Aluminum Hydroxide, Magnesium Hydroxide (OTC drug) & Nutrient Depletion
Also searched as Maalox, Mucogel. What the clinical evidence reports, what it may mean, and what to discuss with your pharmacist.
Aluminum Hydroxide, Magnesium Hydroxide (OTC drug) has been associated with depletion of FOLIC ACID, IRON, CALCIUM and PHOSPHATE SALTS and 1 more. This does not mean a deficiency will occur — it means these are worth knowing about and, if you take Aluminum Hydroxide, Magnesium Hydroxide (OTC drug) long-term, worth raising with your pharmacist or healthcare provider.
Take more than one medication? Open the checker with Aluminum Hydroxide, Magnesium Hydroxide (OTC drug) pre-loaded and add the rest to see overlapping nutrient signals.
Reported nutrient depletions with Aluminum Hydroxide, Magnesium Hydroxide (OTC drug)
Each record below is shown as published in our licensed clinical database, with its evidence rating and citations. Expand a section for food sources and talking points.
FOLIC ACID
Insignificant DepletionANTACIDS
Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. This antacid raises the pH in your stomach and small intestine, and since folate absorbs best in a slightly acidic environment, there is a theoretical chance it could interfere a little. In practice, this concern is considered insignificant for most people. Unless your diet is already very low in folate, you likely do not need to worry, though it is always fine to mention it to your pharmacist if you have questions.
What Folic acid (folate) does & food sources
Folate is needed for cell division, red blood cell formation, and healthy fetal development.
Common food sources:
- Leafy green vegetables
- Beans, lentils, and peas
- Fortified grains and cereals
- Citrus fruits
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Ask your provider whether folate monitoring or supplementation is appropriate for you — this matters most before and during pregnancy, and with long-term use of certain seizure or arthritis medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Folate needs are individual. With some medications (for example, methotrexate), folic acid is often prescribed deliberately on a specific schedule — follow your prescriber's instructions rather than adding your own.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: High-dose folic acid can mask vitamin B12 deficiency, so the two are often evaluated together.
Learn more about this nutrient: Folic Acid — uses, safety & interactions
References (2)
- Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
- Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
IRON
Insignificant DepletionANTACIDS
Gastric acid is important for absorption of dietary, non-heme iron. Antacids may therefore reduce iron absorption by increasing gastric pH and reducing iron solubility. This isn't likely to be clinically significant in most people with adequate dietary iron intake. However, antacids can reduce absorption of iron from supplements by 30% to 40%, and reduced efficacy has occurred occasionally. Advise patients who need iron supplements to avoid antacids or separate the doses as much as possible.
Iron helps your body make healthy red blood cells and carry oxygen to your tissues. This antacid works by neutralizing stomach acid, and since stomach acid helps dissolve and absorb the non-heme iron found in plant foods and supplements, reducing that acid can lower how much iron gets absorbed. For most people eating a balanced diet, this is not a real concern. If you happen to take an iron supplement, though, try to space it at least a couple of hours away from this antacid, and check with your pharmacist if you have questions.
What Iron does & food sources
Iron is the core of hemoglobin, which carries oxygen in red blood cells.
Common food sources:
- Red meat and poultry
- Beans and lentils
- Fortified cereals
- Spinach (plant iron absorbs better with vitamin C)
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Iron status is easy to assess (ferritin, iron studies, blood counts). Ask your provider before supplementing — unexplained low iron always deserves a medical evaluation for the cause, not just replacement.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Iron supplements commonly cause constipation or stomach upset and interfere with the absorption of several medications (thyroid medication, some antibiotics). Do not take iron "just in case" — excess iron is harmful.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: Never self-treat suspected anemia; the underlying cause matters as much as the iron level.
Learn more about this nutrient: Iron — uses, safety & interactions
References (3)
- Aymard JP, Aymard B, Netter P, et al. Haematological adverse effects of histamine H2-receptor antagonists. Med Toxicol Adverse Drug Exp 1988;3:430-48. PubMed
- Tatro DS, ed. Drug Interactions Facts. Facts and Comparisons Inc., St. Louis, MO. 1999.
- Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.
CALCIUM
Moderate DepletionALUMINUM
Large doses of aluminum salts (aluminum hydroxide 1-3 grams four times daily, e.g., 90-260 mL Maalox daily) bind dietary phosphate, causing hypophosphatemia. This induces movement of calcium from bone into the blood, increasing urinary calcium excretion. There are reports of negative calcium balance after short-term use of large doses of aluminum-containing antacids, and of osteomalacia after prolonged use of large doses, especially in people with a low dietary phosphate intake, or a low dietary calcium intake (less than 250 mg per day). Advise patients to avoid taking large doses of aluminum-containing antacids for prolonged periods, unless they are taking them for hyperphosphatemia associated with chronic renal failure.
Calcium keeps your bones strong and helps your muscles and heart work properly, so running low on it over time is worth paying attention to. Here is what can happen with large, regular doses of this antacid: the aluminum in it grabs onto phosphate in your gut, which pulls phosphate levels in your blood down, and your body responds by pulling calcium out of your bones to try to rebalance things. That calcium then spills out through your kidneys. This concern is mainly tied to very high doses taken for long stretches, not the occasional antacid use most people do, but if you rely on this medication heavily or regularly, it is worth a conversation with your pharmacist or doctor about your calcium intake and whether anything needs to be monitored.
What Calcium does & food sources
Calcium builds and maintains bone and is essential for muscle contraction and nerve signaling.
Common food sources:
- Dairy products (milk, yogurt, cheese)
- Fortified plant milks and juices
- Canned fish with bones (sardines, salmon)
- Leafy greens like kale
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Ask your provider whether bone health monitoring (and vitamin D testing) makes sense with long-term use of an associated medication — a blood calcium level alone does not capture bone calcium status.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Calcium can interfere with the absorption of several medications (some antibiotics, thyroid medication, iron) — separate the doses and confirm timing with your pharmacist. Total intake from food plus supplements matters more than supplements alone.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: Very high calcium intake has its own risks (kidney stones in susceptible people) — more is not better.
Learn more about this nutrient: Calcium — uses, safety & interactions
References (2)
PHOSPHATE SALTS
Moderate DepletionANTACIDS
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your bones, muscles, and energy systems depend on. The aluminum and magnesium in this antacid can latch onto phosphate right in your gut, preventing it from being absorbed into your bloodstream. For most people taking a normal dose occasionally, this is not a concern. But if you have been taking large amounts of this antacid regularly for a long time, it is worth mentioning to your pharmacist or doctor, since significant depletion over time has been linked to bone and kidney problems.
Learn more about this nutrient: Phosphate Salts — uses, safety & interactions
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
CHROMIUM
Insufficient EvidenceANTACIDS
Antacids increase gastric pH, which might decrease chromium absorption due to formation of less soluble chromium salts. However, the clinical significance of this is not clear.
Chromium is a trace mineral your body uses to help insulin work properly and keep blood sugar steady. This antacid combination neutralizes stomach acid, and there is some thought that a less acidic stomach environment could make chromium harder to absorb since it forms less soluble compounds at higher pH levels. That said, the evidence here is really limited, and no one knows yet whether this matters in a real-world way for most people. If you use these antacids regularly and are curious, it is worth mentioning to your pharmacist or doctor.
Learn more about this nutrient: Chromium — uses, safety & interactions
References (3)
- Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
- Davis ML, Seaborn CD, and Stoecker BJ. Effects of over-the-counter drugs on chromium retention and urinary excretion in rats. Nutrition Research 1995;15(2):201-210.
- Seaborn CD and Stoecker BJ. Effects of antacid or ascorbic acid on tissue accumulation and urinary excretion of 51chromium. Nutrition Research 1990;10:1401-1407. DOI
This tool is educational and is not a substitute for professional medical advice. An association is not a diagnosis and does not mean a deficiency will occur. Always talk to your pharmacist or healthcare provider before starting, stopping, or changing any medication or supplement.
Disclaimer: This checker finds which nutrients might be depleted by prescription or over-the-counter medications. Each nutrient depletion issue is rated based on clinical significance. Use your own professional judgment prior to making clinical decisions.© 2026 Therapeutic Research Center Licensed records refresh weekly · last updated July 3, 2026.
More about Aluminum Hydroxide, Magnesium Hydroxide (OTC drug)
What drug-induced nutrient depletion means
Some medications can, over time, lower the levels of certain vitamins, minerals, or other nutrients — through reduced absorption, increased loss, or changes in how the body uses them.
Association is not deficiency
An entry here means a depletion has been reported or studied — not that it happens to everyone, or that you are deficient. Dose, duration, diet, and your own health all matter.
Evidence varies by pair
Some drug–nutrient links (like metformin and vitamin B12) are well studied; others rest on limited or preliminary research. Each entry shows the evidence rating from our licensed clinical database.
When to ask about labs
If you take an associated medication long-term, ask your healthcare provider whether monitoring is appropriate for you. Not everyone needs testing — your provider can weigh your dose, duration, and symptoms.
Don't self-supplement blindly
Supplements are not risk-free: some can interact with medications, and some (like potassium or magnesium) can be risky with kidney disease. Talk to your pharmacist before adding anything.
Never stop a medication over this
These medications are prescribed for good reasons, and the benefit usually far outweighs a manageable nutrient consideration. Any change belongs in a conversation with your prescriber.
Food first, usually
For many nutrients, a varied diet covers the gap. Each entry lists common food sources; a supplement is a decision to make with your pharmacist or provider, not a default.
Aluminum Hydroxide, Magnesium Hydroxide (OTC drug) & nutrients: FAQs
Does Aluminum Hydroxide, Magnesium Hydroxide (OTC drug) deplete FOLIC ACID?
Should I take a supplement because I take Aluminum Hydroxide, Magnesium Hydroxide (OTC drug)?
Should I stop taking Aluminum Hydroxide, Magnesium Hydroxide (OTC drug)?
Where does this information come from?
Questions about Aluminum Hydroxide, Magnesium Hydroxide (OTC drug) and your nutrition?
Ask a licensed pharmacist — free, no appointment needed.
Sources & How We Checked
Nutrient depletion records for Aluminum Hydroxide, Magnesium Hydroxide (OTC drug) are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for drug-induced nutrient depletions, supplements, and interactions — the basis for this page.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for medication overviews across the site.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.