavailability of levodopa/carbidopa.
Aminoglycoside Antibiotics
Concomitant use of aminoglycoside antibiotics and magnesium can increase the risk for neuromuscular weakness.
Both aminoglycosides and magnesium reduce presynaptic acetylcholine release, which can lead to neuromuscular blockade and possible paralysis. This is most likely to occur with high doses of magnesium given intravenously.
Antacids
Use of acid reducers may reduce the laxative effect of magnesium oxide.
A retrospective analysis shows that, in the presence of H2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs), a higher dose of magnesium oxide is needed for a laxative effect. This may also occur with antacids. Under acidic conditions, magnesium oxide is converted to magnesium chloride and then to magnesium bicarbonate, which has an osmotic laxative effect. By reducing acidity, antacids may reduce the conversion of magnesium oxide to the active bicarbonate salt.
Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)
Magnesium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Advise patients that bictegravir/emtricitabine/tenofovir alafenamide should be taken at least 2 hours before or 6 hours after magnesium containing products.
Bisphosphonates
Magnesium can decrease absorption of bisphosphonates.
Cations, including magnesium, can decrease bisphosphonate absorption. Advise patients to separate doses of magnesium and these drugs by at least 2 hours.
Calcium Channel Blockers
Magnesium can have additive effects with calcium channel blockers, although evidence is conflicting.
Magnesium inhibits calcium entry into smooth muscle cells and may therefore have additive effects with calcium channel blockers. Severe hypotension and neuromuscular blockades may occur when nifedipine is used with intravenous magnesium, although some contradictory evidence suggests that concurrent use of magnesium with nifedipine does not increase the risk of neuromuscular weakness. High doses of magnesium could theoretically have additive effects with other calcium channel blockers.
Digoxin
Magnesium salts may reduce absorption of digoxin.
Clinical evidence suggests that treatment with oral magnesium hydroxide or magnesium trisilicate reduces absorption of digoxin from the intestines. This may reduce the blood levels of digoxin and decrease its therapeutic effects.
Potassium-Sparing Diuretics
Potassium-sparing diuretics decrease excretion of magnesium, possibly increasing magnesium levels.
Potassium-sparing diuretics also have magnesium-sparing properties, which can counteract the magnesium losses associated with loop and thiazide diuretics. Theoretically, increased magnesium levels could result from concomitant use of potassium-sparing diuretics and magnesium supplements.
Quinolone Antibiotics
Magnesium decreases absorption of quinolones.
Magnesium can form insoluble complexes with quinolones and decrease their absorption. Advise patients to take these drugs at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Skeletal Muscle Relaxants
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.
Sulfonylureas
Magnesium increases the systemic absorption of sulfonylureas, increasing their effects and side effects.
Clinical research shows that administration of magnesium hydroxide with glyburide increases glyburide absorption, increases maximal insulin response by 35-fold, and increases the risk of hypoglycemia, when compared with glyburide alone. A similar interaction occurs between magnesium hydroxide and glipizide. The mechanism of this effect appears to be related to the elevation of gastrointestinal pH by magnesium-based antacids, increasing solubility and enhancing absorption of sulfonylureas.
Tetracycline Antibiotics
Magnesium decreases absorption of tetracyclines.
Magnesium can form insoluble complexes with tetracyclines in the gut and decrease their absorption and antibacterial activity. Advise patients to take these drugs 1 hour before or 2 hours after magnesium supplements.
Anticoagulant/Antiplatelet Drugs
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
In vitro evidence shows that magnesium sulfate inhibits platelet aggregation, even at low concentrations. Some preliminary clinical evidence shows that infusion of magnesium sulfate increases bleeding time by 48% and reduces platelet activity. However, other clinical research shows that magnesium does not affect platelet aggregation, although inhibition of platelet-dependent thrombosis can occur.
Gabapentin (Neurontin)
Gabapentin absorption can be decreased by magnesium.
Clinical research shows that giving magnesium oxide orally along with gabapentin decreases the maximum plasma concentration of gabapentin by 33%, time to maximum concentration by 36%, and area under the curve by 43%. Advise patients to take gabapentin at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Sevelamer (Renagel, Renvela)
Sevelamer may increase serum magnesium levels.
In patients on hemodialysis, sevelamer use was associated with a 0.28 mg/dL increase in serum magnesium. The mechanism of this interaction remains unclear.
L-Malic Acid
Antihypertensive Drugs
Theoretically, malic acid might increase the risk of hypotension when taken with antihypertensive drugs.
Animal research shows that malic acid isolated from tagetes roots can reduce mean arterial blood pressure.
Brand information
Manufacturer and brand details for Malic Acid, from the product label.
Genestra Brands
- Name
- Seroyal USA
- City
- Pittsburgh
- State
- PA
- ZipCode
- 15275
- Phone Number
- 1-888-737-6925
- Web Address
- seroyal.com
Malic Acid by Genestra Brands: Common Questions
Does Malic Acid by Genestra Brands interact with any medications?
How can one product interact with so many drugs?
Where does this information come from?
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Does malic acid actually work for fibromyalgia or fatigue?
Will this help my dry mouth?
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Is there anything else in here besides the two active ingredients?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
Not sure if Malic Acid is safe with your meds?
Our pharmacists answer your medication & supplement questions — free.
Label information is sourced from the NIH Dietary Supplement Label Database and reflects the product version on file; always read your actual product label. This page is for education only and is not a substitute for professional medical advice. Confirm with your pharmacist or doctor before combining supplements and medications.
The Full Monographs Behind Malic Acid’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Malic Acid
Interacts with 172 drugsMalic acid is a natural acid found in apples and other fruits, often combined with magnesium in supplements marketed for fibromyalgia and muscle pain. The evidence for its health benefits is...
Read the full Malic Acid monograph → Herb & supplement monographMagnesium
Interacts with 295 drugsMagnesium 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 othe...
Read the full Magnesium monograph →Sources & How We Checked
Malic Acid's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.
- NIH Dietary Supplement Label Database (DSLD) — The official product label on file for this supplement.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference behind the ingredient interaction data.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.
The 89 references behind this product’s interaction data
Every citation that drives the interaction findings for this product’s ingredients, from the evidence-graded Natural Medicines (TRC Healthcare) database. Open an ingredient to browse its citations — links open the study on PubMed or the publisher’s site.
Malic Acid 7 references
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- Fiume, Z. Final report on the safety assessment of malic acid and sodium malate. Int J Toxicol 2001;20 Suppl 1:47-55. PubMed
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