Drug-induced nutrient depletion

Medications That May Deplete MAGNESIUM

Magnesium is involved in muscle and nerve function, heart rhythm, blood sugar control, and bone health. See which medications carry a reported association, how strong the evidence is, and what to discuss with your pharmacist.

223Medications
223Depletion records
About MAGNESIUM

Magnesium is involved in muscle and nerve function, heart rhythm, blood sugar control, and bone health.

Common food sources: Nuts and seeds (almonds, pumpkin seeds); Whole grains; Leafy green vegetables; Beans and legumes.

Ask whether a magnesium level is worth checking if you take an associated medication long-term — particularly with symptoms like muscle cramps, twitching, or palpitations. Blood levels do not always reflect total body stores, which is worth discussing too.

Caution: Magnesium supplementation can be risky in kidney disease, where magnesium can accumulate — always check with a clinician first if your kidney function is reduced.

HelloPharmacist pharmacist-reviewed education. The medication records below are licensed clinical data, shown as published.

Deep dive: Magnesium — uses, safety & drug interactions

The evidence

Medications associated with MAGNESIUM depletion

Each record is shown as published in our licensed clinical database. Open a medication for its full nutrient report.

Albuterol

Insignificant Depletion

Brand names include Proventil, Volmax, Ventolin (U.S.)

Beta-2 agonists cause small, generally reversible decreases in magnesium levels.

Beta-2 agonists promote movement of magnesium from the extracellular to the intracellular space, and increase magnesium excretion in the urine. Reduced serum magnesium levels occur after a single dose of albuterol or terbutaline orally, by IV infusion, SC injection, or by inhalation. The reductions are generally small, about 4.5-9%, or 0.04 to 0.06 mmol/L compared with the normal serum magnesium range of 0.65 to 1.1 mmol/L. However, these acute changes could contribute to ECG changes, including prolonged QT intervals. With chronic use of beta-2 agonists, serum magnesium levels generally return to normal, but muscle magnesium levels may remain low. For information on foods that are rich in magnesium, see our chart.
Taking Albuterol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles, nerves, and heart rhythm work properly, so it is worth knowing how albuterol can affect it. When you use albuterol, it activates receptors that shift magnesium out of the bloodstream and into your cells, and it can nudge the kidneys to excrete a little more of it in urine. In practice, these dips are quite small and tend to reverse on their own with regular use, so for most people this is not something that requires a supplement. If you use albuterol heavily or have other reasons to watch your heart rhythm, it is worth a quick conversation with your pharmacist or doctor just to be sure.

References (10)
  1. Tveskov C, Djurhuus MS, Klitgaard NAH, Egstrup K. Potassium and magnesium distribution, ECG changes, and ventricular ectopic beats during beta-2-adrenergic stimulation with terbutaline in healthy subjects. Chest 1994;106:1654-9..
  2. Whyte KF, Addis GJ, Whitesmith R, Reid JL. Adrenergic control of plasma magnesium in man. Clin Sci 1987;72:135-8.. PubMed
  3. Rolla G, Bucca C. Magnesium, beta-agonists, and asthma. Lancet 1988;1:989. PubMed
  4. Bremme K, Eneroth P, Nordstrom L, Nilsson B. Effects of infusion of the beta-adrenoceptor agonist terbutaline on serum magnesium in pregnant women. Magnesium 1986;5:85-94.
  5. Khilnani G, Parchani H, Toshniwal G. Hypomagnesemia due to beta 2-agonist use in bronchial asthma. J Assoc Physicians India 1992;40:346..
  6. Bos WJ, Postma DS, van Doormaal JJ. Magnesiuric and calciuric effects of terbutaline in man. Clin Sci 1988;74:595-7.. PubMed
  7. Lipworth BJ, McDevitt DG. Beta-adrenoceptor responses to inhaled salbutamol in normal subjects. Eur J Clin Pharmacol 1989;36:239-45.. PubMed
  8. Rahman ARA, McDevitt DG, Struthers AD, Lipworth BJ. The effects of enalapril and spironolactone on terbutaline-induced hypokalemia. Chest 1992;102:91-5..
  9. Gustafson T, Boman K, Rosenhall L, et al. Skeletal muscle magnesium and potassium in asthmatics treated with oral beta-2-agonists. Eur Resp J 1996;9:237-40.. PubMed
  10. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..

Full nutrient report for Albuterol →

Albuterol Sulfate

Insignificant Depletion

Brand names include Proair Respiclick

Beta-2 agonists cause small, generally reversible decreases in magnesium levels.

Beta-2 agonists promote movement of magnesium from the extracellular to the intracellular space, and increase magnesium excretion in the urine. Reduced serum magnesium levels occur after a single dose of albuterol or terbutaline orally, by IV infusion, SC injection, or by inhalation. The reductions are generally small, about 4.5-9%, or 0.04 to 0.06 mmol/L compared with the normal serum magnesium range of 0.65 to 1.1 mmol/L. However, these acute changes could contribute to ECG changes, including prolonged QT intervals. With chronic use of beta-2 agonists, serum magnesium levels generally return to normal, but muscle magnesium levels may remain low. For information on foods that are rich in magnesium, see our chart.
Taking Albuterol Sulfate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Albuterol works on beta-2 receptors, and one side effect of that action is that it nudges magnesium out of the bloodstream and into cells, while also causing the kidneys to flush a little extra out in the urine. The dip in blood magnesium levels is real but small, and with regular use those levels tend to normalize on their own. This is rated insignificant for most people, so a supplement is not something you need to seek out on your own, but if you use albuterol frequently and have any heart rhythm concerns, it is worth a quick conversation with your pharmacist or doctor.

References (10)
  1. Tveskov C, Djurhuus MS, Klitgaard NAH, Egstrup K. Potassium and magnesium distribution, ECG changes, and ventricular ectopic beats during beta-2-adrenergic stimulation with terbutaline in healthy subjects. Chest 1994;106:1654-9..
  2. Whyte KF, Addis GJ, Whitesmith R, Reid JL. Adrenergic control of plasma magnesium in man. Clin Sci 1987;72:135-8.. PubMed
  3. Rolla G, Bucca C. Magnesium, beta-agonists, and asthma. Lancet 1988;1:989. PubMed
  4. Bremme K, Eneroth P, Nordstrom L, Nilsson B. Effects of infusion of the beta-adrenoceptor agonist terbutaline on serum magnesium in pregnant women. Magnesium 1986;5:85-94.
  5. Khilnani G, Parchani H, Toshniwal G. Hypomagnesemia due to beta 2-agonist use in bronchial asthma. J Assoc Physicians India 1992;40:346..
  6. Bos WJ, Postma DS, van Doormaal JJ. Magnesiuric and calciuric effects of terbutaline in man. Clin Sci 1988;74:595-7.. PubMed
  7. Lipworth BJ, McDevitt DG. Beta-adrenoceptor responses to inhaled salbutamol in normal subjects. Eur J Clin Pharmacol 1989;36:239-45.. PubMed
  8. Rahman ARA, McDevitt DG, Struthers AD, Lipworth BJ. The effects of enalapril and spironolactone on terbutaline-induced hypokalemia. Chest 1992;102:91-5..
  9. Gustafson T, Boman K, Rosenhall L, et al. Skeletal muscle magnesium and potassium in asthmatics treated with oral beta-2-agonists. Eur Resp J 1996;9:237-40.. PubMed
  10. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..

Full nutrient report for Albuterol Sulfate →

Aldesleukin

Insignificant Depletion

Brand names include Proleukin

Aldesleukin may cause a shift of magnesium into cells.

Asymptomatic hypomagnesemia can occur with aldesleukin therapy, probably due to an intracellular shift of magnesium. There isn't any increase in urinary magnesium, and serum levels normalize a few days after the drug is stopped.
Taking Aldesleukin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles, nerves, and heart rhythm work properly, so keeping levels steady matters. With aldesleukin, what appears to happen is that magnesium moves from the bloodstream into the body's cells rather than being lost through the kidneys, which can make blood levels look low on lab work even when total body magnesium is fine. The good news is that levels typically bounce back on their own within a few days of finishing treatment. Because this is rated as insignificant depletion, most patients do not need a magnesium supplement, but if you have questions about your lab results, your doctor or pharmacist is the right person to ask.

References (1)
  1. Kozeny GA, Nicolas JD, Creekmore S, et al. Effects of interleukin-2 immunotherapy on renal function. J Clin Oncol 1988;6:1170-6.. PubMed

Full nutrient report for Aldesleukin →

Brand names include Talicia

Hypomagnesemia requiring supplementation has been reported with all PPIs.

Taking a PPI long-term, especially over a year, has been linked to an increased risk of hypomagnesemia in observational research. Higher doses are associated with a two-fold increase in the odds of hypomagnesemia when compared with lower doses. Observational research in elderly hospitalized patients has also found that males, smokers, and heavy alcohol use further increase the risk of hypomagnesemia from PPI use. PPIs increase intestinal pH which is thought to inhibit active transport of magnesium in the intestine, reducing its absorption. The American College of Gastroenterology (ACG) does not provide a recommendation related to monitoring magnesium levels in patients taking PPIs. However, other experts, including the US Food and Drug Administration (FDA), recommend that serum magnesium levels should be checked at baseline and annually thereafter in patients who are likely to take a PPI long-term. In up to 25% of patients who develop hypomagnesemia, the PPI will need to be discontinued permanently to return magnesium levels to normal and maintain them. In some patients, it is possible to continue the PPI and take a magnesium supplement concurrently to maintain magnesium levels. For information on foods that are rich in magnesium, see our chart.
Taking Amoxicillin, Omeprazole Magnesium, Rifabutin? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and omeprazole (the PPI in this combination) is the ingredient most likely to affect it. PPIs raise the pH inside your intestines, and that shift appears to interfere with the active process your gut normally uses to pull magnesium into your bloodstream. Because this is rated a major depletion, long-term users, especially those taking higher doses or using a PPI for more than a year, should ask their pharmacist or doctor about checking magnesium levels and whether a supplement makes sense.

References (18)
  1. Safety Alert. Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use. U.S. Food and Drug Administration, March 2, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/
  2. Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series. QJM 2010;103:387-95. PubMed
  3. Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors--a review. Neth J Med 2009;67:169-72.
  4. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 2008;69:338-41. PubMed
  5. Doornebal J, Bijlsma R, Brouwer RM. [An unknown but potentially serious side effect of proton pump inhibitors: hypomagnesaemia]. Ned Tijdschr Geneeskd 2009;153:A711.
  6. Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6. PubMed
  7. François M, Lévy-Bohbot N, Caron J, Durlach V. [Chronic use of proton-pump inhibitors associated with giardiasis: A rare cause of hypomagnesemic hypoparathyroidism?]. Ann Endocrinol (Paris) 2008;69:446-8.
  8. Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6. PubMed
  9. Hoorn EJ, van der Hoek J, de Man RA, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6. PubMed
  10. Regolisti G, Cabassi A, Parenti E, et al. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74. PubMed
  11. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5. PubMed
  12. Delgado MG, Calleja S, Suarez L, Pascual J. Recurrent confusional episodes associated with hypomagnesaemia due to esomeprazol. BMJ Case Rep 2013;2013. PubMed
  13. Krupa LZ, Fellows IW. Lansoprazole-induced hypomagnesaemia. BMJ Case Rep 2014;2014. PubMed
  14. Liao S, Gan L, Mei Z. Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e15011. PubMed
  15. Srinutta T, Chewcharat A, Takkavatakarn K, et al. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies. Medicine (Baltimore). 2019 Nov;98(44):e17788. PubMed
  16. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed
  17. Anna Vermeulen Windsant-van den Tweel AM, Derijks HJ, Gadiot NPPM, Keijsers CJPW. Proton Pump Inhibitors and Hypomagnesemia in Older Inpatients: An Observational Study. Sr Care Pharm 2022;37(12):623-630. PubMed
  18. Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.

Full nutrient report for Amoxicillin, Omeprazole Magnesium, Rifabutin →

Amphotericin B

Major Depletion

Brand names include Amphocin, Fungizone IV, Abelcet

Amphotericin-B can cause a significant decrease in magnesium levels.

Electrolyte disturbances, including low serum magnesium levels, develop in a large proportion of patients receiving amphotericin-B. Lipid-based formulations might have a lesser effect than the conventional formulations. This disturbance has been association with nephrotoxicity, and may necessitate stopping the drug and giving intravenous electrolyte replacement.
Taking Amphotericin B? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and amphotericin B is well known for draining it. The drug can damage the kidneys' filtering tubes, causing them to leak magnesium out into the urine instead of holding onto it. This is a well-documented, serious concern, not a theoretical one, so most patients on amphotericin B are monitored closely and many need magnesium replacement during treatment. Ask your doctor or pharmacist how your levels are being watched while you are on this medication.

References (1)
  1. Sabra R, Branch RA. Amphotericin B nephrotoxicity. Drug Saf 1990;5:94-108. . PubMed

Full nutrient report for Amphotericin B →

Amphotericin, Tetracycline

Major Depletion

Brand names include Mysteclin-F

Amphotericin-B can cause a significant decrease in magnesium levels.

Electrolyte disturbances, including low serum magnesium levels, develop in a large proportion of patients receiving amphotericin-B. Lipid-based formulations might have a lesser effect than the conventional formulations. This disturbance has been association with nephrotoxicity, and may necessitate stopping the drug and giving intravenous electrolyte replacement.
Taking Amphotericin, Tetracycline? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly, and amphotericin-B is well known for causing significant drops in magnesium levels. It does this primarily by damaging the kidneys' filtering tubes, which then lose their ability to hold magnesium in the body, so it spills out in the urine instead of staying where it belongs. This is not a minor concern, a large number of patients on amphotericin-B experience this, and in serious cases it can require intravenous replacement or even stopping the drug. If you or a loved one is on this medication, please speak with your doctor or pharmacist right away about monitoring and whether supplementation is needed.

References (1)
  1. Sabra R, Branch RA. Amphotericin B nephrotoxicity. Drug Saf 1990;5:94-108. . PubMed

Full nutrient report for Amphotericin, Tetracycline →

Chlortetracycline

Insignificant Depletion

Brand names include Aureomycin

Tetracyclines may bind to dietary magnesium, reducing absorption of both agents.

Tetracyclines form complexes with magnesium in the GI tract, which could reduce absorption of both the tetracycline and magnesium. Significant effects on magnesium levels are unlikely when tetracyclines are taken on an empty stomach, 1 hour before or 2 hours after magnesium supplements.
Taking Chlortetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Chlortetracycline belongs to the tetracycline family, and these antibiotics can latch onto magnesium in the gut, forming a complex that makes both harder to absorb. That said, this is rated as insignificant for most people, meaning it is not something to lose sleep over. If you happen to take a magnesium supplement, just ask your pharmacist about spacing it away from your dose to keep both working their best.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Chlortetracycline →

Cholestyramine

Insignificant Depletion

Brand names include Questran

Small clinical studies show that cholestyramine may slightly increase urinary magnesium excretion, possibly by binding vitamin D and leading to reduced magnesium absorption. Clinically significant magnesium deficiency hasn't been reported, and supplements aren't likely to be needed. For information on foods that are rich in magnesium, see our chart.
Taking Cholestyramine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Cholestyramine works by binding things in your gut, and there is some evidence it may indirectly reduce magnesium absorption by also soaking up vitamin D, which the body uses to absorb magnesium properly. A small amount of extra magnesium may then spill into the urine as well. That said, small studies rate this as insignificant, meaning real deficiency has not been reported with this drug, and most people taking cholestyramine do not need a magnesium supplement. If you have any concerns, a quick chat with your pharmacist or doctor is all you need.

References (2)
  1. Watkins DW, Khalafi R, Cassidy MM, Vahouny GV. Alterations in calcium, magnesium, iron, and zinc metabolism by dietary cholestyramine. Dig Dis Sci 1985;30:477-82.. PubMed
  2. Runeberg L, Miettinen TA, Nikkila EA. Effect of cholestyramine on mineral excretion in man. Acta Med Scand 1972;192:71-6. PubMed

Full nutrient report for Cholestyramine →

Cinoxacin

Insignificant Depletion

Brand names include Cinobac

Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Cinoxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Cinoxacin belongs to the quinolone antibiotic family, and these drugs can latch onto magnesium in the gut, forming a complex that may slightly reduce how much magnesium your body absorbs. That said, this interaction is rated insignificant, meaning a meaningful drop in your magnesium levels is not really expected during a typical course of treatment. If you happen to take a magnesium supplement, just ask your pharmacist about spacing it a couple of hours apart from your dose.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Cinoxacin →

Ciprofloxacin

Insignificant Depletion

Brand names include Cipro, Ciprobay, Cipro XR

Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Ciprofloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on every day. Ciprofloxacin belongs to a class of antibiotics that can physically latch onto magnesium in the digestive tract, which in theory could reduce how much magnesium your body absorbs from a supplement taken at the same time. In practice, this is rated as an insignificant concern for most people, especially since ciprofloxacin is usually taken for only a short course. If you do take a magnesium supplement, spacing it a couple of hours away from your dose is a simple precaution worth mentioning to your pharmacist.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Ciprofloxacin →

Clinafloxacin

Insignificant Depletion
Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Clinafloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on every day. Clinafloxacin belongs to the quinolone antibiotic family, and these drugs can latch onto magnesium in the digestive tract, forming a complex that may reduce how much of either one gets absorbed. In practice, this is rated insignificant for most people, especially since clinafloxacin is typically taken as a short course. If you happen to take a magnesium supplement, spacing it a couple of hours away from the antibiotic is a sensible habit worth mentioning to your pharmacist.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Clinafloxacin →

Demeclocycline

Insignificant Depletion

Brand names include Declomycin

Tetracyclines may bind to dietary magnesium, reducing absorption of both agents.

Tetracyclines form complexes with magnesium in the GI tract, which could reduce absorption of both the tetracycline and magnesium. Significant effects on magnesium levels are unlikely when tetracyclines are taken on an empty stomach, 1 hour before or 2 hours after magnesium supplements.
Taking Demeclocycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Demeclocycline, like other tetracycline antibiotics, can latch onto magnesium in the gut and form a combined complex, which may slightly reduce how much of the mineral your body absorbs. In practice, this is rated as an insignificant concern, and most people taking demeclocycline will not need a magnesium supplement because of it. If you do take magnesium, spacing it a couple of hours away from your dose is a simple way to sidestep any interaction, but check with your pharmacist if you have questions.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Demeclocycline →

Dexlansoprazole

Major Depletion

Brand names include Dexilant Solutab

Hypomagnesemia requiring supplementation has been reported with all PPIs.

Taking a PPI long-term, especially over a year, has been linked to an increased risk of hypomagnesemia in observational research. Higher doses are associated with a two-fold increase in the odds of hypomagnesemia when compared with lower doses. Observational research in elderly hospitalized patients has also found that males, smokers, and heavy alcohol use further increase the risk of hypomagnesemia from PPI use. PPIs increase intestinal pH which is thought to inhibit active transport of magnesium in the intestine, reducing its absorption. The American College of Gastroenterology (ACG) does not provide a recommendation related to monitoring magnesium levels in patients taking PPIs. However, other experts, including the US Food and Drug Administration (FDA), recommend that serum magnesium levels should be checked at baseline and annually thereafter in patients who are likely to take a PPI long-term. In up to 25% of patients who develop hypomagnesemia, the PPI will need to be discontinued permanently to return magnesium levels to normal and maintain them. In some patients, it is possible to continue the PPI and take a magnesium supplement concurrently to maintain magnesium levels. For information on foods that are rich in magnesium, see our chart.
Taking Dexlansoprazole? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and this is one nutrient worth paying real attention to if you take dexlansoprazole long-term. As a proton pump inhibitor, dexlansoprazole raises the pH inside your intestines, and that change appears to interfere with the active pumping system your gut uses to absorb magnesium, so less gets into your bloodstream over time. Studies have consistently linked long-term PPI use, especially at higher doses or beyond a year, to low magnesium levels, which is why the FDA recommends getting your magnesium checked at the start of therapy and once a year after that. Ask your doctor or pharmacist whether those baseline and annual checks make sense for you.

References (18)
  1. Safety Alert. Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use. U.S. Food and Drug Administration, March 2, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/
  2. Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series. QJM 2010;103:387-95. PubMed
  3. Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors--a review. Neth J Med 2009;67:169-72.
  4. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 2008;69:338-41. PubMed
  5. Doornebal J, Bijlsma R, Brouwer RM. [An unknown but potentially serious side effect of proton pump inhibitors: hypomagnesaemia]. Ned Tijdschr Geneeskd 2009;153:A711.
  6. Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6. PubMed
  7. François M, Lévy-Bohbot N, Caron J, Durlach V. [Chronic use of proton-pump inhibitors associated with giardiasis: A rare cause of hypomagnesemic hypoparathyroidism?]. Ann Endocrinol (Paris) 2008;69:446-8.
  8. Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6. PubMed
  9. Hoorn EJ, van der Hoek J, de Man RA, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6. PubMed
  10. Regolisti G, Cabassi A, Parenti E, et al. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74. PubMed
  11. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5. PubMed
  12. Delgado MG, Calleja S, Suarez L, Pascual J. Recurrent confusional episodes associated with hypomagnesaemia due to esomeprazol. BMJ Case Rep 2013;2013. PubMed
  13. Krupa LZ, Fellows IW. Lansoprazole-induced hypomagnesaemia. BMJ Case Rep 2014;2014. PubMed
  14. Liao S, Gan L, Mei Z. Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e15011. PubMed
  15. Srinutta T, Chewcharat A, Takkavatakarn K, et al. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies. Medicine (Baltimore). 2019 Nov;98(44):e17788. PubMed
  16. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed
  17. Anna Vermeulen Windsant-van den Tweel AM, Derijks HJ, Gadiot NPPM, Keijsers CJPW. Proton Pump Inhibitors and Hypomagnesemia in Older Inpatients: An Observational Study. Sr Care Pharm 2022;37(12):623-630. PubMed
  18. Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.

Full nutrient report for Dexlansoprazole →

Doripenem

Insignificant Depletion

Brand names include Doribax

Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Doripenem? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, nerves, and heartbeat working steadily, so your body watches its levels closely. Doripenem is a carbapenem antibiotic, not an aminoglycoside, so the kidney-stress mechanism described above applies more directly to drugs in that aminoglycoside class. That said, because this record is rated as moderate depletion, patients receiving doripenem in a hospital setting are typically monitored for falling magnesium levels and may need replacement if levels dip. If you are on or have recently finished this medication, it is worth asking your doctor or pharmacist whether your electrolytes were checked.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Doripenem →

Enoxacin

Insignificant Depletion

Brand names include Penetrex

Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Enoxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart depend on to work properly. Enoxacin belongs to a class of antibiotics that can latch onto magnesium in the digestive tract, forming a complex that may reduce how much of both the drug and the mineral your body absorbs. In practice, this is considered an insignificant concern, and most people taking a short course of Enoxacin do not need to worry about their magnesium levels. If you do take a magnesium supplement, just ask your pharmacist about timing the two apart to keep this from being an issue.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Enoxacin →

Esomeprazole

Major Depletion

Brand names include Nexium

Hypomagnesemia requiring supplementation has been reported with all PPIs.

Taking a PPI long-term, especially over a year, has been linked to an increased risk of hypomagnesemia in observational research. Higher doses are associated with a two-fold increase in the odds of hypomagnesemia when compared with lower doses. Observational research in elderly hospitalized patients has also found that males, smokers, and heavy alcohol use further increase the risk of hypomagnesemia from PPI use. PPIs increase intestinal pH which is thought to inhibit active transport of magnesium in the intestine, reducing its absorption. The American College of Gastroenterology (ACG) does not provide a recommendation related to monitoring magnesium levels in patients taking PPIs. However, other experts, including the US Food and Drug Administration (FDA), recommend that serum magnesium levels should be checked at baseline and annually thereafter in patients who are likely to take a PPI long-term. In up to 25% of patients who develop hypomagnesemia, the PPI will need to be discontinued permanently to return magnesium levels to normal and maintain them. In some patients, it is possible to continue the PPI and take a magnesium supplement concurrently to maintain magnesium levels. For information on foods that are rich in magnesium, see our chart.
Taking Esomeprazole? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working smoothly, steadies your heartbeat, and supports hundreds of chemical reactions your body runs every day. Esomeprazole raises the pH inside your intestines, and that shift appears to block a key transport system your gut uses to pull magnesium into the bloodstream, so less gets absorbed over time. This is a well-documented concern, not a minor footnote: long-term use, higher doses, and certain risk factors like older age or heavy alcohol use raise the odds further. If you have been on esomeprazole for a year or more, it is worth asking your doctor or pharmacist whether your magnesium level has been checked recently.

References (18)
  1. Safety Alert. Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use. U.S. Food and Drug Administration, March 2, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/
  2. Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series. QJM 2010;103:387-95. PubMed
  3. Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors--a review. Neth J Med 2009;67:169-72.
  4. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 2008;69:338-41. PubMed
  5. Doornebal J, Bijlsma R, Brouwer RM. [An unknown but potentially serious side effect of proton pump inhibitors: hypomagnesaemia]. Ned Tijdschr Geneeskd 2009;153:A711.
  6. Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6. PubMed
  7. François M, Lévy-Bohbot N, Caron J, Durlach V. [Chronic use of proton-pump inhibitors associated with giardiasis: A rare cause of hypomagnesemic hypoparathyroidism?]. Ann Endocrinol (Paris) 2008;69:446-8.
  8. Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6. PubMed
  9. Hoorn EJ, van der Hoek J, de Man RA, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6. PubMed
  10. Regolisti G, Cabassi A, Parenti E, et al. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74. PubMed
  11. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5. PubMed
  12. Delgado MG, Calleja S, Suarez L, Pascual J. Recurrent confusional episodes associated with hypomagnesaemia due to esomeprazol. BMJ Case Rep 2013;2013. PubMed
  13. Krupa LZ, Fellows IW. Lansoprazole-induced hypomagnesaemia. BMJ Case Rep 2014;2014. PubMed
  14. Liao S, Gan L, Mei Z. Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e15011. PubMed
  15. Srinutta T, Chewcharat A, Takkavatakarn K, et al. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies. Medicine (Baltimore). 2019 Nov;98(44):e17788. PubMed
  16. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed
  17. Anna Vermeulen Windsant-van den Tweel AM, Derijks HJ, Gadiot NPPM, Keijsers CJPW. Proton Pump Inhibitors and Hypomagnesemia in Older Inpatients: An Observational Study. Sr Care Pharm 2022;37(12):623-630. PubMed
  18. Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.

Full nutrient report for Esomeprazole →

Esomeprazole Magnesium

Major Depletion

Brand names include Nexium 24hr

Hypomagnesemia requiring supplementation has been reported with all PPIs.

Taking a PPI long-term, especially over a year, has been linked to an increased risk of hypomagnesemia in observational research. Higher doses are associated with a two-fold increase in the odds of hypomagnesemia when compared with lower doses. Observational research in elderly hospitalized patients has also found that males, smokers, and heavy alcohol use further increase the risk of hypomagnesemia from PPI use. PPIs increase intestinal pH which is thought to inhibit active transport of magnesium in the intestine, reducing its absorption. The American College of Gastroenterology (ACG) does not provide a recommendation related to monitoring magnesium levels in patients taking PPIs. However, other experts, including the US Food and Drug Administration (FDA), recommend that serum magnesium levels should be checked at baseline and annually thereafter in patients who are likely to take a PPI long-term. In up to 25% of patients who develop hypomagnesemia, the PPI will need to be discontinued permanently to return magnesium levels to normal and maintain them. In some patients, it is possible to continue the PPI and take a magnesium supplement concurrently to maintain magnesium levels. For information on foods that are rich in magnesium, see our chart.
Taking Esomeprazole Magnesium? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so keeping levels in a healthy range really matters. Esomeprazole belongs to a drug class called PPIs, and these medications raise the pH inside your intestines, which appears to interfere with the special pumps your gut uses to actively pull magnesium into your bloodstream. Over time, especially after a year or more of use, this can meaningfully lower magnesium levels, and the evidence here is rated as a major concern. If you take esomeprazole long-term, it is worth asking your doctor or pharmacist whether your magnesium level should be checked periodically.

References (18)
  1. Safety Alert. Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use. U.S. Food and Drug Administration, March 2, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/
  2. Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series. QJM 2010;103:387-95. PubMed
  3. Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors--a review. Neth J Med 2009;67:169-72.
  4. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 2008;69:338-41. PubMed
  5. Doornebal J, Bijlsma R, Brouwer RM. [An unknown but potentially serious side effect of proton pump inhibitors: hypomagnesaemia]. Ned Tijdschr Geneeskd 2009;153:A711.
  6. Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6. PubMed
  7. François M, Lévy-Bohbot N, Caron J, Durlach V. [Chronic use of proton-pump inhibitors associated with giardiasis: A rare cause of hypomagnesemic hypoparathyroidism?]. Ann Endocrinol (Paris) 2008;69:446-8.
  8. Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6. PubMed
  9. Hoorn EJ, van der Hoek J, de Man RA, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6. PubMed
  10. Regolisti G, Cabassi A, Parenti E, et al. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74. PubMed
  11. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5. PubMed
  12. Delgado MG, Calleja S, Suarez L, Pascual J. Recurrent confusional episodes associated with hypomagnesaemia due to esomeprazol. BMJ Case Rep 2013;2013. PubMed
  13. Krupa LZ, Fellows IW. Lansoprazole-induced hypomagnesaemia. BMJ Case Rep 2014;2014. PubMed
  14. Liao S, Gan L, Mei Z. Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e15011. PubMed
  15. Srinutta T, Chewcharat A, Takkavatakarn K, et al. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies. Medicine (Baltimore). 2019 Nov;98(44):e17788. PubMed
  16. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed
  17. Anna Vermeulen Windsant-van den Tweel AM, Derijks HJ, Gadiot NPPM, Keijsers CJPW. Proton Pump Inhibitors and Hypomagnesemia in Older Inpatients: An Observational Study. Sr Care Pharm 2022;37(12):623-630. PubMed
  18. Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.

Full nutrient report for Esomeprazole Magnesium →

Esomeprazole Strontium

Major Depletion
Hypomagnesemia requiring supplementation has been reported with all PPIs.

Taking a PPI long-term, especially over a year, has been linked to an increased risk of hypomagnesemia in observational research. Higher doses are associated with a two-fold increase in the odds of hypomagnesemia when compared with lower doses. Observational research in elderly hospitalized patients has also found that males, smokers, and heavy alcohol use further increase the risk of hypomagnesemia from PPI use. PPIs increase intestinal pH which is thought to inhibit active transport of magnesium in the intestine, reducing its absorption. The American College of Gastroenterology (ACG) does not provide a recommendation related to monitoring magnesium levels in patients taking PPIs. However, other experts, including the US Food and Drug Administration (FDA), recommend that serum magnesium levels should be checked at baseline and annually thereafter in patients who are likely to take a PPI long-term. In up to 25% of patients who develop hypomagnesemia, the PPI will need to be discontinued permanently to return magnesium levels to normal and maintain them. In some patients, it is possible to continue the PPI and take a magnesium supplement concurrently to maintain magnesium levels. For information on foods that are rich in magnesium, see our chart.
Taking Esomeprazole Strontium? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly, and this is one nutrient worth paying real attention to if you take esomeprazole long-term. As a proton pump inhibitor, esomeprazole raises the pH inside your intestine, and researchers believe that change interferes with the active process your gut uses to pull magnesium into the bloodstream, so less gets absorbed over time. The risk grows with higher doses and use beyond a year, and the FDA recommends that your magnesium level be checked before starting and then once a year if you stay on this medication. Please bring this up with your doctor or pharmacist so they can decide whether monitoring or a supplement makes sense for you.

References (18)
  1. Safety Alert. Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use. U.S. Food and Drug Administration, March 2, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/
  2. Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series. QJM 2010;103:387-95. PubMed
  3. Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors--a review. Neth J Med 2009;67:169-72.
  4. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 2008;69:338-41. PubMed
  5. Doornebal J, Bijlsma R, Brouwer RM. [An unknown but potentially serious side effect of proton pump inhibitors: hypomagnesaemia]. Ned Tijdschr Geneeskd 2009;153:A711.
  6. Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6. PubMed
  7. François M, Lévy-Bohbot N, Caron J, Durlach V. [Chronic use of proton-pump inhibitors associated with giardiasis: A rare cause of hypomagnesemic hypoparathyroidism?]. Ann Endocrinol (Paris) 2008;69:446-8.
  8. Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6. PubMed
  9. Hoorn EJ, van der Hoek J, de Man RA, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6. PubMed
  10. Regolisti G, Cabassi A, Parenti E, et al. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74. PubMed
  11. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5. PubMed
  12. Delgado MG, Calleja S, Suarez L, Pascual J. Recurrent confusional episodes associated with hypomagnesaemia due to esomeprazol. BMJ Case Rep 2013;2013. PubMed
  13. Krupa LZ, Fellows IW. Lansoprazole-induced hypomagnesaemia. BMJ Case Rep 2014;2014. PubMed
  14. Liao S, Gan L, Mei Z. Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e15011. PubMed
  15. Srinutta T, Chewcharat A, Takkavatakarn K, et al. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies. Medicine (Baltimore). 2019 Nov;98(44):e17788. PubMed
  16. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed
  17. Anna Vermeulen Windsant-van den Tweel AM, Derijks HJ, Gadiot NPPM, Keijsers CJPW. Proton Pump Inhibitors and Hypomagnesemia in Older Inpatients: An Observational Study. Sr Care Pharm 2022;37(12):623-630. PubMed
  18. Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.

Full nutrient report for Esomeprazole Strontium →

Esomeprazole, Naproxen

Major Depletion

Brand names include Vimovo

Hypomagnesemia requiring supplementation has been reported with all PPIs.

Taking a PPI long-term, especially over a year, has been linked to an increased risk of hypomagnesemia in observational research. Higher doses are associated with a two-fold increase in the odds of hypomagnesemia when compared with lower doses. Observational research in elderly hospitalized patients has also found that males, smokers, and heavy alcohol use further increase the risk of hypomagnesemia from PPI use. PPIs increase intestinal pH which is thought to inhibit active transport of magnesium in the intestine, reducing its absorption. The American College of Gastroenterology (ACG) does not provide a recommendation related to monitoring magnesium levels in patients taking PPIs. However, other experts, including the US Food and Drug Administration (FDA), recommend that serum magnesium levels should be checked at baseline and annually thereafter in patients who are likely to take a PPI long-term. In up to 25% of patients who develop hypomagnesemia, the PPI will need to be discontinued permanently to return magnesium levels to normal and maintain them. In some patients, it is possible to continue the PPI and take a magnesium supplement concurrently to maintain magnesium levels. For information on foods that are rich in magnesium, see our chart.
Taking Esomeprazole, Naproxen? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart rhythm, and nerve signals all depend on, so keeping levels in a healthy range really matters. Esomeprazole belongs to a class of acid-suppressing drugs called PPIs, and over time these medications raise the pH inside your intestine in a way that appears to block a key transport system your gut uses to pull magnesium into your body. This is a well-documented concern, not a theoretical one, and the FDA has weighed in recommending that people likely to take a PPI for the long haul have their magnesium level checked at the start and once a year after that. If you have been on esomeprazole for a year or more, it is worth bringing this up with your pharmacist or doctor at your next visit.

References (18)
  1. Safety Alert. Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use. U.S. Food and Drug Administration, March 2, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/
  2. Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series. QJM 2010;103:387-95. PubMed
  3. Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors--a review. Neth J Med 2009;67:169-72.
  4. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 2008;69:338-41. PubMed
  5. Doornebal J, Bijlsma R, Brouwer RM. [An unknown but potentially serious side effect of proton pump inhibitors: hypomagnesaemia]. Ned Tijdschr Geneeskd 2009;153:A711.
  6. Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6. PubMed
  7. François M, Lévy-Bohbot N, Caron J, Durlach V. [Chronic use of proton-pump inhibitors associated with giardiasis: A rare cause of hypomagnesemic hypoparathyroidism?]. Ann Endocrinol (Paris) 2008;69:446-8.
  8. Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6. PubMed
  9. Hoorn EJ, van der Hoek J, de Man RA, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6. PubMed
  10. Regolisti G, Cabassi A, Parenti E, et al. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74. PubMed
  11. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5. PubMed
  12. Delgado MG, Calleja S, Suarez L, Pascual J. Recurrent confusional episodes associated with hypomagnesaemia due to esomeprazol. BMJ Case Rep 2013;2013. PubMed
  13. Krupa LZ, Fellows IW. Lansoprazole-induced hypomagnesaemia. BMJ Case Rep 2014;2014. PubMed
  14. Liao S, Gan L, Mei Z. Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e15011. PubMed
  15. Srinutta T, Chewcharat A, Takkavatakarn K, et al. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies. Medicine (Baltimore). 2019 Nov;98(44):e17788. PubMed
  16. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed
  17. Anna Vermeulen Windsant-van den Tweel AM, Derijks HJ, Gadiot NPPM, Keijsers CJPW. Proton Pump Inhibitors and Hypomagnesemia in Older Inpatients: An Observational Study. Sr Care Pharm 2022;37(12):623-630. PubMed
  18. Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.

Full nutrient report for Esomeprazole, Naproxen →

Fluticasone Proprionate, Salmeterol

Insignificant Depletion

Brand names include Airduo Respiclick

Beta-2 agonists cause small, generally reversible decreases in magnesium levels.

Beta-2 agonists promote movement of magnesium from the extracellular to the intracellular space, and increase magnesium excretion in the urine. Reduced serum magnesium levels occur after a single dose of albuterol or terbutaline orally, by IV infusion, SC injection, or by inhalation. The reductions are generally small, about 4.5-9%, or 0.04 to 0.06 mmol/L compared with the normal serum magnesium range of 0.65 to 1.1 mmol/L. However, these acute changes could contribute to ECG changes, including prolonged QT intervals. With chronic use of beta-2 agonists, serum magnesium levels generally return to normal, but muscle magnesium levels may remain low. For information on foods that are rich in magnesium, see our chart.
Taking Fluticasone Proprionate, Salmeterol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Salmeterol is a beta-2 agonist, and that class of medication can nudge magnesium, a mineral your muscles and heart rhythm depend on, to shift from the bloodstream into cells while also nudging the kidneys to excrete a little more of it. The drops seen are generally small and tend to reverse on their own with continued use, which is why this interaction is rated insignificant for most people. A routine supplement is not considered necessary, but if you have any concerns about your heart rhythm or muscle cramping while using this inhaler, it is worth bringing up with your pharmacist or doctor.

References (10)
  1. Tveskov C, Djurhuus MS, Klitgaard NAH, Egstrup K. Potassium and magnesium distribution, ECG changes, and ventricular ectopic beats during beta-2-adrenergic stimulation with terbutaline in healthy subjects. Chest 1994;106:1654-9..
  2. Whyte KF, Addis GJ, Whitesmith R, Reid JL. Adrenergic control of plasma magnesium in man. Clin Sci 1987;72:135-8.. PubMed
  3. Rolla G, Bucca C. Magnesium, beta-agonists, and asthma. Lancet 1988;1:989. PubMed
  4. Bremme K, Eneroth P, Nordstrom L, Nilsson B. Effects of infusion of the beta-adrenoceptor agonist terbutaline on serum magnesium in pregnant women. Magnesium 1986;5:85-94.
  5. Khilnani G, Parchani H, Toshniwal G. Hypomagnesemia due to beta 2-agonist use in bronchial asthma. J Assoc Physicians India 1992;40:346..
  6. Bos WJ, Postma DS, van Doormaal JJ. Magnesiuric and calciuric effects of terbutaline in man. Clin Sci 1988;74:595-7.. PubMed
  7. Lipworth BJ, McDevitt DG. Beta-adrenoceptor responses to inhaled salbutamol in normal subjects. Eur J Clin Pharmacol 1989;36:239-45.. PubMed
  8. Rahman ARA, McDevitt DG, Struthers AD, Lipworth BJ. The effects of enalapril and spironolactone on terbutaline-induced hypokalemia. Chest 1992;102:91-5..
  9. Gustafson T, Boman K, Rosenhall L, et al. Skeletal muscle magnesium and potassium in asthmatics treated with oral beta-2-agonists. Eur Resp J 1996;9:237-40.. PubMed
  10. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..

Full nutrient report for Fluticasone Proprionate, Salmeterol →

Inhaled Insulin

Insignificant Depletion

Brand names include Exubera

Insulin can increase magnesium excretion.

Insulin can enhance the renal excretion of magnesium. Theoretically, it might lower magnesium stores; however, lower magnesium stores are common in patients with diabetes due to decreased intake and osmotic diuresis resulting in increased magnesium excretion. For information on foods that are rich in magnesium, see our chart.
Taking Inhaled Insulin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles, nerves, and blood sugar stay steady, so it plays a real role for people managing diabetes. Insulin, including the inhaled form, can nudge the kidneys to release a little more magnesium in the urine than usual. That said, the evidence here is rated insignificant, meaning this is more of a theoretical concern than a practical one for most people. If you have questions about your magnesium levels, your doctor or pharmacist is the right person to ask.

References (1)
  1. De Leeuw I, Engelen W, De Block C, Van Gaal L. Long term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm). Magnes Res 2004;17:109-14..

Full nutrient report for Inhaled Insulin →

Insulin

Insignificant Depletion

Brand names include NovoRapid Insulin

Insulin can increase magnesium excretion.

Insulin can enhance the renal excretion of magnesium. Theoretically, it might lower magnesium stores; however, lower magnesium stores are common in patients with diabetes due to decreased intake and osmotic diuresis resulting in increased magnesium excretion. For information on foods that are rich in magnesium, see our chart.
Taking Insulin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, nerves, and heart rhythm working properly. Insulin can nudge the kidneys to release a little more magnesium into the urine than usual, which in theory could chip away at your body's stores over time. That said, the evidence puts this in the 'insignificant' category, meaning most people using insulin don't need a supplement just for this reason. If you have concerns, a quick conversation with your pharmacist or doctor can help you figure out whether your levels are worth checking.

References (1)
  1. De Leeuw I, Engelen W, De Block C, Van Gaal L. Long term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm). Magnes Res 2004;17:109-14..

Full nutrient report for Insulin →

Insulin (Bovine)

Insignificant Depletion

Brand names include Hypurin Bovine Neutral

Insulin can increase magnesium excretion.

Insulin can enhance the renal excretion of magnesium. Theoretically, it might lower magnesium stores; however, lower magnesium stores are common in patients with diabetes due to decreased intake and osmotic diuresis resulting in increased magnesium excretion. For information on foods that are rich in magnesium, see our chart.
Taking Insulin (Bovine)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on every day. Insulin can nudge the kidneys to release a little more magnesium in the urine than usual, which theoretically could chip away at your body's stores over time. That said, the evidence here is rated insignificant, meaning most people on insulin don't need a supplement just because of the medication itself. If you have concerns, a quick chat with your pharmacist or doctor can put your mind at ease.

References (1)
  1. De Leeuw I, Engelen W, De Block C, Van Gaal L. Long term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm). Magnes Res 2004;17:109-14..

Full nutrient report for Insulin (Bovine) →

Insulin (Human)

Insignificant Depletion

Brand names include Novolin N, Novolin 70/30, Novolin R

Insulin can increase magnesium excretion.

Insulin can enhance the renal excretion of magnesium. Theoretically, it might lower magnesium stores; however, lower magnesium stores are common in patients with diabetes due to decreased intake and osmotic diuresis resulting in increased magnesium excretion. For information on foods that are rich in magnesium, see our chart.
Taking Insulin (Human)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on, and insulin appears to prompt the kidneys to release a little more of it into the urine than usual. That said, the evidence rates this as insignificant for most people on insulin, meaning it is not considered a clinically important concern on its own. What is worth knowing is that people with diabetes can have lower magnesium levels for other reasons, such as blood sugar spills pulling extra fluid and minerals through the kidneys. Eating magnesium-rich foods is always a sensible idea, but talk with your pharmacist or doctor before adding a supplement.

References (1)
  1. De Leeuw I, Engelen W, De Block C, Van Gaal L. Long term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm). Magnes Res 2004;17:109-14..

Full nutrient report for Insulin (Human) →

Insulin (Pork)

Insignificant Depletion

Brand names include Lente Iletin II, NPH Iletin, Regular Iletin

Insulin can increase magnesium excretion.

Insulin can enhance the renal excretion of magnesium. Theoretically, it might lower magnesium stores; however, lower magnesium stores are common in patients with diabetes due to decreased intake and osmotic diuresis resulting in increased magnesium excretion. For information on foods that are rich in magnesium, see our chart.
Taking Insulin (Pork)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Insulin can nudge the kidneys to release a little more magnesium in the urine than usual, which is worth knowing about, especially since people with diabetes sometimes run lower in magnesium to begin with. That said, the evidence here is rated insignificant, meaning most people taking insulin do not need extra magnesium because of the medication itself. If you want to double-check your levels or talk through your diet, your pharmacist or doctor is a great place to start.

References (1)
  1. De Leeuw I, Engelen W, De Block C, Van Gaal L. Long term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm). Magnes Res 2004;17:109-14..

Full nutrient report for Insulin (Pork) →

Insulin (rDNA)

Insignificant Depletion

Brand names include Humalog, Humalog Mix 75/25, Humulin R

Insulin can increase magnesium excretion.

Insulin can enhance the renal excretion of magnesium. Theoretically, it might lower magnesium stores; however, lower magnesium stores are common in patients with diabetes due to decreased intake and osmotic diuresis resulting in increased magnesium excretion. For information on foods that are rich in magnesium, see our chart.
Taking Insulin (rDNA)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, nerves, and heart rhythm working properly. Insulin can nudge your kidneys to release a little more magnesium into the urine than usual, which theoretically could chip away at your body's stores over time. That said, the evidence rates this as insignificant for most people on insulin, so routine supplementation is not something the majority of patients need to worry about. If you have diabetes and want to know whether your magnesium level is worth checking, it is a good question to bring up with your doctor or pharmacist.

References (1)
  1. De Leeuw I, Engelen W, De Block C, Van Gaal L. Long term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm). Magnes Res 2004;17:109-14..

Full nutrient report for Insulin (rDNA) →

Insulin determir

Insignificant Depletion

Brand names include Levemir

Insulin can increase magnesium excretion.

Insulin can enhance the renal excretion of magnesium. Theoretically, it might lower magnesium stores; however, lower magnesium stores are common in patients with diabetes due to decreased intake and osmotic diuresis resulting in increased magnesium excretion. For information on foods that are rich in magnesium, see our chart.
Taking Insulin determir? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and it turns out insulin can prompt the kidneys to release a little more of it into the urine than usual. That said, for most people using insulin detemir, this effect is rated as insignificant, meaning it is not expected to cause a real problem on its own. Keep in mind that low magnesium is actually fairly common in people with diabetes for several reasons beyond the medication itself, so if you have any concerns, it is worth bringing up with your pharmacist or doctor.

References (1)
  1. De Leeuw I, Engelen W, De Block C, Van Gaal L. Long term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm). Magnes Res 2004;17:109-14..

Full nutrient report for Insulin determir →

Insulin Glargine

Insignificant Depletion

Brand names include Basaglar, Lusduna, Semglee

Insulin can increase magnesium excretion.

Insulin can enhance the renal excretion of magnesium. Theoretically, it might lower magnesium stores; however, lower magnesium stores are common in patients with diabetes due to decreased intake and osmotic diuresis resulting in increased magnesium excretion. For information on foods that are rich in magnesium, see our chart.
Taking Insulin Glargine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, nerves, and heart rhythm working properly, so your body really does depend on steady levels of it. Insulin, including glargine, can nudge the kidneys to release a little more magnesium in the urine than usual, which in theory could edge levels down over time. That said, the evidence rates this as insignificant for most people, meaning a magnesium supplement is not something the average person on insulin glargine needs to worry about. If you have diabetes and are curious about your magnesium status, it is worth a quick conversation with your pharmacist or doctor.

References (1)
  1. De Leeuw I, Engelen W, De Block C, Van Gaal L. Long term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm). Magnes Res 2004;17:109-14..

Full nutrient report for Insulin Glargine →

Insulin Glargine (rDNA)

Insignificant Depletion

Brand names include Lantus

Insulin can increase magnesium excretion.

Insulin can enhance the renal excretion of magnesium. Theoretically, it might lower magnesium stores; however, lower magnesium stores are common in patients with diabetes due to decreased intake and osmotic diuresis resulting in increased magnesium excretion. For information on foods that are rich in magnesium, see our chart.
Taking Insulin Glargine (rDNA)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Insulin can nudge the kidneys to release a little more magnesium in the urine than usual, so there is a theoretical possibility of lower levels over time. That said, the evidence rates this as insignificant for most people on insulin glargine, meaning a supplement is not routinely needed. If you have concerns, a simple conversation with your pharmacist or doctor can help you decide whether checking your levels makes sense for you.

References (1)
  1. De Leeuw I, Engelen W, De Block C, Van Gaal L. Long term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm). Magnes Res 2004;17:109-14..

Full nutrient report for Insulin Glargine (rDNA) →

Insulin Glargine Recombinant

Insignificant Depletion

Brand names include Toujeo Solostar

Insulin can increase magnesium excretion.

Insulin can enhance the renal excretion of magnesium. Theoretically, it might lower magnesium stores; however, lower magnesium stores are common in patients with diabetes due to decreased intake and osmotic diuresis resulting in increased magnesium excretion. For information on foods that are rich in magnesium, see our chart.
Taking Insulin Glargine Recombinant? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Insulin, including glargine, can nudge the kidneys to release a little more magnesium in the urine than usual, which theoretically could chip away at your body's stores over time. That said, the evidence rates this as insignificant for most people, meaning a supplement is not something the average insulin user needs to worry about. If you have diabetes and are curious about your magnesium level, it is a reasonable thing to bring up with your doctor or pharmacist at your next visit.

References (1)
  1. De Leeuw I, Engelen W, De Block C, Van Gaal L. Long term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm). Magnes Res 2004;17:109-14..

Full nutrient report for Insulin Glargine Recombinant →

Insulin Glargine, Lixisenatide

Insignificant Depletion

Brand names include Soliqua 100/33

Insulin can increase magnesium excretion.

Insulin can enhance the renal excretion of magnesium. Theoretically, it might lower magnesium stores; however, lower magnesium stores are common in patients with diabetes due to decreased intake and osmotic diuresis resulting in increased magnesium excretion. For information on foods that are rich in magnesium, see our chart.
Taking Insulin Glargine, Lixisenatide? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, nerves, and heartbeat working properly, and people with diabetes sometimes run a little low on it even without medication. Insulin itself can nudge the kidneys to release a bit more magnesium in the urine, so there is a theoretical reason to mention it. That said, the evidence rates this as insignificant for most patients, meaning a supplement is not something the average person on this medication needs to worry about. If you have concerns or already have diabetes-related kidney changes, a quick check-in with your pharmacist or doctor can give you a clearer picture.

References (1)
  1. De Leeuw I, Engelen W, De Block C, Van Gaal L. Long term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm). Magnes Res 2004;17:109-14..

Full nutrient report for Insulin Glargine, Lixisenatide →

Insulin Human, Sodium Chloride

Insignificant Depletion

Brand names include Myxredlin

Insulin can increase magnesium excretion.

Insulin can enhance the renal excretion of magnesium. Theoretically, it might lower magnesium stores; however, lower magnesium stores are common in patients with diabetes due to decreased intake and osmotic diuresis resulting in increased magnesium excretion. For information on foods that are rich in magnesium, see our chart.
Taking Insulin Human, Sodium Chloride? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles contract, keeps your heart rhythm steady, and supports hundreds of chemical reactions throughout the body. Insulin appears to prompt the kidneys to release a little more magnesium into the urine than usual, which could theoretically nudge levels downward over time. That said, the evidence rates this as insignificant, meaning most people on insulin do not need a magnesium supplement because of the medication itself. If you have concerns, especially since low magnesium is already more common in people with diabetes for other reasons, it is worth bringing up with your pharmacist or doctor.

References (1)
  1. De Leeuw I, Engelen W, De Block C, Van Gaal L. Long term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm). Magnes Res 2004;17:109-14..

Full nutrient report for Insulin Human, Sodium Chloride →

Insulin Lispro Recombinant

Insignificant Depletion

Brand names include Humalog Kwikpen

Insulin can increase magnesium excretion.

Insulin can enhance the renal excretion of magnesium. Theoretically, it might lower magnesium stores; however, lower magnesium stores are common in patients with diabetes due to decreased intake and osmotic diuresis resulting in increased magnesium excretion. For information on foods that are rich in magnesium, see our chart.
Taking Insulin Lispro Recombinant? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles contract, keeps your heart rhythm steady, and supports hundreds of chemical reactions throughout the body. Insulin lispro can nudge the kidneys to release a little more magnesium into the urine than usual, which in theory could gradually chip away at your body's stores. That said, the evidence rates this as insignificant for most people, meaning a supplement is not something the average patient on this medication needs to worry about. If you have diabetes and are curious about your magnesium level, it is worth a quick conversation with your pharmacist or doctor, since diet and blood sugar control also play a role.

References (1)
  1. De Leeuw I, Engelen W, De Block C, Van Gaal L. Long term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm). Magnes Res 2004;17:109-14..

Full nutrient report for Insulin Lispro Recombinant →

Ipratropium, Albuterol

Insignificant Depletion

Brand names include Combivent, Combivent Respimat

Beta-2 agonists cause small, generally reversible decreases in magnesium levels.

Beta-2 agonists promote movement of magnesium from the extracellular to the intracellular space, and increase magnesium excretion in the urine. Reduced serum magnesium levels occur after a single dose of albuterol or terbutaline orally, by IV infusion, SC injection, or by inhalation. The reductions are generally small, about 4.5-9%, or 0.04 to 0.06 mmol/L compared with the normal serum magnesium range of 0.65 to 1.1 mmol/L. However, these acute changes could contribute to ECG changes, including prolonged QT intervals. With chronic use of beta-2 agonists, serum magnesium levels generally return to normal, but muscle magnesium levels may remain low. For information on foods that are rich in magnesium, see our chart.
Taking Ipratropium, Albuterol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles contract, keeps your heart rhythm steady, and supports hundreds of chemical reactions in the body. The albuterol component of this inhaler works on beta-2 receptors and, in doing so, can shift magnesium from the bloodstream into cells and nudge the kidneys to excrete a little more of it in urine. That said, the dip in blood magnesium levels is typically small and tends to reverse on its own with regular use, which is why this is rated insignificant. Most people using this inhaler do not need a magnesium supplement, but if you have questions about your levels, a quick conversation with your pharmacist or doctor is always a good idea.

References (10)
  1. Tveskov C, Djurhuus MS, Klitgaard NAH, Egstrup K. Potassium and magnesium distribution, ECG changes, and ventricular ectopic beats during beta-2-adrenergic stimulation with terbutaline in healthy subjects. Chest 1994;106:1654-9..
  2. Whyte KF, Addis GJ, Whitesmith R, Reid JL. Adrenergic control of plasma magnesium in man. Clin Sci 1987;72:135-8.. PubMed
  3. Rolla G, Bucca C. Magnesium, beta-agonists, and asthma. Lancet 1988;1:989. PubMed
  4. Bremme K, Eneroth P, Nordstrom L, Nilsson B. Effects of infusion of the beta-adrenoceptor agonist terbutaline on serum magnesium in pregnant women. Magnesium 1986;5:85-94.
  5. Khilnani G, Parchani H, Toshniwal G. Hypomagnesemia due to beta 2-agonist use in bronchial asthma. J Assoc Physicians India 1992;40:346..
  6. Bos WJ, Postma DS, van Doormaal JJ. Magnesiuric and calciuric effects of terbutaline in man. Clin Sci 1988;74:595-7.. PubMed
  7. Lipworth BJ, McDevitt DG. Beta-adrenoceptor responses to inhaled salbutamol in normal subjects. Eur J Clin Pharmacol 1989;36:239-45.. PubMed
  8. Rahman ARA, McDevitt DG, Struthers AD, Lipworth BJ. The effects of enalapril and spironolactone on terbutaline-induced hypokalemia. Chest 1992;102:91-5..
  9. Gustafson T, Boman K, Rosenhall L, et al. Skeletal muscle magnesium and potassium in asthmatics treated with oral beta-2-agonists. Eur Resp J 1996;9:237-40.. PubMed
  10. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..

Full nutrient report for Ipratropium, Albuterol →

Isoproterenol

Insignificant Depletion

Brand names include Isuprel

Beta-2 agonists cause small, generally reversible decreases in magnesium levels.

Beta-2 agonists promote movement of magnesium from the extracellular to the intracellular space, and increase magnesium excretion in the urine. Reduced serum magnesium levels occur after a single dose of albuterol or terbutaline orally, by IV infusion, SC injection, or by inhalation. The reductions are generally small, about 4.5-9%, or 0.04 to 0.06 mmol/L compared with the normal serum magnesium range of 0.65 to 1.1 mmol/L. However, these acute changes could contribute to ECG changes, including prolonged QT intervals. With chronic use of beta-2 agonists, serum magnesium levels generally return to normal, but muscle magnesium levels may remain low. For information on foods that are rich in magnesium, see our chart.
Taking Isoproterenol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Isoproterenol is a beta-2 agonist, and drugs in this class can nudge magnesium (a mineral your muscles, nerves, and heart rhythm depend on) to shift out of the bloodstream and into cells, while also causing the kidneys to excrete a little more of it in urine. The dip is typically small and tends to normalize with ongoing use, so for most people this is not something that requires action. That said, if you have any heart rhythm concerns or questions about your magnesium levels, it is always worth a quick conversation with your pharmacist or doctor.

References (10)
  1. Tveskov C, Djurhuus MS, Klitgaard NAH, Egstrup K. Potassium and magnesium distribution, ECG changes, and ventricular ectopic beats during beta-2-adrenergic stimulation with terbutaline in healthy subjects. Chest 1994;106:1654-9..
  2. Whyte KF, Addis GJ, Whitesmith R, Reid JL. Adrenergic control of plasma magnesium in man. Clin Sci 1987;72:135-8.. PubMed
  3. Rolla G, Bucca C. Magnesium, beta-agonists, and asthma. Lancet 1988;1:989. PubMed
  4. Bremme K, Eneroth P, Nordstrom L, Nilsson B. Effects of infusion of the beta-adrenoceptor agonist terbutaline on serum magnesium in pregnant women. Magnesium 1986;5:85-94.
  5. Khilnani G, Parchani H, Toshniwal G. Hypomagnesemia due to beta 2-agonist use in bronchial asthma. J Assoc Physicians India 1992;40:346..
  6. Bos WJ, Postma DS, van Doormaal JJ. Magnesiuric and calciuric effects of terbutaline in man. Clin Sci 1988;74:595-7.. PubMed
  7. Lipworth BJ, McDevitt DG. Beta-adrenoceptor responses to inhaled salbutamol in normal subjects. Eur J Clin Pharmacol 1989;36:239-45.. PubMed
  8. Rahman ARA, McDevitt DG, Struthers AD, Lipworth BJ. The effects of enalapril and spironolactone on terbutaline-induced hypokalemia. Chest 1992;102:91-5..
  9. Gustafson T, Boman K, Rosenhall L, et al. Skeletal muscle magnesium and potassium in asthmatics treated with oral beta-2-agonists. Eur Resp J 1996;9:237-40.. PubMed
  10. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..

Full nutrient report for Isoproterenol →

Lansoprazole

Major Depletion

Brand names include Prevacid

Hypomagnesemia requiring supplementation has been reported with all PPIs.

Taking a PPI long-term, especially over a year, has been linked to an increased risk of hypomagnesemia in observational research. Higher doses are associated with a two-fold increase in the odds of hypomagnesemia when compared with lower doses. Observational research in elderly hospitalized patients has also found that males, smokers, and heavy alcohol use further increase the risk of hypomagnesemia from PPI use. PPIs increase intestinal pH which is thought to inhibit active transport of magnesium in the intestine, reducing its absorption. The American College of Gastroenterology (ACG) does not provide a recommendation related to monitoring magnesium levels in patients taking PPIs. However, other experts, including the US Food and Drug Administration (FDA), recommend that serum magnesium levels should be checked at baseline and annually thereafter in patients who are likely to take a PPI long-term. In up to 25% of patients who develop hypomagnesemia, the PPI will need to be discontinued permanently to return magnesium levels to normal and maintain them. In some patients, it is possible to continue the PPI and take a magnesium supplement concurrently to maintain magnesium levels. For information on foods that are rich in magnesium, see our chart.
Taking Lansoprazole? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and lansoprazole belongs to a drug class that can quietly lower your levels over time. It works by raising the pH inside your gut, and researchers think that change interferes with the active process your intestines use to pull magnesium into the bloodstream. Because this is a well-documented concern, people who take lansoprazole long-term, especially beyond a year or at higher doses, are often advised to have their magnesium checked at the start and then roughly once a year. If you've been on it a while, it's worth bringing up with your pharmacist or doctor.

References (18)
  1. Safety Alert. Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use. U.S. Food and Drug Administration, March 2, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/
  2. Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series. QJM 2010;103:387-95. PubMed
  3. Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors--a review. Neth J Med 2009;67:169-72.
  4. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 2008;69:338-41. PubMed
  5. Doornebal J, Bijlsma R, Brouwer RM. [An unknown but potentially serious side effect of proton pump inhibitors: hypomagnesaemia]. Ned Tijdschr Geneeskd 2009;153:A711.
  6. Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6. PubMed
  7. François M, Lévy-Bohbot N, Caron J, Durlach V. [Chronic use of proton-pump inhibitors associated with giardiasis: A rare cause of hypomagnesemic hypoparathyroidism?]. Ann Endocrinol (Paris) 2008;69:446-8.
  8. Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6. PubMed
  9. Hoorn EJ, van der Hoek J, de Man RA, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6. PubMed
  10. Regolisti G, Cabassi A, Parenti E, et al. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74. PubMed
  11. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5. PubMed
  12. Delgado MG, Calleja S, Suarez L, Pascual J. Recurrent confusional episodes associated with hypomagnesaemia due to esomeprazol. BMJ Case Rep 2013;2013. PubMed
  13. Krupa LZ, Fellows IW. Lansoprazole-induced hypomagnesaemia. BMJ Case Rep 2014;2014. PubMed
  14. Liao S, Gan L, Mei Z. Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e15011. PubMed
  15. Srinutta T, Chewcharat A, Takkavatakarn K, et al. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies. Medicine (Baltimore). 2019 Nov;98(44):e17788. PubMed
  16. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed
  17. Anna Vermeulen Windsant-van den Tweel AM, Derijks HJ, Gadiot NPPM, Keijsers CJPW. Proton Pump Inhibitors and Hypomagnesemia in Older Inpatients: An Observational Study. Sr Care Pharm 2022;37(12):623-630. PubMed
  18. Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.

Full nutrient report for Lansoprazole →

Brand names include Prevpac

Hypomagnesemia requiring supplementation has been reported with all PPIs.

Taking a PPI long-term, especially over a year, has been linked to an increased risk of hypomagnesemia in observational research. Higher doses are associated with a two-fold increase in the odds of hypomagnesemia when compared with lower doses. Observational research in elderly hospitalized patients has also found that males, smokers, and heavy alcohol use further increase the risk of hypomagnesemia from PPI use. PPIs increase intestinal pH which is thought to inhibit active transport of magnesium in the intestine, reducing its absorption. The American College of Gastroenterology (ACG) does not provide a recommendation related to monitoring magnesium levels in patients taking PPIs. However, other experts, including the US Food and Drug Administration (FDA), recommend that serum magnesium levels should be checked at baseline and annually thereafter in patients who are likely to take a PPI long-term. In up to 25% of patients who develop hypomagnesemia, the PPI will need to be discontinued permanently to return magnesium levels to normal and maintain them. In some patients, it is possible to continue the PPI and take a magnesium supplement concurrently to maintain magnesium levels. For information on foods that are rich in magnesium, see our chart.
Taking Lansoprazole, Amoxicillin, Clarithromycin? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on, and the lansoprazole in this regimen is the piece most likely to affect it. Lansoprazole is a proton pump inhibitor, and over time these medications raise the pH inside your intestines in a way that seems to interfere with the active process your gut uses to pull magnesium out of food and into your bloodstream. This is rated a major depletion concern, so if you plan to stay on a PPI long-term, it is worth asking your doctor or pharmacist whether your magnesium level should be checked.

References (18)
  1. Safety Alert. Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use. U.S. Food and Drug Administration, March 2, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/
  2. Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series. QJM 2010;103:387-95. PubMed
  3. Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors--a review. Neth J Med 2009;67:169-72.
  4. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 2008;69:338-41. PubMed
  5. Doornebal J, Bijlsma R, Brouwer RM. [An unknown but potentially serious side effect of proton pump inhibitors: hypomagnesaemia]. Ned Tijdschr Geneeskd 2009;153:A711.
  6. Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6. PubMed
  7. François M, Lévy-Bohbot N, Caron J, Durlach V. [Chronic use of proton-pump inhibitors associated with giardiasis: A rare cause of hypomagnesemic hypoparathyroidism?]. Ann Endocrinol (Paris) 2008;69:446-8.
  8. Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6. PubMed
  9. Hoorn EJ, van der Hoek J, de Man RA, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6. PubMed
  10. Regolisti G, Cabassi A, Parenti E, et al. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74. PubMed
  11. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5. PubMed
  12. Delgado MG, Calleja S, Suarez L, Pascual J. Recurrent confusional episodes associated with hypomagnesaemia due to esomeprazol. BMJ Case Rep 2013;2013. PubMed
  13. Krupa LZ, Fellows IW. Lansoprazole-induced hypomagnesaemia. BMJ Case Rep 2014;2014. PubMed
  14. Liao S, Gan L, Mei Z. Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e15011. PubMed
  15. Srinutta T, Chewcharat A, Takkavatakarn K, et al. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies. Medicine (Baltimore). 2019 Nov;98(44):e17788. PubMed
  16. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed
  17. Anna Vermeulen Windsant-van den Tweel AM, Derijks HJ, Gadiot NPPM, Keijsers CJPW. Proton Pump Inhibitors and Hypomagnesemia in Older Inpatients: An Observational Study. Sr Care Pharm 2022;37(12):623-630. PubMed
  18. Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.

Full nutrient report for Lansoprazole, Amoxicillin, Clarithromycin →

Levalbuterol

Insignificant Depletion

Brand names include Xopenex

Beta-2 agonists cause small, generally reversible decreases in magnesium levels.

Beta-2 agonists promote movement of magnesium from the extracellular to the intracellular space, and increase magnesium excretion in the urine. Reduced serum magnesium levels occur after a single dose of albuterol or terbutaline orally, by IV infusion, SC injection, or by inhalation. The reductions are generally small, about 4.5-9%, or 0.04 to 0.06 mmol/L compared with the normal serum magnesium range of 0.65 to 1.1 mmol/L. However, these acute changes could contribute to ECG changes, including prolonged QT intervals. With chronic use of beta-2 agonists, serum magnesium levels generally return to normal, but muscle magnesium levels may remain low. For information on foods that are rich in magnesium, see our chart.
Taking Levalbuterol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles and heart rhythm work properly, so even small dips in it matter a little. Levalbuterol, like other beta-2 agonists, nudges magnesium to shift from your bloodstream into your cells and also causes your kidneys to release a bit more of it in urine. The good news is that these changes are small and tend to reverse on their own with ongoing use, which is why this is rated insignificant for most people. No supplement is typically needed, but if you use levalbuterol regularly and have any concerns, a quick chat with your pharmacist or doctor is always a reasonable step.

References (10)
  1. Tveskov C, Djurhuus MS, Klitgaard NAH, Egstrup K. Potassium and magnesium distribution, ECG changes, and ventricular ectopic beats during beta-2-adrenergic stimulation with terbutaline in healthy subjects. Chest 1994;106:1654-9..
  2. Whyte KF, Addis GJ, Whitesmith R, Reid JL. Adrenergic control of plasma magnesium in man. Clin Sci 1987;72:135-8.. PubMed
  3. Rolla G, Bucca C. Magnesium, beta-agonists, and asthma. Lancet 1988;1:989. PubMed
  4. Bremme K, Eneroth P, Nordstrom L, Nilsson B. Effects of infusion of the beta-adrenoceptor agonist terbutaline on serum magnesium in pregnant women. Magnesium 1986;5:85-94.
  5. Khilnani G, Parchani H, Toshniwal G. Hypomagnesemia due to beta 2-agonist use in bronchial asthma. J Assoc Physicians India 1992;40:346..
  6. Bos WJ, Postma DS, van Doormaal JJ. Magnesiuric and calciuric effects of terbutaline in man. Clin Sci 1988;74:595-7.. PubMed
  7. Lipworth BJ, McDevitt DG. Beta-adrenoceptor responses to inhaled salbutamol in normal subjects. Eur J Clin Pharmacol 1989;36:239-45.. PubMed
  8. Rahman ARA, McDevitt DG, Struthers AD, Lipworth BJ. The effects of enalapril and spironolactone on terbutaline-induced hypokalemia. Chest 1992;102:91-5..
  9. Gustafson T, Boman K, Rosenhall L, et al. Skeletal muscle magnesium and potassium in asthmatics treated with oral beta-2-agonists. Eur Resp J 1996;9:237-40.. PubMed
  10. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..

Full nutrient report for Levalbuterol →

Levofloxacin

Insignificant Depletion

Brand names include Levaquin, Levaquin Injection, Leva-pak

Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Levofloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles, nerves, and heart rhythm work properly, so it is worth understanding how levofloxacin fits in. This antibiotic belongs to a class called quinolones, which can latch onto magnesium in the gut and form a complex that briefly slows absorption of both. In practice, though, this interaction is rated as insignificant for your magnesium levels, meaning a supplement is not something most people need while taking a short antibiotic course. If you do take magnesium regularly, just ask your pharmacist about spacing it a couple of hours apart from your levofloxacin dose.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Levofloxacin →

Levofloxacin (ophthalmic)

Insignificant Depletion

Brand names include Levofloxacin

Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Levofloxacin (ophthalmic)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Here is the thing to keep in mind with levofloxacin eye drops though: the absorption concern that comes up with quinolone antibiotics involves the gut, where the drug can latch onto magnesium and reduce how much of each gets absorbed. Since these are eye drops, the medication is not traveling through your digestive tract, so any effect on magnesium levels is considered insignificant. For most people using this form, there is nothing to worry about, but if you have questions about your magnesium levels in general, your pharmacist or doctor is a good place to start.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Levofloxacin (ophthalmic) →

Lomefloxacin

Insignificant Depletion

Brand names include Maxaquin

Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Lomefloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Lomefloxacin belongs to the quinolone antibiotic family, and quinolones can physically bind to magnesium in the gut, which in theory could reduce how much magnesium your body absorbs. In practice, this interaction is considered insignificant for most people, especially because lomefloxacin is taken for short courses. If you happen to use magnesium supplements, spacing them at least two hours apart from your antibiotic dose is a simple, sensible precaution worth mentioning to your pharmacist.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Lomefloxacin →

Metaproterenol

Insignificant Depletion

Brand names include Metaprel

Beta-2 agonists cause small, generally reversible decreases in magnesium levels.

Beta-2 agonists promote movement of magnesium from the extracellular to the intracellular space, and increase magnesium excretion in the urine. Reduced serum magnesium levels occur after a single dose of albuterol or terbutaline orally, by IV infusion, SC injection, or by inhalation. The reductions are generally small, about 4.5-9%, or 0.04 to 0.06 mmol/L compared with the normal serum magnesium range of 0.65 to 1.1 mmol/L. However, these acute changes could contribute to ECG changes, including prolonged QT intervals. With chronic use of beta-2 agonists, serum magnesium levels generally return to normal, but muscle magnesium levels may remain low. For information on foods that are rich in magnesium, see our chart.
Taking Metaproterenol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles contract, keeps your heart rhythm steady, and supports hundreds of chemical reactions throughout the body. Metaproterenol is a beta-2 agonist, and drugs in this class can nudge magnesium out of the bloodstream and into cells, while also causing the kidneys to release a bit more of it in the urine. That said, this effect is rated insignificant, the dip is small and tends to reverse on its own with continued use, so most people taking this medication do not need a magnesium supplement. If you have any concerns, your pharmacist or doctor is the right person to check in with.

References (10)
  1. Tveskov C, Djurhuus MS, Klitgaard NAH, Egstrup K. Potassium and magnesium distribution, ECG changes, and ventricular ectopic beats during beta-2-adrenergic stimulation with terbutaline in healthy subjects. Chest 1994;106:1654-9..
  2. Whyte KF, Addis GJ, Whitesmith R, Reid JL. Adrenergic control of plasma magnesium in man. Clin Sci 1987;72:135-8.. PubMed
  3. Rolla G, Bucca C. Magnesium, beta-agonists, and asthma. Lancet 1988;1:989. PubMed
  4. Bremme K, Eneroth P, Nordstrom L, Nilsson B. Effects of infusion of the beta-adrenoceptor agonist terbutaline on serum magnesium in pregnant women. Magnesium 1986;5:85-94.
  5. Khilnani G, Parchani H, Toshniwal G. Hypomagnesemia due to beta 2-agonist use in bronchial asthma. J Assoc Physicians India 1992;40:346..
  6. Bos WJ, Postma DS, van Doormaal JJ. Magnesiuric and calciuric effects of terbutaline in man. Clin Sci 1988;74:595-7.. PubMed
  7. Lipworth BJ, McDevitt DG. Beta-adrenoceptor responses to inhaled salbutamol in normal subjects. Eur J Clin Pharmacol 1989;36:239-45.. PubMed
  8. Rahman ARA, McDevitt DG, Struthers AD, Lipworth BJ. The effects of enalapril and spironolactone on terbutaline-induced hypokalemia. Chest 1992;102:91-5..
  9. Gustafson T, Boman K, Rosenhall L, et al. Skeletal muscle magnesium and potassium in asthmatics treated with oral beta-2-agonists. Eur Resp J 1996;9:237-40.. PubMed
  10. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..

Full nutrient report for Metaproterenol →

Brand names include Pylera

Tetracyclines may bind to dietary magnesium, reducing absorption of both agents.

Tetracyclines form complexes with magnesium in the GI tract, which could reduce absorption of both the tetracycline and magnesium. Significant effects on magnesium levels are unlikely when tetracyclines are taken on an empty stomach, 1 hour before or 2 hours after magnesium supplements.
Taking Metronidazole, Tetracyline, Bismuth Subcitrate Potassium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles, nerves, and heart rhythm work properly. In this three-drug combination, the tetracycline component is the one worth noting here: it can physically latch onto magnesium in the digestive tract, forming a complex that may slightly reduce how much magnesium your body absorbs. That said, the evidence rates this as insignificant for most people, so a magnesium supplement is generally not needed. If you are already taking a separate magnesium supplement, ask your pharmacist about spacing it out from your antibiotic doses.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Metronidazole, Tetracyline, Bismuth Subcitrate Potassium →

Minocycline

Insignificant Depletion

Brand names include Vectrin, Dynacin, Minocin

Tetracyclines may bind to dietary magnesium, reducing absorption of both agents.

Tetracyclines form complexes with magnesium in the GI tract, which could reduce absorption of both the tetracycline and magnesium. Significant effects on magnesium levels are unlikely when tetracyclines are taken on an empty stomach, 1 hour before or 2 hours after magnesium supplements.
Taking Minocycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles contract, keeps your heart rhythm steady, and supports hundreds of chemical reactions throughout the body. Minocycline belongs to the tetracycline family of antibiotics, and these drugs can latch onto magnesium in the gut, forming a complex that makes it harder for your body to absorb either one fully. That said, the evidence rates this as insignificant for most people, so it is not something the average patient needs to worry about. If you are on minocycline long-term and also take magnesium supplements, just ask your pharmacist about spacing them apart to sidestep any interaction.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Minocycline →

Minocycline Hydrochloride

Insignificant Depletion

Brand names include Ximino, Minolira

Tetracyclines may bind to dietary magnesium, reducing absorption of both agents.

Tetracyclines form complexes with magnesium in the GI tract, which could reduce absorption of both the tetracycline and magnesium. Significant effects on magnesium levels are unlikely when tetracyclines are taken on an empty stomach, 1 hour before or 2 hours after magnesium supplements.
Taking Minocycline Hydrochloride? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Minocycline belongs to the tetracycline antibiotic family, and like other tetracyclines it can latch onto magnesium in your gut, forming a kind of chemical pair that makes it harder for your body to absorb either one. That said, this interaction is rated insignificant, meaning meaningful changes to your magnesium levels are not expected for most people taking it. If you are also taking a magnesium supplement, just ask your pharmacist about spacing the two apart to keep things simple.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Minocycline Hydrochloride →

Moxifloxacin

Insignificant Depletion

Brand names include Avelox

Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Moxifloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles, nerves, and heart rhythm stay steady, so it is worth knowing that moxifloxacin, like other quinolone antibiotics, can latch onto magnesium in the gut and form a complex that keeps both the drug and the mineral from being fully absorbed. In practice, though, this is only a concern if you are taking magnesium supplements right alongside the antibiotic. Since moxifloxacin is a short course, most people do not need to worry about their magnesium levels at all. If you do take magnesium supplements, just ask your pharmacist about spacing them a few hours apart from your antibiotic.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Moxifloxacin →

Nalidixic Acid

Insignificant Depletion

Brand names include NegGram

Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Nalidixic Acid? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Nalidixic acid belongs to a class of antibiotics that can latch onto magnesium in the digestive tract, forming a complex that may slightly reduce how much magnesium your body absorbs. That said, the evidence rates this as insignificant for most people, so a supplement is not something most patients need to worry about. If you do take magnesium separately, spacing it a couple of hours away from your antibiotic is a sensible habit worth mentioning to your pharmacist.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Nalidixic Acid →

Norfloxacin

Insignificant Depletion

Brand names include Norflox, Noroxin

Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Norfloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles contract, keeps your heart rhythm steady, and supports hundreds of chemical reactions throughout the body. Norfloxacin, like other quinolone antibiotics, can latch onto magnesium in the gut and form a complex that limits how well either one is absorbed. That sounds concerning, but the evidence rates this as insignificant for most people, especially since the antibiotic is taken for only a short course. If you also take a magnesium supplement, just ask your pharmacist about spacing the two apart to sidestep any interaction.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Norfloxacin →

Ofloxacin

Insignificant Depletion

Brand names include Oflox, Floxin, Floxin Injection

Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Ofloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Ofloxacin belongs to a class of antibiotics that can latch onto magnesium in the digestive tract, which in theory could reduce how much of the mineral gets absorbed. That said, this is rated as insignificant, so for a typical short course of ofloxacin most people do not need to worry about it. If you happen to take a magnesium supplement, just mention it to your pharmacist, who can advise on the best timing.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Ofloxacin →

Omadacycline (IV)

Insignificant Depletion

Brand names include Nuzyra

Tetracyclines may bind to dietary magnesium, reducing absorption of both agents.

Tetracyclines form complexes with magnesium in the GI tract, which could reduce absorption of both the tetracycline and magnesium. Significant effects on magnesium levels are unlikely when tetracyclines are taken on an empty stomach, 1 hour before or 2 hours after magnesium supplements.
Taking Omadacycline (IV)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, heart rhythm, and nerves working properly. Omadacycline belongs to the tetracycline antibiotic family, and like other tetracyclines it can latch onto magnesium in the gut and form a complex that neither gets absorbed as well. In practice though, since IV omadacycline bypasses the digestive tract entirely, any effect on magnesium from this route is considered insignificant, and most patients do not need to worry about it or take a supplement. If you have questions about your magnesium levels, your pharmacist or doctor is the right person to ask.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Omadacycline (IV) →

Omadacycline (Oral)

Insignificant Depletion

Brand names include Nuzyra

Tetracyclines may bind to dietary magnesium, reducing absorption of both agents.

Tetracyclines form complexes with magnesium in the GI tract, which could reduce absorption of both the tetracycline and magnesium. Significant effects on magnesium levels are unlikely when tetracyclines are taken on an empty stomach, 1 hour before or 2 hours after magnesium supplements.
Taking Omadacycline (Oral)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles contract, keeps your heart rhythm steady, and supports hundreds of chemical reactions throughout the body. Omadacycline, like other tetracycline antibiotics, can physically latch onto magnesium in the gut and form a complex that neither the drug nor the mineral absorbs well. In practice, this interaction is rated insignificant, and since omadacycline is already taken on an empty stomach, meaningful magnesium loss is very unlikely for most people. No action is needed for the typical short course, but if you have any concerns, a quick chat with your pharmacist is always a good idea.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Omadacycline (Oral) →

Omeprazole

Major Depletion

Brand names include Prilosec, Zegerid, Losec

Hypomagnesemia requiring supplementation has been reported with all PPIs.

Taking a PPI long-term, especially over a year, has been linked to an increased risk of hypomagnesemia in observational research. Higher doses are associated with a two-fold increase in the odds of hypomagnesemia when compared with lower doses. Observational research in elderly hospitalized patients has also found that males, smokers, and heavy alcohol use further increase the risk of hypomagnesemia from PPI use. PPIs increase intestinal pH which is thought to inhibit active transport of magnesium in the intestine, reducing its absorption. The American College of Gastroenterology (ACG) does not provide a recommendation related to monitoring magnesium levels in patients taking PPIs. However, other experts, including the US Food and Drug Administration (FDA), recommend that serum magnesium levels should be checked at baseline and annually thereafter in patients who are likely to take a PPI long-term. In up to 25% of patients who develop hypomagnesemia, the PPI will need to be discontinued permanently to return magnesium levels to normal and maintain them. In some patients, it is possible to continue the PPI and take a magnesium supplement concurrently to maintain magnesium levels. For information on foods that are rich in magnesium, see our chart.
Taking Omeprazole? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and omeprazole has a well-documented connection to lowering it over time. Omeprazole reduces acid in the stomach, and that higher intestinal pH seems to interfere with the active process your gut uses to pull magnesium into your body, so less gets absorbed. This is rated a major depletion, meaning long-term users, especially those on higher doses or taking it for more than a year, have a real reason to bring this up with their doctor or pharmacist and ask whether their magnesium levels should be checked.

References (18)
  1. Safety Alert. Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use. U.S. Food and Drug Administration, March 2, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/
  2. Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series. QJM 2010;103:387-95. PubMed
  3. Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors--a review. Neth J Med 2009;67:169-72.
  4. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 2008;69:338-41. PubMed
  5. Doornebal J, Bijlsma R, Brouwer RM. [An unknown but potentially serious side effect of proton pump inhibitors: hypomagnesaemia]. Ned Tijdschr Geneeskd 2009;153:A711.
  6. Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6. PubMed
  7. François M, Lévy-Bohbot N, Caron J, Durlach V. [Chronic use of proton-pump inhibitors associated with giardiasis: A rare cause of hypomagnesemic hypoparathyroidism?]. Ann Endocrinol (Paris) 2008;69:446-8.
  8. Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6. PubMed
  9. Hoorn EJ, van der Hoek J, de Man RA, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6. PubMed
  10. Regolisti G, Cabassi A, Parenti E, et al. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74. PubMed
  11. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5. PubMed
  12. Delgado MG, Calleja S, Suarez L, Pascual J. Recurrent confusional episodes associated with hypomagnesaemia due to esomeprazol. BMJ Case Rep 2013;2013. PubMed
  13. Krupa LZ, Fellows IW. Lansoprazole-induced hypomagnesaemia. BMJ Case Rep 2014;2014. PubMed
  14. Liao S, Gan L, Mei Z. Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e15011. PubMed
  15. Srinutta T, Chewcharat A, Takkavatakarn K, et al. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies. Medicine (Baltimore). 2019 Nov;98(44):e17788. PubMed
  16. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed
  17. Anna Vermeulen Windsant-van den Tweel AM, Derijks HJ, Gadiot NPPM, Keijsers CJPW. Proton Pump Inhibitors and Hypomagnesemia in Older Inpatients: An Observational Study. Sr Care Pharm 2022;37(12):623-630. PubMed
  18. Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.

Full nutrient report for Omeprazole →

Brand names include Konvomep

Hypomagnesemia requiring supplementation has been reported with all PPIs.

Taking a PPI long-term, especially over a year, has been linked to an increased risk of hypomagnesemia in observational research. Higher doses are associated with a two-fold increase in the odds of hypomagnesemia when compared with lower doses. Observational research in elderly hospitalized patients has also found that males, smokers, and heavy alcohol use further increase the risk of hypomagnesemia from PPI use. PPIs increase intestinal pH which is thought to inhibit active transport of magnesium in the intestine, reducing its absorption. The American College of Gastroenterology (ACG) does not provide a recommendation related to monitoring magnesium levels in patients taking PPIs. However, other experts, including the US Food and Drug Administration (FDA), recommend that serum magnesium levels should be checked at baseline and annually thereafter in patients who are likely to take a PPI long-term. In up to 25% of patients who develop hypomagnesemia, the PPI will need to be discontinued permanently to return magnesium levels to normal and maintain them. In some patients, it is possible to continue the PPI and take a magnesium supplement concurrently to maintain magnesium levels. For information on foods that are rich in magnesium, see our chart.
Taking Omeprazole, Sodium Bicarbonate? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly. Omeprazole belongs to a class of drugs called PPIs, and one well-documented way they can lower magnesium is by raising the pH inside your intestine, which seems to interfere with the active process your gut uses to pull magnesium into your body. This is rated a major depletion concern, and research shows the risk grows meaningfully the longer you take a PPI, especially past a year. If you are on this medication long-term, it is worth asking your pharmacist or doctor whether your magnesium levels should be checked.

References (18)
  1. Safety Alert. Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use. U.S. Food and Drug Administration, March 2, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/
  2. Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series. QJM 2010;103:387-95. PubMed
  3. Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors--a review. Neth J Med 2009;67:169-72.
  4. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 2008;69:338-41. PubMed
  5. Doornebal J, Bijlsma R, Brouwer RM. [An unknown but potentially serious side effect of proton pump inhibitors: hypomagnesaemia]. Ned Tijdschr Geneeskd 2009;153:A711.
  6. Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6. PubMed
  7. François M, Lévy-Bohbot N, Caron J, Durlach V. [Chronic use of proton-pump inhibitors associated with giardiasis: A rare cause of hypomagnesemic hypoparathyroidism?]. Ann Endocrinol (Paris) 2008;69:446-8.
  8. Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6. PubMed
  9. Hoorn EJ, van der Hoek J, de Man RA, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6. PubMed
  10. Regolisti G, Cabassi A, Parenti E, et al. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74. PubMed
  11. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5. PubMed
  12. Delgado MG, Calleja S, Suarez L, Pascual J. Recurrent confusional episodes associated with hypomagnesaemia due to esomeprazol. BMJ Case Rep 2013;2013. PubMed
  13. Krupa LZ, Fellows IW. Lansoprazole-induced hypomagnesaemia. BMJ Case Rep 2014;2014. PubMed
  14. Liao S, Gan L, Mei Z. Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e15011. PubMed
  15. Srinutta T, Chewcharat A, Takkavatakarn K, et al. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies. Medicine (Baltimore). 2019 Nov;98(44):e17788. PubMed
  16. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed
  17. Anna Vermeulen Windsant-van den Tweel AM, Derijks HJ, Gadiot NPPM, Keijsers CJPW. Proton Pump Inhibitors and Hypomagnesemia in Older Inpatients: An Observational Study. Sr Care Pharm 2022;37(12):623-630. PubMed
  18. Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.

Full nutrient report for Omeprazole, Sodium Bicarbonate →

Oxytetracycline

Insignificant Depletion

Brand names include Terramycin

Tetracyclines may bind to dietary magnesium, reducing absorption of both agents.

Tetracyclines form complexes with magnesium in the GI tract, which could reduce absorption of both the tetracycline and magnesium. Significant effects on magnesium levels are unlikely when tetracyclines are taken on an empty stomach, 1 hour before or 2 hours after magnesium supplements.
Taking Oxytetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, nerves, and heartbeat working smoothly. Here is something interesting about oxytetracycline: it can physically latch onto magnesium in your digestive tract, forming a complex that makes it harder for your body to absorb either one. That said, this interaction is rated insignificant, meaning it is not expected to cause a meaningful drop in your magnesium levels for most people, especially when the antibiotic is taken on an empty stomach. No extra magnesium supplementation is needed for most patients, but if you have questions about timing your medications, your pharmacist is a great person to ask.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Oxytetracycline →

Brand names include Urobiotic

Tetracyclines may bind to dietary magnesium, reducing absorption of both agents.

Tetracyclines form complexes with magnesium in the GI tract, which could reduce absorption of both the tetracycline and magnesium. Significant effects on magnesium levels are unlikely when tetracyclines are taken on an empty stomach, 1 hour before or 2 hours after magnesium supplements.
Taking Oxytetracycline, Phenazopyridine, Sulfamethizole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on every day. The tetracycline component of this combination (oxytetracycline) can latch onto magnesium in the gut, forming a complex that makes it harder for your body to absorb either one fully. That said, this interaction is rated insignificant, meaning noticeable changes in your magnesium level are unlikely for most people taking this medication. If you have questions or take magnesium supplements, ask your pharmacist about timing them correctly.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Oxytetracycline, Phenazopyridine, Sulfamethizole →

Ozenoxacin

Insignificant Depletion

Brand names include Xepi

Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Ozenoxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Ozenoxacin is a topical quinolone antibiotic used on the skin, so it is not swallowed, meaning the gut interaction that sometimes occurs with oral quinolones (where the drug can latch onto magnesium in the digestive tract and reduce absorption of both) simply does not apply here. The evidence rating for this pair is insignificant, so for most people using ozenoxacin cream there is nothing to worry about regarding magnesium levels. If you have questions or take magnesium supplements, your pharmacist is a great first stop.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Ozenoxacin →

Pantoprazole

Major Depletion

Brand names include Protonix, Pantoloc, Protonix IV

Hypomagnesemia requiring supplementation has been reported with all PPIs.

Taking a PPI long-term, especially over a year, has been linked to an increased risk of hypomagnesemia in observational research. Higher doses are associated with a two-fold increase in the odds of hypomagnesemia when compared with lower doses. Observational research in elderly hospitalized patients has also found that males, smokers, and heavy alcohol use further increase the risk of hypomagnesemia from PPI use. PPIs increase intestinal pH which is thought to inhibit active transport of magnesium in the intestine, reducing its absorption. The American College of Gastroenterology (ACG) does not provide a recommendation related to monitoring magnesium levels in patients taking PPIs. However, other experts, including the US Food and Drug Administration (FDA), recommend that serum magnesium levels should be checked at baseline and annually thereafter in patients who are likely to take a PPI long-term. In up to 25% of patients who develop hypomagnesemia, the PPI will need to be discontinued permanently to return magnesium levels to normal and maintain them. In some patients, it is possible to continue the PPI and take a magnesium supplement concurrently to maintain magnesium levels. For information on foods that are rich in magnesium, see our chart.
Taking Pantoprazole? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly, and pantoprazole can genuinely lower your levels over time. Because pantoprazole raises the pH inside your intestines, it appears to interfere with the active transport system your gut uses to pull magnesium into your bloodstream, so you absorb less of it with each dose. This is rated a major depletion, meaning long-term users, especially those on higher doses or taking it for more than a year, have a real, documented risk of running low. If you have been on pantoprazole for a while, it is worth asking your doctor or pharmacist whether checking your magnesium level makes sense for you.

References (18)
  1. Safety Alert. Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use. U.S. Food and Drug Administration, March 2, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/
  2. Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series. QJM 2010;103:387-95. PubMed
  3. Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors--a review. Neth J Med 2009;67:169-72.
  4. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 2008;69:338-41. PubMed
  5. Doornebal J, Bijlsma R, Brouwer RM. [An unknown but potentially serious side effect of proton pump inhibitors: hypomagnesaemia]. Ned Tijdschr Geneeskd 2009;153:A711.
  6. Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6. PubMed
  7. François M, Lévy-Bohbot N, Caron J, Durlach V. [Chronic use of proton-pump inhibitors associated with giardiasis: A rare cause of hypomagnesemic hypoparathyroidism?]. Ann Endocrinol (Paris) 2008;69:446-8.
  8. Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6. PubMed
  9. Hoorn EJ, van der Hoek J, de Man RA, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6. PubMed
  10. Regolisti G, Cabassi A, Parenti E, et al. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74. PubMed
  11. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5. PubMed
  12. Delgado MG, Calleja S, Suarez L, Pascual J. Recurrent confusional episodes associated with hypomagnesaemia due to esomeprazol. BMJ Case Rep 2013;2013. PubMed
  13. Krupa LZ, Fellows IW. Lansoprazole-induced hypomagnesaemia. BMJ Case Rep 2014;2014. PubMed
  14. Liao S, Gan L, Mei Z. Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e15011. PubMed
  15. Srinutta T, Chewcharat A, Takkavatakarn K, et al. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies. Medicine (Baltimore). 2019 Nov;98(44):e17788. PubMed
  16. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed
  17. Anna Vermeulen Windsant-van den Tweel AM, Derijks HJ, Gadiot NPPM, Keijsers CJPW. Proton Pump Inhibitors and Hypomagnesemia in Older Inpatients: An Observational Study. Sr Care Pharm 2022;37(12):623-630. PubMed
  18. Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.

Full nutrient report for Pantoprazole →

Pentamidine

Major Depletion

Brand names include Pentam 300

Pentamidine can increase magnesium loss in the urine, probably by causing damage to the renal tubules.

Symptomatic hypomagnesemia can occur with pentamidine, especially when given intravenously. This is likely due to renal tubular injury, leading to increased urinary losses of magnesium. Hypomagnesemia usually requires treatment with intravenous, followed by oral, magnesium supplements. Supplementation may need to be continued after pentamidine is stopped since the drug effects remain for six to eight weeks.
Taking Pentamidine? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, heart rhythm, and nerves working properly, and pentamidine is known to cause significant losses of it through the kidneys. The drug appears to injure the tiny filtering tubes in the kidneys called renal tubules, which normally hold magnesium back, so instead the body flushes it out in the urine. This is rated a major concern, meaning most patients on pentamidine will need magnesium supplementation, often starting with IV magnesium and then switching to pills. Worth knowing: the kidney effects can linger six to eight weeks after the drug is stopped, so please talk with your doctor or pharmacist about how long monitoring and supplementation should continue.

References (3)
  1. Shah GM, Alvarado P, Kirschenbaum MA. Symptomatic hypocalcemia and hypomagnesemia with renal magnesium wasting associated with pentamidine therapy in a patient with AIDS. Am J Med 1990;89:380-2. PubMed
  2. Burnett RJ, Reents SB. Severe hypomagnesemia induced by pentamidine. DICP Ann Pharmacother 1990;24:239-40.. PubMed
  3. Gradon JD, Fricchione L, Sepkowitz D. Severe hypomagnesemia associated with pentamidine therapy. Rev Infect Dis 1991;13:511-2.. PubMed

Full nutrient report for Pentamidine →

Rabeprazole

Major Depletion

Brand names include Pariet

Hypomagnesemia requiring supplementation has been reported with all PPIs.

Taking a PPI long-term, especially over a year, has been linked to an increased risk of hypomagnesemia in observational research. Higher doses are associated with a two-fold increase in the odds of hypomagnesemia when compared with lower doses. Observational research in elderly hospitalized patients has also found that males, smokers, and heavy alcohol use further increase the risk of hypomagnesemia from PPI use. PPIs increase intestinal pH which is thought to inhibit active transport of magnesium in the intestine, reducing its absorption. The American College of Gastroenterology (ACG) does not provide a recommendation related to monitoring magnesium levels in patients taking PPIs. However, other experts, including the US Food and Drug Administration (FDA), recommend that serum magnesium levels should be checked at baseline and annually thereafter in patients who are likely to take a PPI long-term. In up to 25% of patients who develop hypomagnesemia, the PPI will need to be discontinued permanently to return magnesium levels to normal and maintain them. In some patients, it is possible to continue the PPI and take a magnesium supplement concurrently to maintain magnesium levels. For information on foods that are rich in magnesium, see our chart.
Taking Rabeprazole? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on every day. Rabeprazole belongs to a class of acid-reducing drugs that raise the pH inside your intestines, and researchers believe this interferes with the special transport system your gut uses to pull magnesium in from food. Because this is a well-documented concern, especially for people who have been on this type of medication for a year or more, it is worth asking your pharmacist or doctor whether your magnesium level should be checked periodically.

References (18)
  1. Safety Alert. Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use. U.S. Food and Drug Administration, March 2, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/
  2. Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series. QJM 2010;103:387-95. PubMed
  3. Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors--a review. Neth J Med 2009;67:169-72.
  4. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 2008;69:338-41. PubMed
  5. Doornebal J, Bijlsma R, Brouwer RM. [An unknown but potentially serious side effect of proton pump inhibitors: hypomagnesaemia]. Ned Tijdschr Geneeskd 2009;153:A711.
  6. Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6. PubMed
  7. François M, Lévy-Bohbot N, Caron J, Durlach V. [Chronic use of proton-pump inhibitors associated with giardiasis: A rare cause of hypomagnesemic hypoparathyroidism?]. Ann Endocrinol (Paris) 2008;69:446-8.
  8. Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6. PubMed
  9. Hoorn EJ, van der Hoek J, de Man RA, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6. PubMed
  10. Regolisti G, Cabassi A, Parenti E, et al. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74. PubMed
  11. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5. PubMed
  12. Delgado MG, Calleja S, Suarez L, Pascual J. Recurrent confusional episodes associated with hypomagnesaemia due to esomeprazol. BMJ Case Rep 2013;2013. PubMed
  13. Krupa LZ, Fellows IW. Lansoprazole-induced hypomagnesaemia. BMJ Case Rep 2014;2014. PubMed
  14. Liao S, Gan L, Mei Z. Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e15011. PubMed
  15. Srinutta T, Chewcharat A, Takkavatakarn K, et al. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies. Medicine (Baltimore). 2019 Nov;98(44):e17788. PubMed
  16. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed
  17. Anna Vermeulen Windsant-van den Tweel AM, Derijks HJ, Gadiot NPPM, Keijsers CJPW. Proton Pump Inhibitors and Hypomagnesemia in Older Inpatients: An Observational Study. Sr Care Pharm 2022;37(12):623-630. PubMed
  18. Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.

Full nutrient report for Rabeprazole →

Rabeprazole Sodium

Major Depletion

Brand names include Aciphex, Aciphex Sprinkle

Hypomagnesemia requiring supplementation has been reported with all PPIs.

Taking a PPI long-term, especially over a year, has been linked to an increased risk of hypomagnesemia in observational research. Higher doses are associated with a two-fold increase in the odds of hypomagnesemia when compared with lower doses. Observational research in elderly hospitalized patients has also found that males, smokers, and heavy alcohol use further increase the risk of hypomagnesemia from PPI use. PPIs increase intestinal pH which is thought to inhibit active transport of magnesium in the intestine, reducing its absorption. The American College of Gastroenterology (ACG) does not provide a recommendation related to monitoring magnesium levels in patients taking PPIs. However, other experts, including the US Food and Drug Administration (FDA), recommend that serum magnesium levels should be checked at baseline and annually thereafter in patients who are likely to take a PPI long-term. In up to 25% of patients who develop hypomagnesemia, the PPI will need to be discontinued permanently to return magnesium levels to normal and maintain them. In some patients, it is possible to continue the PPI and take a magnesium supplement concurrently to maintain magnesium levels. For information on foods that are rich in magnesium, see our chart.
Taking Rabeprazole Sodium? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working smoothly, your heart rhythm steady, and your nerves firing correctly, so keeping levels in a healthy range really matters. Rabeprazole belongs to a drug class called PPIs, and these medicines raise the pH inside your intestines, which appears to block the gut's active transport system for pulling magnesium into the bloodstream. This is a well-documented concern, especially for people who have been taking a PPI for a year or longer or who use higher doses. If that sounds like you, it is worth asking your doctor or pharmacist whether your magnesium level should be checked.

References (18)
  1. Safety Alert. Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use. U.S. Food and Drug Administration, March 2, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/
  2. Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series. QJM 2010;103:387-95. PubMed
  3. Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors--a review. Neth J Med 2009;67:169-72.
  4. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 2008;69:338-41. PubMed
  5. Doornebal J, Bijlsma R, Brouwer RM. [An unknown but potentially serious side effect of proton pump inhibitors: hypomagnesaemia]. Ned Tijdschr Geneeskd 2009;153:A711.
  6. Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6. PubMed
  7. François M, Lévy-Bohbot N, Caron J, Durlach V. [Chronic use of proton-pump inhibitors associated with giardiasis: A rare cause of hypomagnesemic hypoparathyroidism?]. Ann Endocrinol (Paris) 2008;69:446-8.
  8. Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6. PubMed
  9. Hoorn EJ, van der Hoek J, de Man RA, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6. PubMed
  10. Regolisti G, Cabassi A, Parenti E, et al. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74. PubMed
  11. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5. PubMed
  12. Delgado MG, Calleja S, Suarez L, Pascual J. Recurrent confusional episodes associated with hypomagnesaemia due to esomeprazol. BMJ Case Rep 2013;2013. PubMed
  13. Krupa LZ, Fellows IW. Lansoprazole-induced hypomagnesaemia. BMJ Case Rep 2014;2014. PubMed
  14. Liao S, Gan L, Mei Z. Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e15011. PubMed
  15. Srinutta T, Chewcharat A, Takkavatakarn K, et al. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies. Medicine (Baltimore). 2019 Nov;98(44):e17788. PubMed
  16. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed
  17. Anna Vermeulen Windsant-van den Tweel AM, Derijks HJ, Gadiot NPPM, Keijsers CJPW. Proton Pump Inhibitors and Hypomagnesemia in Older Inpatients: An Observational Study. Sr Care Pharm 2022;37(12):623-630. PubMed
  18. Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.

Full nutrient report for Rabeprazole Sodium →

Retapamulin

Insignificant Depletion

Brand names include Altabax, Altargo

Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Retapamulin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Here is something worth flagging: retapamulin is a topical antibiotic used on the skin, and there is no well-established reason it would affect magnesium levels, which your muscles, nerves, and heart rhythm depend on. The depletion record on file actually describes a mechanism tied to aminoglycoside antibiotics, a different drug class entirely, not retapamulin. Given that mismatch, please talk with your pharmacist or doctor before drawing any conclusions or considering a magnesium supplement.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Retapamulin →

Sparfloxacin

Insignificant Depletion

Brand names include Zagam

Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Sparfloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Sparfloxacin belongs to a class of antibiotics that can latch onto magnesium in the gut, forming a kind of chemical pair that neither the drug nor the mineral can break free from easily, which could in theory reduce how much magnesium your body absorbs. That said, the evidence rates this as insignificant for most people, so a supplement is not something the average patient needs to worry about. If you do happen to take a magnesium supplement, just mention it to your pharmacist so they can advise on timing.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Sparfloxacin →

Tacrolimus

Major Depletion

Brand names include Prograf (capsule), Prograf (injectable), Protopic

Tacrolimus increases magnesium losses in the urine.

Tacrolimus reduces renal tubular reabsorption of magnesium, producing increased magnesium wasting. This leads to hypomagnesemia in a significant proportion of people treated with tacrolimus. For information on foods that are rich in magnesium, see our chart.
Taking Tacrolimus? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on every day. Tacrolimus interferes with how the kidneys reclaim magnesium, so more of it gets lost in the urine than normal. Because this happens in a meaningful number of people on this medication, low magnesium levels are a real concern here, not just a theoretical one. If you take tacrolimus regularly, it is worth asking your doctor or pharmacist whether your magnesium level should be checked and whether a supplement makes sense for you.

References (2)
  1. Lote CJ, Thewles A, Wood JA, Zafar T. The hypomagnesaemic action of FK506: urinary excretion of magnesium and calcium and the role of parathyroid hormone. Clin Sci 2000;99:285-92.. DOI
  2. Niederstadt C, Steinhoff J, Erbsloh-Moller B, et al. Effect of FK506 on magnesium homeostasis after renal transplantation. Transplant Proc 1997;29:3161-2. PubMed

Full nutrient report for Tacrolimus →

Terbutaline

Insignificant Depletion

Brand names include Bricanyl, Brethine, Bricanyl Injection

Beta-2 agonists cause small, generally reversible decreases in magnesium levels.

Beta-2 agonists promote movement of magnesium from the extracellular to the intracellular space, and increase magnesium excretion in the urine. Reduced serum magnesium levels occur after a single dose of albuterol or terbutaline orally, by IV infusion, SC injection, or by inhalation. The reductions are generally small, about 4.5-9%, or 0.04 to 0.06 mmol/L compared with the normal serum magnesium range of 0.65 to 1.1 mmol/L. However, these acute changes could contribute to ECG changes, including prolonged QT intervals. With chronic use of beta-2 agonists, serum magnesium levels generally return to normal, but muscle magnesium levels may remain low. For information on foods that are rich in magnesium, see our chart.
Taking Terbutaline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles contract, keeps your heart rhythm steady, and supports hundreds of chemical reactions throughout the body. Terbutaline, a beta-2 agonist, can nudge magnesium out of the bloodstream by shifting it into cells and prompting the kidneys to release a little more of it in the urine. That said, the dip is small and tends to reverse on its own, especially with ongoing use, so most people taking terbutaline do not need a magnesium supplement. If you have any concerns, your pharmacist or doctor is the right person to ask.

References (10)
  1. Tveskov C, Djurhuus MS, Klitgaard NAH, Egstrup K. Potassium and magnesium distribution, ECG changes, and ventricular ectopic beats during beta-2-adrenergic stimulation with terbutaline in healthy subjects. Chest 1994;106:1654-9..
  2. Whyte KF, Addis GJ, Whitesmith R, Reid JL. Adrenergic control of plasma magnesium in man. Clin Sci 1987;72:135-8.. PubMed
  3. Rolla G, Bucca C. Magnesium, beta-agonists, and asthma. Lancet 1988;1:989. PubMed
  4. Bremme K, Eneroth P, Nordstrom L, Nilsson B. Effects of infusion of the beta-adrenoceptor agonist terbutaline on serum magnesium in pregnant women. Magnesium 1986;5:85-94.
  5. Khilnani G, Parchani H, Toshniwal G. Hypomagnesemia due to beta 2-agonist use in bronchial asthma. J Assoc Physicians India 1992;40:346..
  6. Bos WJ, Postma DS, van Doormaal JJ. Magnesiuric and calciuric effects of terbutaline in man. Clin Sci 1988;74:595-7.. PubMed
  7. Lipworth BJ, McDevitt DG. Beta-adrenoceptor responses to inhaled salbutamol in normal subjects. Eur J Clin Pharmacol 1989;36:239-45.. PubMed
  8. Rahman ARA, McDevitt DG, Struthers AD, Lipworth BJ. The effects of enalapril and spironolactone on terbutaline-induced hypokalemia. Chest 1992;102:91-5..
  9. Gustafson T, Boman K, Rosenhall L, et al. Skeletal muscle magnesium and potassium in asthmatics treated with oral beta-2-agonists. Eur Resp J 1996;9:237-40.. PubMed
  10. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..

Full nutrient report for Terbutaline →

Tetracycline

Insignificant Depletion

Brand names include Sumycin, Sumycin 250, Tetrex BID

Tetracyclines may bind to dietary magnesium, reducing absorption of both agents.

Tetracyclines form complexes with magnesium in the GI tract, which could reduce absorption of both the tetracycline and magnesium. Significant effects on magnesium levels are unlikely when tetracyclines are taken on an empty stomach, 1 hour before or 2 hours after magnesium supplements.
Taking Tetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles contract, keeps your heart rhythm steady, and supports hundreds of chemical reactions throughout the body. Here is the interesting thing about tetracycline: it can physically latch onto magnesium in the gut, forming a combined complex that neither absorbs well. In practice, though, this interaction is rated insignificant, meaning it rarely causes a real drop in magnesium levels for most people. If you take tetracycline on an empty stomach and keep magnesium supplements spaced a couple of hours apart, there is generally nothing to worry about, but feel free to ask your pharmacist if you have any questions.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Tetracycline →

Tigecycline

Insignificant Depletion

Brand names include Tygacil

Tetracyclines may bind to dietary magnesium, reducing absorption of both agents.

Tetracyclines form complexes with magnesium in the GI tract, which could reduce absorption of both the tetracycline and magnesium. Significant effects on magnesium levels are unlikely when tetracyclines are taken on an empty stomach, 1 hour before or 2 hours after magnesium supplements.
Taking Tigecycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so keeping levels in a healthy range really does matter. The concern here is that tigecycline can be hard on the kidneys, and when the kidneys are stressed, they may not hold onto magnesium properly, letting too much slip out in the urine. Because this is rated as a moderate depletion risk, it is worth taking seriously, especially during a longer course of treatment. Ask your doctor or pharmacist whether your magnesium levels are being monitored and whether any supplementation makes sense for you.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Tigecycline →

Trovafloxacin

Insignificant Depletion

Brand names include Trovan, Trovan Injection

Quinolone antibiotics bind magnesium in the gut, reducing absorption of both agents.

Quinolones form complexes with magnesium in the GI tract. This could theoretically reduce absorption of both the quinolone and magnesium if taken at the same time. Significant effects on magnesium levels are unlikely when quinolones are taken at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Taking Trovafloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, nerves, and heartbeat working properly, so it is a mineral your body uses constantly. Trovafloxacin belongs to a class of antibiotics called quinolones, and these drugs can latch onto magnesium in the digestive tract, forming a kind of chemical pair that the gut has trouble absorbing. The good news is that the evidence rates this as insignificant for most people, especially since trovafloxacin is typically taken as a short course. If you happen to use magnesium supplements, spacing them a couple of hours apart from your antibiotic dose is an easy way to sidestep any potential overlap, but routine supplementation is not considered necessary here.

References (1)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.

Full nutrient report for Trovafloxacin →

Brand names include Midol Max Strength Menstrual

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Acetaminophen, Caffeine, Pyrilamine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on every day. This combination product contains caffeine, which has a mild diuretic effect, meaning it can nudge your kidneys to pass more fluid, and with that fluid some magnesium can be lost in the urine over time. Because the evidence here is rated as moderate depletion, long-term or frequent users have a reasonable reason to bring this up with their pharmacist or doctor, who can decide whether your levels are worth checking or whether a supplement makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Acetaminophen, Caffeine, Pyrilamine →

Brand names include Midol Max Strength PMS, Pamprin, Pamprin ES

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Acetaminophen, Pamabrom, Pyrilamine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Pamabrom, the diuretic component in this combination product, works by nudging your kidneys to release more water, and magnesium, a mineral your muscles and nerves depend on, can get swept out along with it. Because pamabrom acts similarly to thiazide diuretics, it may reduce how much magnesium your kidneys hold onto, gradually lowering your body's supply over time. The evidence here is rated moderate, so this is worth paying attention to if you use this product regularly, especially for monthly menstrual relief. It is a good idea to mention this to your pharmacist or doctor, who can help decide whether any monitoring or dietary changes make sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Acetaminophen, Pamabrom, Pyrilamine →

Acetazolamide

Moderate Depletion

Brand names include Diamox, Ak-Zol

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Acetazolamide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Acetazolamide works as a diuretic, meaning it makes your kidneys produce more urine, and one side effect of that process is that magnesium, a mineral your muscles and nerves depend on, can get flushed out along with it. Because this loss happens through the urine rather than the gut, long-term users have a real reason to pay attention. This one is rated moderate, so some people taking acetazolamide do end up needing a supplement, though not everyone will. It is worth asking your pharmacist or doctor whether your magnesium levels should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Acetazolamide →

Amikacin

Moderate Depletion

Brand names include Amikin, Arikayce

Increased urinary magnesium loss occurs with nephrotoxicity caused by aminoglycosides.

Nephrotoxicity caused by aminoglycosides may lead to increased urinary losses of various electrolytes, including magnesium. Monitor patients closely to detect declining renal function and electrolyte disturbances. The aminoglycoside may need to be discontinued and intravenous electrolyte replacement given.
Taking Amikacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working properly, supports a steady heartbeat, and plays a role in hundreds of chemical reactions your body runs every day. Amikacin belongs to a drug family called aminoglycosides, and one known risk with these antibiotics is stress on the kidneys. When the kidneys are affected, they can lose their ability to hold onto magnesium, so more of it gets flushed out in the urine than normal. Because this is rated a moderate concern, patients on amikacin are typically watched closely with blood tests, and some do need magnesium replacement, so let your care team know right away if you notice muscle cramps, weakness, or irregular heartbeat.

References (1)
  1. L'Hommedieu CS, Nicholas D, Armes DA, et al. Potentiation of magnesium sulfate--induced neuromuscular weakness by gentamicin, tobramycin, and amikacin. J Pediatr 1983;102:629-31..

Full nutrient report for Amikacin →

Amiloride, Hydrochlorothiazide

Moderate Depletion

Brand names include Moduretic, Amilzide, Moduret 25

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Amiloride, Hydrochlorothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, nerves, and heart rhythm working smoothly. Here is what makes this combination interesting: the hydrochlorothiazide portion can cause your kidneys to flush extra magnesium out in the urine, but the amiloride portion actually works in the opposite direction, helping the kidneys hold onto magnesium. Because of that counterbalancing effect, the overall risk with this combo is real but varies from person to person. If you have been on this medication long-term, it is worth asking your pharmacist or doctor whether checking your magnesium level makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Amiloride, Hydrochlorothiazide →

Ammonium Chloride

Moderate Depletion
Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Ammonium Chloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so keeping levels steady matters. Ammonium chloride works partly as a diuretic, meaning it nudges the kidneys to push out more fluid, and magnesium can get swept out along with that extra urine rather than being held onto. The rating here is Moderate Depletion, which means this is a real enough concern that some people taking it do need to be monitored or even use a supplement. If you are on this medication regularly, it is worth asking your pharmacist or doctor whether your magnesium level should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Ammonium Chloride →

Atenolol, Chlortalidone

Moderate Depletion

Brand names include AtenixCo, Totaretic, Tenoret 50

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Atenolol, Chlortalidone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Chlortalidone is a thiazide diuretic, meaning it works by making your kidneys pull more water and salt out of your blood to lower blood pressure. That same process can also cause your kidneys to flush out extra magnesium in your urine, which is a mineral your muscles, nerves, and heart rhythm all depend on. Because the evidence here is rated as moderate depletion, this is worth paying attention to, especially if you have been on this combination for a long time. Ask your pharmacist or doctor whether your magnesium level has been checked recently.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Atenolol, Chlortalidone →

Atenolol, Chlorthalidone

Moderate Depletion

Brand names include Tenoretic

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Atenolol, Chlorthalidone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Chlorthalidone is a thiazide-type diuretic, and one known side effect is that the kidneys end up releasing more magnesium in the urine than they normally would. Magnesium is a mineral your muscles, heart, and nerves depend on every day, so losing extra amounts over time is worth paying attention to. Because this is rated as a moderate concern, it does not affect everyone, but long-term users should ask their pharmacist or doctor whether checking magnesium levels makes sense for them.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Atenolol, Chlorthalidone →

Brand names include Dymista

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Azelastine Hydrochloride, Fluticasone Propionate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart all depend on to work properly. The fluticasone in this spray is a corticosteroid, and long-term corticosteroid use can cause the body to break down bone tissue faster than usual, which releases magnesium into the bloodstream and then out through the urine at higher-than-normal levels. That said, actual blood levels often stay in the normal range for most people, so the concern here is mainly for those using it chronically. If you have been relying on this spray for a long time, it is worth asking your pharmacist or doctor whether any monitoring or dietary changes make sense for you.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Azelastine Hydrochloride, Fluticasone Propionate →

Azilsartan, Chlorthalidone

Moderate Depletion

Brand names include Edarbyclor

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Azilsartan, Chlorthalidone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Chlorthalidone is a thiazide-type diuretic, and one known side effect is that it can cause your kidneys to flush out more magnesium than usual in your urine. Magnesium is a mineral your muscles, heart, and nerves depend on to work properly. Because this combination carries a moderate depletion rating, it is worth keeping on your radar, especially if you have been taking it long-term. Ask your pharmacist or doctor whether your magnesium level should be checked or whether a supplement makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Azilsartan, Chlorthalidone →

Brand names include Duavee

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Bazedoxifene Acetate, Conjugated Estrogens? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working properly, supports nerve signaling, and plays a role in heart rhythm. The estrogen component in this medication appears to pull magnesium out of the bloodstream and into soft tissues and bone, which can quietly lower the levels circulating in your blood. Because this is rated a moderate depletion concern, long-term users have a reasonable reason to bring it up with their doctor or pharmacist, since some people do end up needing a supplement.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Bazedoxifene Acetate, Conjugated Estrogens →

Beclometasone dipropionate

Moderate Depletion

Brand names include Becotide

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Beclometasone dipropionate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, nerves, and heart rhythm working smoothly, so it is worth keeping an eye on when you use a corticosteroid like beclometasone long term. Here is what happens: corticosteroids can slowly break down bone tissue, and as bone breaks down it releases stored magnesium into the bloodstream, where the kidneys then filter more of it out through the urine. In practice, blood levels often stay normal despite this extra loss, but with the moderate depletion rating here, long-term users are reasonable to ask their pharmacist or doctor whether their magnesium levels should be checked.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Beclometasone dipropionate →

Beclomethasone

Moderate Depletion

Brand names include Beclovent, Vanceril

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Beclomethasone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. With long-term use of a corticosteroid like beclomethasone, the body may break down small amounts of bone tissue, and that process can release magnesium into the bloodstream where the kidneys then flush it out in the urine. The good news is that actual blood levels usually stay in a normal range for most people, though this rating is moderate, meaning some long-term users may need monitoring. If you have been on beclomethasone for months or longer, it is worth asking your pharmacist or doctor whether checking your magnesium level makes sense for you.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Beclomethasone →

Beclomethasone dipropionate

Moderate Depletion

Brand names include Qvar, QNASL

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Beclomethasone dipropionate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Long-term use of inhaled or systemic corticosteroids like beclomethasone has been linked to higher magnesium losses through the urine, possibly because these medications break down bone tissue over time, releasing magnesium that the kidneys then filter out. The good news is that actual blood levels often stay in the normal range for most people, so this is more of a 'keep an eye on it' situation than an urgent concern. If you have been using beclomethasone for a long time, it is worth asking your pharmacist or doctor whether your magnesium should be checked.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Beclomethasone dipropionate →

Benazepril, Hydrochlorothiazide

Moderate Depletion

Brand names include Lotensin HCT

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Benazepril, Hydrochlorothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles, heart rhythm, and nerves work properly, so keeping levels in a healthy range really does matter. The hydrochlorothiazide in this combination is a thiazide diuretic, and thiazides can cause your kidneys to flush out more magnesium than usual through the urine rather than holding onto it. This is a moderate concern, meaning some long-term users do end up with lower magnesium levels worth addressing. If you have been on this medication for a while, it is worth asking your pharmacist or doctor whether checking your magnesium level or taking a supplement makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Benazepril, Hydrochlorothiazide →

Bendroflumethiazide

Moderate Depletion

Brand names include Naturetin, Aprinox, Neo-NaClex

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Bendroflumethiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so keeping levels in a healthy range genuinely matters. Bendroflumethiazide is a thiazide diuretic, meaning it works partly by making your kidneys produce more urine, and that process can carry extra magnesium out of the body before it gets a chance to be reabsorbed. The evidence here is rated moderate, so this is not just a theoretical concern, and some people on long-term thiazide therapy do end up needing a supplement. It is worth asking your pharmacist or doctor whether your levels should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Bendroflumethiazide →

Bendroflumethiazide, Nadolol

Moderate Depletion

Brand names include Corzide

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Bendroflumethiazide, Nadolol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working properly, supports a steady heartbeat, and plays a role in bone strength. Bendroflumethiazide is a thiazide diuretic, meaning it works partly by making your kidneys pass more fluid out through urine, and unfortunately magnesium can get flushed out along with it. This is rated as a moderate depletion concern, so it is not something to ignore, especially if you have been on this medication long term. It is worth asking your pharmacist or doctor whether your magnesium level should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Bendroflumethiazide, Nadolol →

Bendroflumethiazide, Potassium

Moderate Depletion

Brand names include Neo-NaClex-K, Centyl K

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Bendroflumethiazide, Potassium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working smoothly, supports a steady heartbeat, and plays a role in hundreds of chemical reactions throughout the body. Bendroflumethiazide is a thiazide diuretic, and thiazides can cause the kidneys to hold on to less magnesium than usual, so more of it gets flushed out in the urine rather than being kept in the bloodstream. This combination product also contains potassium, which is potassium-sparing, and that component may help offset some of the magnesium loss. Even so, this is rated as a moderate depletion concern, so if you have been taking this medication long-term, it is worth asking your pharmacist or doctor whether your magnesium levels should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Bendroflumethiazide, Potassium →

Brand names include Rauzide

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Bendroflumethiazide, Rauwolfia Serpentina? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working properly, supports a steady heartbeat, and plays a role in hundreds of chemical reactions your body runs every day. Bendroflumethiazide is a thiazide diuretic, meaning it works in the kidneys to flush out extra fluid, and as a side effect it can reduce how much magnesium the kidneys hold on to, so more of it leaves the body in urine than usual. This is rated a moderate concern, so it is not something to ignore, especially if you have been on this medication for a long time. It is worth asking your pharmacist or doctor whether your magnesium level should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Bendroflumethiazide, Rauwolfia Serpentina →

Benzthiazide

Moderate Depletion

Brand names include Exna

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Benzthiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Benzthiazide is a thiazide diuretic, meaning it works partly by telling your kidneys to flush out more fluid through urine. The problem is that your kidneys can end up releasing extra magnesium along with that fluid, a mineral your muscles, heart, and nerves all depend on to work properly. Because this is rated a moderate depletion, it is worth paying attention to over the long haul, especially if you take benzthiazide regularly. Ask your pharmacist or doctor whether checking your magnesium level makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Benzthiazide →

Betamethasone

Moderate Depletion

Brand names include Celestone, Diprolene AF, Diprosone

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Betamethasone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so keeping levels in a healthy range matters. Long-term betamethasone use can cause the kidneys to lose more magnesium in the urine, partly because corticosteroids break down bone tissue and release stored magnesium into the bloodstream, where it becomes available to be flushed out. The good news is that blood levels often stay within normal range despite this, but the evidence is strong enough that long-term users are worth monitoring. If you have been on this medication for a while, it is a reasonable thing to bring up with your pharmacist or doctor.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Betamethasone →

Betamethasone Dipropionate

Moderate Depletion

Brand names include Sernivo

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Betamethasone Dipropionate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles contract, keeps your heart rhythm steady, and supports hundreds of chemical reactions throughout the body. Long-term use of a corticosteroid like betamethasone dipropionate can cause the kidneys to release more magnesium into the urine than usual, partly because these medications can break down bone tissue, freeing magnesium that then gets flushed out. The rating here is moderate, meaning this is worth paying attention to for people using this medication regularly, even though blood levels do not always drop in a noticeable way. If you have been using betamethasone dipropionate for an extended period, it is worth asking your pharmacist or doctor whether your magnesium levels should be checked.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Betamethasone Dipropionate →

Brand names include Enstilar, Wynzora

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Betamethasone Dipropionate, Calcipotriene? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on, so keeping levels in a healthy range matters. The corticosteroid in this combination (betamethasone) can, over time, break down small amounts of bone tissue, and the magnesium released from that process gets filtered out through the kidneys rather than kept by the body. The good news is that blood levels often stay normal despite this, but with long-term use it is worth mentioning to your pharmacist or doctor so they can decide whether your levels should be checked.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Betamethasone Dipropionate, Calcipotriene →

Betamethasone valerate

Moderate Depletion

Brand names include Luxiq

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Betamethasone valerate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working smoothly, supports a steady heartbeat, and is important for strong bones. Betamethasone valerate is a corticosteroid, and long-term use of corticosteroids may cause the body to break down bone tissue faster than usual, which can release extra magnesium into the bloodstream and then flush more of it out through the urine. The good news is that for most people, actual blood levels stay in a normal range, but longer-term users are worth keeping an eye on. If you have been using this medication regularly for an extended period, it is a reasonable thing to bring up with your pharmacist or doctor.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Betamethasone valerate →

Bisoprolol, Hydrochlorothiazide

Moderate Depletion

Brand names include Ziac

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Bisoprolol, Hydrochlorothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and the hydrochlorothiazide in this combination pill can cause your kidneys to flush out more of it in the urine than usual. Over time, that steady loss can nudge levels low enough to matter for some people, which is why this one carries a moderate rating rather than a theoretical flag. If you have been on this medication long-term, it is worth asking your pharmacist or doctor whether your magnesium level has been checked recently.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Bisoprolol, Hydrochlorothiazide →

Budesonide

Moderate Depletion

Brand names include Entocort EC, Pulmicort, Uceris

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Budesonide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working properly, supports your heart rhythm, and is important for strong bones. Long-term budesonide use, like other corticosteroids, may cause your kidneys to release more magnesium into the urine than usual, partly because the medication can break down bone tissue and free up magnesium that then gets flushed out. That said, actual blood levels often stay in the normal range for most people, so this is something to keep an eye on rather than panic about. If you have been on budesonide for a long time, it is worth asking your pharmacist or doctor whether your magnesium levels should be checked.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Budesonide →

Bumetanide

Moderate Depletion

Brand names include Burinex

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Bumetanide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Bumetanide is a loop diuretic, and one of its well-known effects is that it keeps your kidneys from holding onto magnesium, so more of it gets flushed out in your urine. Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so ongoing losses can matter. Because this is rated a moderate depletion concern, long-term users have a real reason to bring it up with their doctor or pharmacist, since some people do need a supplement while others manage fine with diet alone.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Bumetanide →

Bumetanide, Potassium

Moderate Depletion

Brand names include Burinex K

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Bumetanide, Potassium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles contract properly, keeps your heart rhythm steady, and supports hundreds of chemical reactions throughout the body. Bumetanide is a loop diuretic, meaning it works by making your kidneys flush out extra fluid through urine, and unfortunately magnesium gets swept out along with it because the drug interferes with how the kidneys normally hold magnesium back. This is a moderate concern, so while not everyone will end up low, long-term users are worth watching. It is a good idea to ask your doctor or pharmacist whether your levels should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Bumetanide, Potassium →

Brand names include Trim-Elim

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Caffeine, Potassium Salicylate, Salicylamide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles relax, keeps your heart rhythm steady, and supports hundreds of chemical reactions throughout the body. This combination product contains salicylate compounds that can act as mild diuretics, nudging the kidneys to flush out more magnesium in the urine than usual. A moderate rating means this is worth paying attention to, especially with longer-term use, and some people do end up needing a supplement. It is a good idea to ask your pharmacist or doctor whether monitoring your magnesium level makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Caffeine, Potassium Salicylate, Salicylamide →

Brand names include Atacand HCT

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Candesartan Cilexetil, Hydrochlorothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and the hydrochlorothiazide in this combination pill can nudge your kidneys to flush more of it out in your urine than usual. Over time, that steady loss can add up, which is why this one carries a moderate depletion rating rather than just a theoretical flag. If you have been on this medication long-term, it is worth asking your pharmacist or doctor whether your magnesium level should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Candesartan Cilexetil, Hydrochlorothiazide →

Capecitabine

Moderate Depletion

Brand names include Xeloda

Capecitabine may damage renal tubules and increase magnesium losses.

A case of hypomagnesemia, characterized by weakness and dizziness, has been reported in a patient treated with capecitabine 2 months earlier. Capecitabine may cause magnesium wasting due to its effects on the renal tubules. For information on foods that are rich in magnesium, see our chart.
Taking Capecitabine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and capecitabine has been linked to lower levels through a kidney-related mechanism: the drug can irritate the tiny filtering tubes in the kidneys (called renal tubules), causing the body to flush out more magnesium in the urine than it should. This is rated a moderate concern, meaning it does not happen to everyone, but it is real enough that some patients on capecitabine do need supplementation. If you are on this medication long-term, it is worth asking your oncologist or pharmacist whether your magnesium levels are being checked.

References (1)
  1. Rajapakse S, Rodrigo C, Rajapakse AC. Isolated hypomagnesemia in a patient treated with capecitabine. J Oncol Pharm Pract 2013;19(3):254-6. PubMed

Full nutrient report for Capecitabine →

Captopril, Hydrochlorothiazide

Moderate Depletion

Brand names include Capozide, Acezide

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Captopril, Hydrochlorothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Hydrochlorothiazide is a thiazide diuretic, and one known side effect is that it can cause the kidneys to flush out more magnesium than usual through the urine. Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so losing too much of it over time is worth watching. This is rated as a moderate concern, meaning some long-term users do end up needing a supplement while others are fine. It is a good idea to bring this up with your pharmacist or doctor, especially if you have been on this medication for a while.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Captopril, Hydrochlorothiazide →

Cetuximab

Moderate Depletion

Brand names include Erbitux

Cetuximab causes increased loss of magnesium in the urine.

Cetuximab causes renal magnesium wasting, leading to lowered magnesium levels in 50% to 97% of patients. Hypomagnesemia severe enough to require treatment occurs in 10% to 15% of cases. For information on foods that are rich in magnesium, see our chart.
Taking Cetuximab? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles, heart, and nerves work properly, and cetuximab can cause your kidneys to flush out more of it than usual rather than holding onto it. This is a well-documented concern: studies show a large share of people on cetuximab end up with low magnesium levels, and a smaller but real portion need treatment for it. If you are taking this medication, it is worth asking your doctor or pharmacist whether your levels are being checked and whether a supplement makes sense for you.

References (2)
  1. Fakih M. Anti-EGFR monoclonal antibody-induced hypomagnesaemia. Lancet Oncol 2007;8:366-7. PubMed
  2. Erbitux (cetuximab) product information. Bristol-Myers Squibb Company, Princeton, NJ. May 2007.

Full nutrient report for Cetuximab →

Chlorothiazide

Moderate Depletion

Brand names include Diuril

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Chlorothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so keeping levels in a healthy range matters. Chlorothiazide is a thiazide diuretic, meaning it works by making your kidneys remove extra fluid, and as a side effect the kidneys can also flush out more magnesium than usual in the urine. This is a moderate concern, not just a theoretical one, so long-term users are worth watching. If you have been on this medication for a while, it is worth asking your pharmacist or doctor whether your magnesium levels should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Chlorothiazide →

Chlorothiazide, Methyldopa

Moderate Depletion

Brand names include Aldoclor 150, Aldochlor, Aldoclor 250

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Chlorothiazide, Methyldopa? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly. Chlorothiazide is a thiazide diuretic, meaning it tells your kidneys to flush out more fluid through urine, and unfortunately magnesium can get swept out along with it. This is a moderate concern, so it does not affect everyone, but people taking this medication long-term are worth monitoring. Ask your pharmacist or doctor whether your levels should be checked or whether extra magnesium makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Chlorothiazide, Methyldopa →

Chlorothiazide, Reserpine

Moderate Depletion

Brand names include Diupres

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Chlorothiazide, Reserpine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly. The thiazide diuretic in this combination works in the kidneys to remove excess fluid, but as a side effect it also causes the kidneys to flush out more magnesium in the urine than they normally would. Because the rating here is moderate, this is something worth paying attention to over the long haul, and some people on thiazide diuretics do end up needing a supplement. Worth a conversation with your pharmacist or doctor, especially if you have been taking this medication for a while.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Chlorothiazide, Reserpine →

Chlorthalidone

Moderate Depletion

Brand names include Hygroton, Thalitone

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Chlorthalidone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so keeping levels in a healthy range matters. Chlorthalidone, a thiazide-type diuretic, works by making the kidneys remove extra fluid, but in doing so it can also cause the kidneys to flush out more magnesium than usual in the urine. The evidence rates this as a moderate concern, meaning it does not affect everyone but is real enough that long-term users should have it on their radar. If you have been on chlorthalidone for a while, it is worth asking your pharmacist or doctor whether your magnesium level should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Chlorthalidone →

Chlorthalidone, Clonidine

Moderate Depletion

Brand names include Clorpres, Combipres

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Chlorthalidone, Clonidine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Chlorthalidone is a thiazide-type diuretic, and one thing thiazide diuretics are known to do is cause the kidneys to flush out more magnesium than usual in the urine. Magnesium is a mineral your muscles, heart, and nerves depend on to work properly, so losing extra amounts over time is worth keeping an eye on. This interaction is rated as moderate, meaning some long-term users do end up needing a supplement, though not everyone does. If you have been on this medication for a while, it is worth asking your pharmacist or doctor whether checking your magnesium level makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Chlorthalidone, Clonidine →

Clobetasol

Moderate Depletion

Brand names include Temovate, Clobex

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Clobetasol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Long-term use of a corticosteroid like clobetasol may cause the body to break down small amounts of bone tissue, and the magnesium released from that process can get filtered out through the kidneys at a higher rate than usual. That said, this typically does not cause a dramatic drop in blood levels for most people, though the rating here is Moderate, meaning some long-term users may need a supplement. If you use clobetasol regularly over a long period, it is worth asking your pharmacist or doctor whether checking your magnesium levels makes sense for you.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Clobetasol →

Conjugated Estrogens

Moderate Depletion

Brand names include Premarin, Cenestin, Enjuvia

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Conjugated Estrogens? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and conjugated estrogens appear to lower the amount circulating in your blood by pushing more of it into soft tissues and bone. Think of it as the estrogen redirecting magnesium away from the bloodstream rather than flushing it out through the kidneys. Because this is rated a moderate depletion, it is worth paying attention to, especially for long-term users. Ask your pharmacist or doctor whether checking your magnesium level or adjusting your diet makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Conjugated Estrogens →

Brand names include Prempro, Premplus

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Conjugated Estrogens, Medroxyprogesterone Acetate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working, your heart rhythm steady, and your bones strong. With conjugated estrogens and medroxyprogesterone, the estrogen component appears to push magnesium out of the bloodstream and into body tissues like bone and soft tissue, which can leave circulating levels lower than they should be. This is rated a moderate concern, meaning some people on long-term hormone therapy do end up needing extra magnesium. It is worth bringing up with your pharmacist or doctor, especially if you notice muscle cramps, fatigue, or other symptoms that might point to low levels.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Conjugated Estrogens, Medroxyprogesterone Acetate →

Brand names include PMB 200, PMB 400

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Conjugated Estrogens, Meprobamate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on, and conjugated estrogens can nudge your levels lower by pushing more magnesium out of the bloodstream and into body tissues and bone. Because the magnesium moves rather than disappears, serum levels drop even if your total body stores are adequate, though in some people this shift is significant enough to matter clinically. This is rated a moderate concern, meaning it is worth keeping on your radar rather than ignoring, especially with long-term use. Ask your pharmacist or doctor whether checking your magnesium level or adjusting your diet makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Conjugated Estrogens, Meprobamate →

Brand names include Premarin with Methyltestosterone

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Conjugated Estrogens, Methyltestosterone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on every day. The estrogen component of this medication appears to pull magnesium out of the bloodstream and push it into soft tissues and bone, which can leave circulating levels lower than they should be. Because this effect is rated as moderate, long-term users have a real reason to bring it up with their doctor or pharmacist, since some people on estrogen therapy do end up needing a supplement to keep their levels in a healthy range.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Conjugated Estrogens, Methyltestosterone →

Cortisone Acetate

Moderate Depletion

Brand names include Cortone, Cortisone Tablets

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Cortisone Acetate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart depend on to work properly. Long-term cortisone use can cause the body to break down bone tissue, which releases stored magnesium into the bloodstream and then out through the urine at a higher-than-normal rate. In practice, blood levels often stay in a normal range, but this is rated a moderate depletion concern, so if you have been on cortisone for a long time it is worth asking your pharmacist or doctor whether your magnesium levels should be checked.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Cortisone Acetate →

Cryptenamine, Methyclothiazide

Moderate Depletion

Brand names include Diutensen

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Cryptenamine, Methyclothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Methyclothiazide is a thiazide diuretic, and one trade-off with this type of water pill is that it can cause your kidneys to flush out more magnesium than usual in your urine, rather than holding onto it the way they normally would. Magnesium is a mineral your muscles, heart, and nerves depend on, so losing more of it over time is worth paying attention to. This is rated a moderate depletion concern, meaning not everyone is affected, but long-term users should check in with their pharmacist or doctor about whether monitoring or a supplement makes sense for them.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Cryptenamine, Methyclothiazide →

Cyclosporine

Moderate Depletion

Brand names include Neoral, Gengraf, Sandimmune

Cyclosporine can increase magnesium loss in the urine, possibly by causing damage to the renal tubules.

Cyclosporine can cause significant loss of magnesium in the urine, probably by causing renal tubular damage which reduces tubular reabsorption. Hypomagnesemia may contribute to seizures and neurotoxicity associated with cyclosporine.
Taking Cyclosporine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and cyclosporine is known to cause the kidneys to spill more of it into the urine than they should. The likely reason is that cyclosporine can injure the tiny filtering tubes inside the kidneys, making them less able to hold magnesium back before urine leaves the body. This is rated a moderate concern, meaning low magnesium is genuinely seen in some people on this drug, not just a theoretical worry. If you have been on cyclosporine for a while, it is worth asking your doctor or pharmacist whether your magnesium level has been checked.

References (3)
  1. Rahman MA, Ing TS. Cyclosporine and magnesium metabolism. J Lab Clin Med 1989;114:213-4.
  2. Thompson CB, Sullivan KM, June CH, Thomas ED. Association between cyclosporine neurotoxicity and hypomagnesemia. Lancet 1984;2:1116-20.
  3. Allen RD, Hunnisett AG, Morris PJ. Cyclosporine and magnesium. Lancet 1985;1:1283-4.

Full nutrient report for Cyclosporine →

Cyclothiazide

Moderate Depletion

Brand names include Fluidil, Anhydron

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Cyclothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Cyclothiazide is a thiazide diuretic, meaning it helps your kidneys remove extra fluid, but that same process can cause your kidneys to flush out more magnesium than usual in your urine. Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so losing too much over time is worth paying attention to. Because this is rated as a moderate depletion concern, longer-term users have a real reason to bring it up with their pharmacist or doctor, who can check your levels and decide whether any dietary changes or a supplement make sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Cyclothiazide →

Brand names include Diane-35, Dianette

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Cyproterone Acetate, Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles contract, keeps your heart rhythm steady, and supports hundreds of chemical reactions throughout the body. The ethinyl estradiol in this combination pill appears to pull magnesium out of the bloodstream and into soft tissues and bones, so circulating levels can drop over time. Because this is rated a moderate depletion, it is worth paying attention to if you are a long-term user. Ask your pharmacist or doctor whether checking your magnesium level or adjusting your diet makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Cyproterone Acetate, Ethinyl Estradiol →

Brand names include Oreticyl Forte, Oreticyl

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Deserpidine, Hydrochlorothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Hydrochlorothiazide, the diuretic in this combination, works partly by telling your kidneys to release more fluid, but magnesium (a mineral your muscles, nerves, and heart rhythm depend on) can quietly get flushed out along with that fluid. Because the kidneys have a harder time holding onto magnesium while this drug is on board, levels can gradually drop over time. With a moderate depletion rating, this is a real-enough concern that some long-term users do end up needing a supplement. It is worth bringing up with your doctor or pharmacist, especially if you notice muscle cramps or feel unusually fatigued.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Deserpidine, Hydrochlorothiazide →

Deserpidine, Methyclothiazide

Moderate Depletion

Brand names include Enduronyl Forte, Enduronyl

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Deserpidine, Methyclothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Methyclothiazide is a thiazide diuretic, meaning it helps your body shed excess fluid through the kidneys. The catch is that those same kidneys can also let too much magnesium slip out in the urine, a mineral your muscles and heart depend on to work smoothly. Because this is rated a moderate depletion concern, long-term users have a real reason to bring it up with their pharmacist or doctor, who can check whether your levels are staying in a good range and whether you might benefit from a supplement.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Deserpidine, Methyclothiazide →

Desogestrel, Ethinyl Estradiol

Moderate Depletion

Brand names include Ortho-Cept 28, Ortho-Cept 21, Marvelon 21

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Desogestrel, Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

The estrogen in this birth control pill, which your muscles, nerves, and heart rhythm all depend on for magnesium, appears to pull magnesium out of the bloodstream and push it into soft tissues and bone, leaving less circulating where the body can readily use it. This is rated a moderate depletion concern, meaning it is worth paying attention to rather than dismissing, and some people on long-term oral contraceptives do end up needing a supplement. It is a good idea to bring this up with your pharmacist or doctor, especially if you notice muscle cramps, fatigue, or other symptoms that could hint at low magnesium levels.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Desogestrel, Ethinyl Estradiol →

Dexamethasone

Moderate Depletion

Brand names include Decadron, Hexadrol, Dexone

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Dexamethasone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Long-term dexamethasone use can cause the body to break down bone tissue, which releases stored magnesium into the bloodstream and then the kidneys flush out the extra through urine. That said, blood levels often stay in a normal range despite this, so this is a 'watch and see' situation rather than an automatic concern. If you take dexamethasone for an extended period, it is worth asking your doctor or pharmacist whether your magnesium level should be checked.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Dexamethasone →

Digoxin

Moderate Depletion

Brand names include Lanoxicaps, Lanoxin, Digitek

Digoxin increases excretion of magnesium in the urine.

Digoxin decreases renal tubular reabsorption of magnesium, increasing excretion in the urine. People taking digoxin for heart failure may also be taking loop or thiazide diuretics, increasing the potential for hypomagnesemia. Low magnesium levels increase the risk of arrhythmias associated with high digoxin levels. For information on foods that are rich in magnesium, see our chart.
Taking Digoxin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your heart rhythm steady and your muscles and nerves working properly, so it matters quite a bit when you are on a heart medication like digoxin. Digoxin appears to interfere with how the kidneys reclaim magnesium, causing more of it to spill out in the urine than usual. This is rated a moderate concern, and the risk goes up further if you are also taking a diuretic for heart failure. It is worth asking your pharmacist or doctor whether your magnesium level should be checked, since low levels and digoxin together can be a tricky combination for heart rhythm.

References (4)
  1. Schwinger RH, Eromann E. Heart failure and electrolyte disturbances. Methods Find Exp Clin Pharmacol 1992;14:315-25.
  2. Gottlieb SS. Importance of magnesium in congestive heart failure. Am J Cardiol 1989;63:39G-42G.. PubMed
  3. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  4. Raja Rao MP, Panduranga P, Sulaiman K, Al-Jufaili M. Digoxin toxicity with normal digoxin and serum potassium levels: beware of magnesium, the hidden malefactor. J Emerg Med 2013;45(2):e31-4. PubMed

Full nutrient report for Digoxin →

Drospirenone, Estetrol

Moderate Depletion

Brand names include Nextstellis

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Drospirenone, Estetrol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and the estrogen component in this pill appears to nudge your body into pulling more magnesium out of the bloodstream and tucking it into tissues and bone, leaving less circulating in your blood. This is rated as a moderate concern, meaning it does not affect everyone but is worth paying attention to, especially over the long term. If you have been on this pill for a while, it is reasonable to ask your pharmacist or doctor whether checking your magnesium level or adjusting your diet makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Drospirenone, Estetrol →

Drospirenone, Ethinyl Estradiol

Moderate Depletion

Brand names include Yasmin, Gianvi, Angeliq

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Drospirenone, Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and the estrogen in this birth control pill may gradually pull more of it out of your bloodstream by pushing it into soft tissues and bone. This is a moderate, real concern, not just a theoretical one, so levels can quietly drop over time without obvious symptoms at first. If you have been taking this pill long-term, it is worth bringing up with your pharmacist or doctor, since some people in this situation do benefit from a supplement or a closer look at their diet.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Drospirenone, Ethinyl Estradiol →

Brand names include Beyaz

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking drospirenone, ethinyl estradiol, levomefolate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and the estrogen in this pill appears to redirect magnesium away from the bloodstream and into bones and soft tissues, which can leave circulating levels lower than they should be. This is a moderate concern, not a minor footnote, so long-term users are worth keeping an eye on. If you have been on this pill for a while and notice things like muscle cramps, fatigue, or irregular heartbeat, it is worth bringing up with your pharmacist or doctor to see whether your magnesium levels should be checked.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for drospirenone, ethinyl estradiol, levomefolate →

Brand names include Vaseretic

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Enalapril Maleate, Hydrochlorothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly. The hydrochlorothiazide in this combination pill is a thiazide diuretic, meaning it makes the kidneys produce more urine, and in doing so the kidneys can lose more magnesium than usual instead of holding onto it. This is a moderate concern, so while not everyone on this medication will develop a problem, long-term users are worth keeping an eye on. It is a reasonable thing to bring up with your pharmacist or doctor, especially if you notice muscle cramps or unusual fatigue.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Enalapril Maleate, Hydrochlorothiazide →

Esterified Estrogens

Moderate Depletion

Brand names include Menest, Estratab

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Esterified Estrogens? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and esterified estrogens can quietly lower the amount circulating in your blood. The reason is a bit counterintuitive: estrogen actually pushes magnesium out of the bloodstream and into soft tissues and bones, so your serum levels drop even though the magnesium is still somewhere in your body. This is rated moderate, meaning some long-term users do end up with levels low enough to matter. If you have been on this therapy for a while, it is worth asking your pharmacist or doctor whether checking your magnesium level makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Esterified Estrogens →

Brand names include Estratest

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Esterified Estrogens, Methyltestosterone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and here is something worth knowing about this medication: the estrogen component appears to pull magnesium out of the bloodstream by pushing it into soft tissues and bone, which leaves less circulating in the blood. Because this is rated a moderate depletion, it is not something to panic about, but long-term users are reasonably advised to keep an eye on it. Ask your pharmacist or doctor whether your levels should be checked or whether a supplement makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Esterified Estrogens, Methyltestosterone →

Estradiol

Moderate Depletion

Brand names include Estrace, Gynodiol, Vagifem

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working smoothly, supports a steady heartbeat, and plays a role in hundreds of chemical reactions throughout the body. Estradiol appears to push magnesium out of the bloodstream and into soft tissues and bone, so blood levels can quietly drop over time. Because this is rated a moderate depletion, long-term users are worth watching, and some people do end up needing a supplement. It is a good idea to bring this up with your pharmacist or doctor, especially if you notice muscle cramps, fatigue, or other new symptoms.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Estradiol →

Estradiol, Medroxyprogesterone

Moderate Depletion

Brand names include Divitren

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Estradiol, Medroxyprogesterone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and here is something worth knowing: estrogen appears to pull magnesium out of the bloodstream and push it into soft tissues and bones, which can leave circulating levels lower than they should be. Because this combination includes estradiol, that same effect is at play. The rating here is moderate, meaning it is a real enough concern that some long-term users do need support. It is worth asking your pharmacist or doctor whether monitoring your magnesium level or adjusting your diet makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Estradiol, Medroxyprogesterone →

Brand names include Activella

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Estradiol, Norethindrone Acetate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and this combination of estradiol and norethindrone acetate has a moderate, real-world association with lower magnesium levels. The estrogen component appears to push magnesium out of the bloodstream and into soft tissues and bone, so blood levels drop even though the mineral is still in your body. This is rated as moderate, meaning it matters enough to keep an eye on, and some people on long-term therapy do need a supplement. Worth a conversation with your pharmacist or doctor, especially if you notice muscle cramps, fatigue, or irregular heartbeat.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Estradiol, Norethindrone Acetate →

Estradiol, Norgestimate

Moderate Depletion

Brand names include Ortho-Prefest

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Estradiol, Norgestimate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and estrogen-containing medications like this one can pull it down by pushing magnesium out of the bloodstream and into bones and soft tissues. Because this shift is well-documented and not just theoretical, long-term users have a reasonable reason to bring it up with their pharmacist or doctor. Most people will not develop a serious deficiency, but some do need a supplement, so this is worth a quick conversation rather than something to simply ignore.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Estradiol, Norgestimate →

Estradiol, Progesterone

Moderate Depletion

Brand names include Bijuvanda

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Estradiol, Progesterone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly. Here is something interesting about estrogen: rather than blocking magnesium in the gut or flushing it out through the kidneys, it actually pulls magnesium out of the bloodstream and into soft tissues and bone, which leaves less circulating in your blood. With a moderate depletion rating, this is worth paying attention to, especially for long-term users. Ask your pharmacist or doctor whether checking your magnesium level or adding a supplement makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Estradiol, Progesterone →

Estrogen

Moderate Depletion
Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Estrogen? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and estrogen therapy has a well-documented way of pulling it down: the hormone pushes magnesium out of the bloodstream and into soft tissues and bone, so serum levels can drop even if your diet stays the same. This is rated moderate depletion, meaning it is a real enough concern that some people on long-term estrogen therapy (including oral contraceptives) may genuinely need a supplement. It is worth bringing up with your pharmacist or doctor, especially if you notice muscle cramps, fatigue, or irregular heartbeats.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Estrogen →

Estrone

Moderate Depletion

Brand names include Ortho-Est

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Estrone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and estrone, like other estrogens, can nudge your body to pull more of it out of the bloodstream and store it in soft tissues and bone, leaving less circulating where it is most needed. This is rated a moderate depletion concern, meaning it is real enough that some people on estrogen therapy do end up with lower magnesium levels over time. If you have been taking estrone long-term, it is worth asking your pharmacist or doctor whether checking your magnesium level or adding a supplement makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Estrone →

Estropipate

Moderate Depletion

Brand names include Ogen, Ortho EST

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Estropipate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and estropipate (an estrogen) appears to pull it out of the bloodstream by pushing it into soft tissues and bone rather than blocking it in the gut. Because of that shift, blood magnesium levels can drop with ongoing use, and for some people the drop is meaningful enough to need attention. This one carries a moderate rating, so it is worth bringing up with your pharmacist or doctor, especially if you have been on estropipate for a while or have symptoms like muscle cramps or fatigue.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Estropipate →

Ethacrynic Acid

Moderate Depletion

Brand names include Edecrin

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Ethacrynic Acid? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly. Ethacrynic acid is a loop diuretic, meaning it makes your kidneys remove extra fluid through urine, and one side effect of that process is that the kidneys also flush out more magnesium than they normally would. Because this loss is real and documented, long-term users should ask their pharmacist or doctor whether their magnesium levels should be checked, and whether a supplement makes sense for them.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Ethacrynic Acid →

Brand names include Logynon, Microgynon 30 ED

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Ethiny Estradiol, Levonorgestrel? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. The estrogen in this birth control pill appears to push magnesium out of the bloodstream and into soft tissues and bone, which can leave circulating levels lower than normal. Because this is rated a moderate depletion, it is worth paying attention to, especially with long-term use. Ask your pharmacist or doctor whether your levels should be checked or whether a supplement makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Ethiny Estradiol, Levonorgestrel →

Ethinyl Estradiol

Moderate Depletion

Brand names include Estinyl

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and ethinyl estradiol may nudge your levels lower by pushing more magnesium out of the bloodstream and into body tissues and bones. Because this is rated as a moderate depletion, it is a real enough concern for long-term users, though not everyone will be affected. If you have been taking this medication for a while, it is worth asking your pharmacist or doctor whether your magnesium levels should be checked or whether a supplement makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Ethinyl Estradiol →

Ethinyl Estradiol, Desogestrel

Moderate Depletion

Brand names include Linessa, Apri, Reclipsen

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Ethinyl Estradiol, Desogestrel? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and the estrogen component of this birth control pill appears to pull magnesium out of the bloodstream by pushing it into soft tissues and bone. That shift can gradually lower the levels circulating in your blood. Because this is rated a moderate depletion, it is worth paying attention to over time, especially if you take this pill for years. Ask your pharmacist or doctor whether checking your magnesium level or adjusting your diet makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Ethinyl Estradiol, Desogestrel →

Ethinyl Estradiol, Drospirenone

Moderate Depletion

Brand names include Yaz

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Ethinyl Estradiol, Drospirenone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and there is a real reason to keep an eye on it while taking a birth control pill that contains estrogen. The estrogen component appears to pull magnesium out of the bloodstream and push it into soft tissues and bones, which can nudge serum levels lower over time. Because this is rated as a moderate depletion concern, long-term users may want to bring it up with their pharmacist or doctor, since some people do benefit from a supplement while others do not need one.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Ethinyl Estradiol, Drospirenone →

Brand names include Demulen 1/35, Zovia 1/35, Demulen Compack

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Ethinyl Estradiol, Ethynodiol Diacetate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and this combination birth control pill contains estrogen that may push magnesium out of the bloodstream and into body tissues, leaving less circulating where your body can readily use it. Because this is rated a moderate depletion concern, it is something worth paying attention to over the long term rather than dismissing outright. Not everyone will develop a significant drop, but if you have been on this pill for a while, it is a reasonable thing to bring up with your pharmacist or doctor to find out whether your levels should be checked or a supplement makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Ethinyl Estradiol, Ethynodiol Diacetate →

Brand names include Lybrel

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Ethinyl estradiol, Levonogestrel? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and combined hormonal contraceptives like this one contain estrogen, which appears to pull magnesium out of the bloodstream and push it into soft tissues and bone. That shift can leave circulating levels lower than they should be, and this is rated a moderate depletion concern, meaning some long-term users may actually need to address it. It is worth bringing up with your pharmacist or doctor, especially if you notice muscle cramps, fatigue, or irregular heartbeat, so they can decide whether your levels should be checked or a supplement makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Ethinyl estradiol, Levonogestrel →

Brand names include Levlite 28, Tri-Levlen 21, Tri-Levlen 28

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Ethinyl Estradiol, Levonorgestrel? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and the estrogen component of this birth control pill appears to pull magnesium out of the bloodstream by pushing it into soft tissues and bone. Because of that shift, serum levels can run lower than normal in some people taking combination oral contraceptives. This is rated a moderate concern, so it is worth bringing up with your pharmacist or doctor, especially if you have been on the pill long-term or notice symptoms like muscle cramps or fatigue.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Ethinyl Estradiol, Levonorgestrel →

Brand names include Femhrt, Loestrin 21, Ovcon 35 21

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Ethinyl Estradiol, Norethindrone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and the estrogen component of this birth control pill has been shown to push magnesium out of the bloodstream and into body tissues like soft tissue and bone, which lowers the amount circulating in your blood. This is rated a moderate depletion concern, meaning it is real enough that some long-term users may actually need a supplement. It is worth bringing up with your pharmacist or doctor, especially if you have been on this pill for a while or notice symptoms like muscle cramps or fatigue.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Ethinyl Estradiol, Norethindrone →

Brand names include Estrostep Fe, Loestrin Fe, Microgestin FE

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Ethinyl Estradiol, Norethindrone, Ferrous Fumarate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. The estrogen component of this pill appears to pull magnesium out of the bloodstream and push it into soft tissues and bone, leaving less circulating in the body. Because this effect is well-documented and not just theoretical, long-term users are worth monitoring. It is worth asking your pharmacist or doctor whether your magnesium level should be checked or whether a supplement makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Ethinyl Estradiol, Norethindrone, Ferrous Fumarate →

Ethinyl Estradiol, Norgestimate

Moderate Depletion

Brand names include Ortho Tri-Cyclen 28, Ortho Tri-Cyclen Lo, Ortho-Cyclen

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Ethinyl Estradiol, Norgestimate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and the estrogen component of this birth control pill appears to pull more of it out of the bloodstream and push it into soft tissues and bone, leaving lower levels circulating in the blood. This is rated moderate, meaning it is a real effect worth paying attention to, especially with long-term use. Not everyone will need a supplement, but it is worth bringing up with your pharmacist or doctor if you have been on this pill for a while or if you notice symptoms like muscle cramps or fatigue.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Ethinyl Estradiol, Norgestimate →

Ethinyl Estradiol, Norgestrel

Moderate Depletion

Brand names include Ovral, Lo/Ovral, Cryselle

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Ethinyl Estradiol, Norgestrel? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and this combination birth control pill may gradually pull levels down. The estrogen component appears to push magnesium out of the bloodstream and into soft tissues and bones, so less of it stays in circulation. Because this is rated a moderate depletion, it is worth paying attention to over time, especially for long-term users. Ask your pharmacist or doctor whether checking your magnesium level or adjusting your diet makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Ethinyl Estradiol, Norgestrel →

Etonogestrel, Ethinyl Estradiol

Moderate Depletion

Brand names include NuvaRing

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Etonogestrel, Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and the estrogen component of this birth control ring appears to push magnesium out of the bloodstream and into soft tissues and bone, leaving less circulating where the body can readily use it. This is rated as a moderate concern, meaning it is real enough that some long-term users may benefit from checking in with their pharmacist or doctor about whether their levels or symptoms warrant attention. Most people will not need to act right away, but if you notice things like muscle cramps, fatigue, or irregular heartbeat over time, that conversation is worth having.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Etonogestrel, Ethinyl Estradiol →

Fludrocortisone

Moderate Depletion

Brand names include Florinef Acetate

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Fludrocortisone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working smoothly, supports a steady heartbeat, and is important for strong bones. Fludrocortisone is a corticosteroid, and long-term use of corticosteroids can cause your kidneys to release more magnesium into the urine than usual, partly because these medications break down bone tissue over time, freeing up magnesium that then gets flushed out. The good news is that blood magnesium levels often stay in the normal range despite this, but the rating here is moderate, so if you have been on fludrocortisone for a long time it is worth bringing up with your pharmacist or doctor to see whether monitoring or a supplement makes sense for you.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Fludrocortisone →

Fluticasone

Moderate Depletion

Brand names include Flovent, Flonase, Flixotide

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Fluticasone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and bones depend on to work properly. Long-term use of corticosteroids like fluticasone can cause the body to break down small amounts of bone tissue, which releases magnesium into the bloodstream and then out through the kidneys in the urine. Blood levels often stay in the normal range despite this, but the 'Moderate Depletion' rating means it is worth keeping an eye on if you use fluticasone regularly for months or years. Ask your pharmacist or doctor whether your levels should be checked.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Fluticasone →

Brand names include Trelegy Ellipta

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Fluticasone Furoate, Umeclidinium, Vilanterol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

The fluticasone furoate in this combination inhaler is a corticosteroid, and magnesium, which your muscles, nerves, and heart all depend on, can be affected by long-term corticosteroid use. Here is what appears to happen: the steroid gradually breaks down bone tissue, and as bone breaks down it releases magnesium into the bloodstream, where the kidneys then filter more of it out in the urine. The good news is that actual blood levels often stay normal despite this process. Because the rating here is moderate, it is worth mentioning to your pharmacist or doctor if you use this inhaler regularly, just to check whether your levels or diet need any attention.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Fluticasone Furoate, Umeclidinium, Vilanterol →

Brand names include Breo Ellipta

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Fluticasone Furoate, Vilanterol Trifenatate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so keeping levels in a healthy range matters. The fluticasone furoate component of this inhaler is a corticosteroid, and long-term corticosteroid use appears to pull magnesium from bone tissue during normal bone turnover, which can send more of it out through the kidneys in urine. That said, actual blood levels often stay normal even with this extra loss, so the concern is mainly for people using this medication chronically over years. If that describes you, it is worth bringing up magnesium with your pharmacist or doctor at your next visit.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Fluticasone Furoate, Vilanterol Trifenatate →

Foscarnet

Moderate Depletion

Brand names include Foscavir

Foscarnet can increase removal of magnesium from the body, causing symptomatic hypomagnesemia.

Foscarnet can cause various electrolyte disturbances, including symptomatic hypomagnesemia. This may be due to chelation of magnesium and increased elimination. For information on foods that are rich in magnesium, see our chart.
Taking Foscarnet? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, nerves, and heart rhythm working smoothly, so keeping levels in a healthy range really matters. Foscarnet appears to bind to magnesium in the body and pull more of it out through the kidneys than normal, which can drop levels enough to cause noticeable symptoms in some patients. Because this is a well-documented concern with moderate clinical significance, anyone taking foscarnet long-term should have magnesium levels checked regularly, and some people do end up needing a supplement. Talk with your doctor or pharmacist about whether monitoring or supplementation makes sense for you.

References (2)
  1. Gearhart MO, Sorg TB. Foscarnet-induced severe hypomagnesemia and other electrolyte disturbances. Ann Pharmacother 1993;27:285-9..
  2. Palestine AG, Polis MA, De Smet MD, et al. A randomized, controlled trial of foscarnet in the treatment of cytomegalovirus retinitis in patients with AIDS. Ann Int Med 1991;115:665-73.. PubMed

Full nutrient report for Foscarnet →

Fosinopril, Hydrochlorothiazide

Moderate Depletion

Brand names include Monopril HCT

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Fosinopril, Hydrochlorothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and the hydrochlorothiazide in this combination can gradually reduce your levels of it. Thiazide diuretics work by making the kidneys pass more fluid and salt into the urine, but magnesium can get swept out along with it, which is why this interaction is rated as a moderate concern rather than just a theoretical one. Long-term users, especially older adults or anyone with kidney issues, are worth keeping an eye on. It is a good idea to ask your pharmacist or doctor whether checking your magnesium level makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Fosinopril, Hydrochlorothiazide →

Furosemide

Moderate Depletion

Brand names include Lasix

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Furosemide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Furosemide is a loop diuretic, meaning it works by making your kidneys remove extra fluid through urine, and magnesium, a mineral your muscles and heart rhythm depend on, can get flushed out along with that fluid. The kidneys have a natural process to pull magnesium back into the body before it leaves in the urine, and furosemide interferes with that process, so more magnesium gets lost than usual. This is rated as a moderate concern, which means it is real enough that some long-term users do end up needing a supplement. If you take furosemide regularly, it is worth asking your pharmacist or doctor whether your magnesium level has been checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Furosemide →

Furosemide, Potassium

Moderate Depletion

Brand names include Diumide-K Continus, Lasikal

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Furosemide, Potassium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, heart rhythm, and nerves working properly, so it matters more than people often realize. Furosemide is a loop diuretic, meaning it works by making your kidneys flush out extra fluid through urine, and unfortunately magnesium gets swept out along the way because the drug interferes with how the kidneys normally hold on to it. This is a moderate concern, not just a theoretical one, and some people on long-term furosemide do end up needing a supplement. It is worth bringing up with your pharmacist or doctor, especially if you have been on this medication for a while.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Furosemide, Potassium →

Gentamicin (IV)

Moderate Depletion

Brand names include Garamycin

Increased urinary magnesium loss occurs with nephrotoxicity caused by aminoglycosides.

Nephrotoxicity caused by aminoglycosides may lead to increased urinary losses of various electrolytes, including magnesium. Monitor patients closely to detect declining renal function and electrolyte disturbances. The aminoglycoside may need to be discontinued and intravenous electrolyte replacement given.
Taking Gentamicin (IV)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so keeping it in a healthy range really matters. Gentamicin can stress the kidneys, and when the kidneys are stressed by this type of antibiotic, they sometimes lose their ability to hold onto magnesium properly, letting too much spill out in the urine. Because this is rated a moderate concern, your care team will likely watch your kidney function and magnesium levels closely while you are on it, and some patients do end up needing replacement. If you have questions about your lab results or whether you need a supplement, your doctor or pharmacist is the right person to ask.

References (1)
  1. L'Hommedieu CS, Nicholas D, Armes DA, et al. Potentiation of magnesium sulfate--induced neuromuscular weakness by gentamicin, tobramycin, and amikacin. J Pediatr 1983;102:629-31..

Full nutrient report for Gentamicin (IV) →

Brand names include Esimil

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Guanethidine, Hydrochlorothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Hydrochlorothiazide is a thiazide diuretic, and one thing it does in the kidneys is reduce how well magnesium gets reabsorbed back into the bloodstream, so more of it ends up leaving the body in urine. Magnesium is a mineral your muscles, heart, and nerves depend on, so ongoing losses can matter over time. This is rated as a moderate concern, meaning some long-term users do end up needing a supplement, though not everyone will. If you have been on this medication for a while, it is worth asking your pharmacist or doctor whether checking your magnesium level makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Guanethidine, Hydrochlorothiazide →

Brand names include Apresoline-Esidrix, Apresazide

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydralazine, Hydrochlorothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Hydrochlorothiazide is a thiazide diuretic, and one trade-off with this type of water pill is that the kidneys end up releasing more magnesium in the urine than they normally would, rather than holding onto it. Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so ongoing losses can matter over time. Because this combination carries a moderate depletion rating, long-term users are often worth monitoring. Ask your pharmacist or doctor whether checking your magnesium level, or adjusting your diet, makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydralazine, Hydrochlorothiazide →

Brand names include Ser-Ap-Es, Unipres, Uniserp

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydralazine, Hydrochlorothiazide, Reserpine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, heart rhythm, and nerves working properly, so your body needs it in steady supply. The hydrochlorothiazide in this combination medication is a thiazide diuretic, meaning it tells your kidneys to flush out more fluid, and unfortunately magnesium tends to get swept out in that process too. This is rated a moderate concern, so it is not something to ignore, especially if you have been on this medication long-term. It is worth asking your pharmacist or doctor whether your magnesium level should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydralazine, Hydrochlorothiazide, Reserpine →

Hydrochlorothiazide

Moderate Depletion

Brand names include Esidrix, Hydro, Microzide

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Hydrochlorothiazide works in the kidneys to help your body shed excess fluid, but as a side effect it can cause the kidneys to release more magnesium into the urine than usual, gradually lowering your body's supply. Because this is rated as a moderate concern, long-term users are worth keeping an eye on, and some people do end up needing a supplement. It is worth asking your pharmacist or doctor whether your magnesium level should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide →

Hydrochlorothiazide, Irbesartan

Moderate Depletion

Brand names include Avalide

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide, Irbesartan? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Hydrochlorothiazide is a thiazide diuretic, and one real-world trade-off with this type of water pill is that it can cause the kidneys to flush out more magnesium than usual in the urine, rather than holding onto it. Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so ongoing losses can matter. This interaction is rated moderate, meaning some long-term users do end up needing a supplement while others do not. It is worth bringing up with your pharmacist or doctor, especially if you take hydrochlorothiazide regularly.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide, Irbesartan →

Hydrochlorothiazide, Labetalol

Moderate Depletion

Brand names include Trandate HCT

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide, Labetalol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Hydrochlorothiazide is a thiazide diuretic, and one thing thiazide diuretics do is cause the kidneys to release more magnesium into the urine than usual, which over time can nudge magnesium levels lower. Magnesium is a mineral your muscles, nerves, and heart rhythm depend on, so a moderate drop matters more than a minor one. Long-term users of this medication are worth monitoring, and some people do end up needing a supplement. It is a good idea to bring this up with your pharmacist or doctor so they can decide whether checking your levels makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide, Labetalol →

Hydrochlorothiazide, Lisinopril

Moderate Depletion

Brand names include Zestoretic, Prinzide

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide, Lisinopril? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working properly, supports a steady heartbeat, and plays a role in hundreds of chemical reactions throughout the body. The hydrochlorothiazide portion of this combination works in the kidneys to remove excess fluid, but as a side effect it can cause the kidneys to flush out more magnesium in the urine than they normally would. Because this is rated a moderate depletion, it is a real enough concern for long-term users that it is worth bringing up with your pharmacist or doctor, who can check your magnesium level and let you know whether any action makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide, Lisinopril →

Brand names include Hyzaar

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide, Losartan Potassium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and the hydrochlorothiazide in this combination can gradually lower your levels by nudging the kidneys to flush more of it out in the urine rather than holding onto it. This is a moderate concern, meaning it does not affect everyone but is real enough that some long-term users do end up needing a supplement. It is worth bringing up with your pharmacist or doctor, especially if you notice muscle cramps, fatigue, or irregular heartbeats, so they can check whether monitoring or supplementation makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide, Losartan Potassium →

Hydrochlorothiazide, Methyldopa

Moderate Depletion

Brand names include Aldoril 15, Methazide, Aldoril 25

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide, Methyldopa? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, heart rhythm, and nerves working properly, and hydrochlorothiazide (the thiazide diuretic in this combination) can gradually lower your levels by nudging the kidneys to flush more of it out in the urine rather than holding onto it. This is a moderate concern, not just a theoretical one, so it is worth paying attention to over time. If you have been on this medication for a while, ask your pharmacist or doctor whether checking your magnesium level makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide, Methyldopa →

Hydrochlorothiazide, Metoprolol

Moderate Depletion

Brand names include Lopressor HCT

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide, Metoprolol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly. Hydrochlorothiazide, the diuretic (water pill) in this combination, can cause the kidneys to pass more magnesium out through the urine than they normally would, which over time may nudge magnesium levels lower than ideal. The rating here is moderate, meaning this is a real enough concern that some long-term users do end up needing a supplement, though not everyone does. If you have been on this medication for a while, it is worth asking your pharmacist or doctor whether checking your magnesium level makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide, Metoprolol →

Hydrochlorothiazide, Moexipril

Moderate Depletion

Brand names include Uniretic

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide, Moexipril? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Hydrochlorothiazide is a thiazide diuretic, and one trade-off of how it works is that the kidneys end up releasing more magnesium into the urine than they normally would, rather than holding onto it. Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so consistent losses over time can matter. This combination carries a moderate depletion rating, meaning it is a real concern worth watching, not just a theoretical one, and some people on long-term therapy do end up needing a supplement. It is worth bringing up with your pharmacist or doctor, especially if you take this medication every day.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide, Moexipril →

Hydrochlorothiazide, Pindolol

Moderate Depletion

Brand names include Viskazide

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide, Pindolol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Hydrochlorothiazide is a thiazide diuretic, and one thing thiazide diuretics do is cause the kidneys to release more magnesium into the urine than usual, which over time can nudge magnesium levels lower. Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so this is worth paying attention to. The evidence here is rated moderate, meaning some long-term users do end up needing a supplement while others stay fine. If you have been on this medication for a while, it is worth asking your pharmacist or doctor whether checking your magnesium level makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide, Pindolol →

Brand names include Inderide

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide, Propranolol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly. Hydrochlorothiazide, a thiazide diuretic, tells your kidneys to flush out more fluid, and unfortunately magnesium gets swept out in the urine along the way. This is a moderate concern, meaning low magnesium is a real possibility for some long-term users, not just a theoretical one. If you have been on this medication for a while, it is worth asking your pharmacist or doctor whether your magnesium level should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide, Propranolol →

Hydrochlorothiazide, Quinapril

Moderate Depletion

Brand names include Accuretic

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide, Quinapril? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working smoothly, supports a steady heartbeat, and plays a role in hundreds of chemical processes your body runs every day. Hydrochlorothiazide, a thiazide diuretic, works partly by telling the kidneys to pass more fluid out of the body, and magnesium can get swept out in that extra urine. This is a moderate concern, meaning low magnesium levels do show up in some people on long-term thiazide therapy, though not everyone is affected. If you have been on this medication for a while, it is worth asking your pharmacist or doctor whether your magnesium level should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide, Quinapril →

Hydrochlorothiazide, Reserpine

Moderate Depletion

Brand names include Hydropres, Serpasil-Esidrix, Serpasil-Esidrix #1

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide, Reserpine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly. Hydrochlorothiazide is a thiazide diuretic, meaning it makes your kidneys push out extra fluid through urine, and unfortunately magnesium tends to ride along with it, so your body can end up losing more than it takes in. With a moderate depletion rating, this is a real concern worth paying attention to, especially for long-term users. Ask your pharmacist or doctor whether your levels should be checked and whether a supplement makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide, Reserpine →

Brand names include Spirozine, Aldactazide, Aldactide 25

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide, Spironolactone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Here is the interesting wrinkle with this combination: hydrochlorothiazide (a thiazide diuretic) can cause the kidneys to flush out more magnesium than usual in the urine, but spironolactone works in the opposite direction and tends to help the kidneys hold magnesium back. Because these two effects can partly cancel each other out, the concern is real but more moderate than if you were taking the thiazide alone. That said, some people on long-term diuretic therapy do end up with lower magnesium levels, so it is worth mentioning to your pharmacist or doctor, especially if you notice muscle cramps or fatigue.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide, Spironolactone →

Hydrochlorothiazide, Timolol

Moderate Depletion

Brand names include Timolide

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide, Timolol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, heart rhythm, and nerves working smoothly, so running low on it is worth paying attention to. Hydrochlorothiazide is a thiazide diuretic, meaning it works partly by telling your kidneys to flush out more fluid, and unfortunately magnesium tends to get swept out in that process too. Because this is rated a moderate depletion, it is a real concern for long-term users, not just a theoretical one. If you have been on this medication for a while, it is worth asking your pharmacist or doctor whether your magnesium level has been checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide, Timolol →

Brand names include Maxzide, Dyazide, Maxzide-25

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide, Triamterene? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Here is the interesting wrinkle with this combination: hydrochlorothiazide, the thiazide diuretic in this pairing, causes the kidneys to spill extra magnesium into the urine rather than holding onto it. Triamterene, however, is a potassium-sparing diuretic that also tends to conserve magnesium, so it can partially offset that loss. Because the balance between these two effects varies from person to person, magnesium is still worth keeping an eye on, and long-term users should ask their pharmacist or doctor whether periodic monitoring or dietary attention makes sense for them.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide, Triamterene →

Hydrochlorothiazide, Valsartan

Moderate Depletion

Brand names include Diovan HCT

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydrochlorothiazide, Valsartan? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working properly, supports a steady heartbeat, and plays a role in hundreds of chemical reactions your body runs every day. The hydrochlorothiazide portion of this combination pill is a thiazide diuretic, meaning it tells your kidneys to push out more fluid through urine, and unfortunately some magnesium goes along for the ride. This is a moderate concern, so it does not affect everyone, but long-term users are worth watching. If you have been on this medication for a while, it is a good idea to ask your pharmacist or doctor whether checking your magnesium level makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydrochlorothiazide, Valsartan →

Hydrocortisone

Moderate Depletion

Brand names include Cortef, Hydrocortone, Carmol HC cream

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Hydrocortisone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Long-term hydrocortisone use can cause the body to break down bone tissue faster than usual, and as bone breaks down it releases stored magnesium into the bloodstream where the kidneys then flush it out through the urine. That said, blood magnesium levels often stay in the normal range despite this, so this is a rated moderate concern rather than a certainty. If you have been on hydrocortisone for a long stretch of time, it is worth asking your pharmacist or doctor whether your magnesium level should be checked.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Hydrocortisone →

Hydroflumethiazide

Moderate Depletion

Brand names include Saluron

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydroflumethiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so keeping levels in a healthy range matters. Hydroflumethiazide is a thiazide diuretic, and this class of water pill can cause the kidneys to let more magnesium slip out through the urine rather than holding onto it. The rating here is moderate, meaning real losses have been documented and some long-term users do end up needing a supplement. If you have been on this medication for a while, it is worth asking your pharmacist or doctor whether checking your magnesium level makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydroflumethiazide →

Hydroflumethiazide, Reserpine

Moderate Depletion

Brand names include Salutensin-Demi, Salutensin

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Hydroflumethiazide, Reserpine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so keeping levels healthy matters. Hydroflumethiazide is a thiazide diuretic, meaning it makes your kidneys produce more urine, and in doing so your kidneys can let more magnesium slip out in that urine rather than holding onto it. With a moderate depletion rating, this is a real enough concern that some long-term users do end up needing a supplement. Worth asking your pharmacist or doctor whether your levels should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Hydroflumethiazide, Reserpine →

Indapamide

Moderate Depletion

Brand names include Lozol, Lozide

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Indapamide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on, and indapamide can gradually chip away at your levels by causing your kidneys to flush more of it out in the urine than usual. Indapamide is a thiazide-like diuretic, and this type of water pill reduces how well the kidneys hold onto magnesium, so it gets lost rather than recycled. Because this is rated a moderate depletion, it is something worth paying attention to over the long term, especially if you take indapamide every day. Ask your pharmacist or doctor whether checking your magnesium level makes sense for you, since some people do end up needing a supplement.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Indapamide →

Irbesartan, Hydrochlorothiazide

Moderate Depletion

Brand names include CoAprovel

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Irbesartan, Hydrochlorothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly. The hydrochlorothiazide part of this combination pill is a thiazide diuretic, and thiazides can cause the kidneys to flush out more magnesium than usual in the urine rather than holding onto it. This is rated as a moderate concern, meaning low magnesium does not happen to everyone, but it is real enough that some long-term users do need a supplement. If you have been on this medication for a while, it is worth asking your pharmacist or doctor whether checking your magnesium level makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Irbesartan, Hydrochlorothiazide →

Kanamycin

Moderate Depletion

Brand names include Kantrex

Increased urinary magnesium loss occurs with nephrotoxicity caused by aminoglycosides.

Nephrotoxicity caused by aminoglycosides may lead to increased urinary losses of various electrolytes, including magnesium. Monitor patients closely to detect declining renal function and electrolyte disturbances. The aminoglycoside may need to be discontinued and intravenous electrolyte replacement given.
Taking Kanamycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working properly, supports a steady heartbeat, and plays a role in hundreds of chemical processes your body runs every day. Kanamycin is an aminoglycoside antibiotic, and one of its known risks is that it can be hard on the kidneys; when the kidneys are stressed in this way, they can lose their ability to hold onto magnesium, letting too much spill out in the urine. Because this is rated as a moderate depletion concern, patients on kanamycin are typically watched closely with regular kidney and electrolyte checks, and some do end up needing replacement. If you or a family member is being treated with this medication, ask your care team what monitoring is in place.

References (1)
  1. L'Hommedieu CS, Nicholas D, Armes DA, et al. Potentiation of magnesium sulfate--induced neuromuscular weakness by gentamicin, tobramycin, and amikacin. J Pediatr 1983;102:629-31..

Full nutrient report for Kanamycin →

Brand names include Nordette, Logynon ED, Microgynon 30

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Levonorgestrel, Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and the estrogen component of this birth control pill appears to pull magnesium out of the bloodstream by pushing it into soft tissues and bone. That shift can leave serum levels lower than normal over time. Because this is rated as a moderate depletion, long-term users are worth monitoring, and some may benefit from a supplement. It is worth bringing up with your pharmacist or doctor, especially if you notice muscle cramps or fatigue.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Levonorgestrel, Ethinyl Estradiol →

Mannitol

Moderate Depletion

Brand names include Osmitrol, Bronchitol

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Mannitol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, heart rhythm, and nerves working properly, so it is worth paying attention to. Mannitol is an osmotic diuretic, meaning it pulls water out of your tissues and sends it through your kidneys, and extra magnesium gets swept out in that urine flow. Because the rating here is moderate, this is not just a theoretical concern, and some people on mannitol do need a supplement. If you are using mannitol regularly, it is worth asking your pharmacist or doctor whether your magnesium levels should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Mannitol →

Brand names include Premique

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Medroxyprogesterone Acetate, Oestrogens, Conjugated? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on every day. Conjugated estrogens appear to work against keeping magnesium in your bloodstream by pushing more of it into soft tissues and bone, so the level circulating in your blood can drop. Because this is rated a moderate depletion, it is worth paying attention to over time, especially if you take this medication long-term. Ask your pharmacist or doctor whether your magnesium level should be checked or whether a supplement makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Medroxyprogesterone Acetate, Oestrogens, Conjugated →

Methazolamide

Moderate Depletion

Brand names include Neptazane

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Methazolamide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so keeping levels in a healthy range matters. Methazolamide is a carbonic anhydrase inhibitor that works partly like a diuretic, and that diuretic action can cause the kidneys to flush out more magnesium in the urine than usual. Because this is rated a moderate depletion concern, long-term users are worth keeping an eye on, and some people do end up needing a supplement. It is worth bringing this up with your pharmacist or doctor, especially if you use methazolamide regularly.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Methazolamide →

Methyclothiazide

Moderate Depletion

Brand names include Enduron, Aquatensen

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Methyclothiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly. Methyclothiazide is a thiazide diuretic, and one of its effects is that it causes the kidneys to release more magnesium into the urine rather than keeping it in the body. This is a moderate concern, meaning some long-term users do end up with lower magnesium levels, though not everyone will. It is worth asking your pharmacist or doctor whether your levels should be checked, especially if you have been on this medication for a while.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Methyclothiazide →

Methyclothiazide, Pargyline

Moderate Depletion

Brand names include Eutron

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Methyclothiazide, Pargyline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working properly, supports a steady heartbeat, and plays a role in hundreds of chemical reactions throughout the body. Methyclothiazide is a thiazide diuretic, meaning it works partly by telling your kidneys to push more fluid out through urine, and unfortunately magnesium can get swept along with that extra fluid, raising the amount your body loses each day. This is rated as a moderate concern, so it is not something to brush off, especially for long-term users. It is worth asking your pharmacist or doctor whether your magnesium levels should be checked or whether a supplement makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Methyclothiazide, Pargyline →

Methyclothiazide, Reserpine

Moderate Depletion

Brand names include Diutensen-R

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Methyclothiazide, Reserpine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, nerves, and heart rhythm working smoothly, and this thiazide diuretic combination can gradually lower your body's supply of it. The thiazide component works by making your kidneys produce more urine, and as a side effect, extra magnesium gets carried out with that urine instead of being held onto. Because this is rated as a moderate concern, it is not something to ignore if you take this medication long-term. It is worth asking your pharmacist or doctor whether your magnesium level should be checked periodically.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Methyclothiazide, Reserpine →

Methylprednisolone

Moderate Depletion

Brand names include Medrol, Medrol Dosepak

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Methylprednisolone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles contract, your heart keep a steady rhythm, and your bones stay strong, so it matters more than most people realize. Long-term methylprednisolone use can cause your kidneys to flush out more magnesium than usual, likely because the drug breaks down bone tissue and releases magnesium into the bloodstream, where the kidneys then filter it out. The good news is that blood magnesium levels often stay in a normal range despite this process, but with ongoing use the rating here is moderate, meaning some patients do need closer attention. If you take methylprednisolone regularly, it is worth asking your pharmacist or doctor whether your magnesium levels should be checked.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Methylprednisolone →

Metolazone

Moderate Depletion

Brand names include Diulo, Zaroxolyn, Mykrox

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Metolazone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working properly, supports a steady heartbeat, and plays a role in hundreds of chemical reactions throughout the body. Metolazone is a thiazide-type diuretic, and one known side effect is that the kidneys end up releasing more magnesium into the urine than they normally would, so less stays in your bloodstream. Because this is rated as a moderate concern, it is worth paying attention to, especially if you have been on this medication for a while. Ask your pharmacist or doctor whether checking your magnesium level makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Metolazone →

Neomycin

Moderate Depletion

Brand names include Mycifradin, Neo-Fradin, Myciguent

Increased urinary magnesium loss occurs with nephrotoxicity caused by aminoglycosides.

Nephrotoxicity caused by aminoglycosides may lead to increased urinary losses of various electrolytes, including magnesium. Monitor patients closely to detect declining renal function and electrolyte disturbances. The aminoglycoside may need to be discontinued and intravenous electrolyte replacement given.
Taking Neomycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, nerves, and heart rhythm working properly, so your body needs to hold onto it. Neomycin belongs to a family of antibiotics called aminoglycosides, and one known risk with these drugs is that they can be hard on the kidneys. When the kidneys are stressed this way, they may lose their ability to hold magnesium back, letting too much spill out in the urine. This is rated a moderate concern, meaning your care team will likely keep an eye on your kidney function and magnesium levels while you are on this medication, and some patients do end up needing a supplement or extra support. If you have questions about what to watch for, your pharmacist or doctor is the right person to ask.

References (1)
  1. L'Hommedieu CS, Nicholas D, Armes DA, et al. Potentiation of magnesium sulfate--induced neuromuscular weakness by gentamicin, tobramycin, and amikacin. J Pediatr 1983;102:629-31..

Full nutrient report for Neomycin →

Netilmicin

Moderate Depletion

Brand names include Netromycin

Increased urinary magnesium loss occurs with nephrotoxicity caused by aminoglycosides.

Nephrotoxicity caused by aminoglycosides may lead to increased urinary losses of various electrolytes, including magnesium. Monitor patients closely to detect declining renal function and electrolyte disturbances. The aminoglycoside may need to be discontinued and intravenous electrolyte replacement given.
Taking Netilmicin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heartbeat depend on to work properly. Netilmicin belongs to a class of antibiotics called aminoglycosides, and one known risk with these drugs is that they can be hard on the kidneys. When the kidneys are stressed this way, they may lose their ability to hold onto magnesium, causing more of it to spill out in the urine than normal. Because this is rated a moderate concern, patients on netilmicin are typically watched closely with lab work, and some do end up needing magnesium replacement, so it is worth asking your care team what monitoring is in place for you.

References (1)
  1. L'Hommedieu CS, Nicholas D, Armes DA, et al. Potentiation of magnesium sulfate--induced neuromuscular weakness by gentamicin, tobramycin, and amikacin. J Pediatr 1983;102:629-31..

Full nutrient report for Netilmicin →

Brand names include Ortho Evra, Evra

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Norelgestromin, Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on, and the estrogen component of this patch appears to pull magnesium out of the bloodstream by pushing it into soft tissues and bone. That shift can leave serum levels lower than normal over time. Because this is rated as moderate depletion, long-term users have a reasonable reason to bring it up with their pharmacist or doctor and ask whether their levels should be checked or a supplement makes sense for them.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Norelgestromin, Ethinyl Estradiol →

Brand names include Minastrin 24 FE, LoMinastrin FE

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Norethindrone Acetate, Ethinyl Estradiol, Ferrous Fumarate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm depend on every day. The ethinyl estradiol in this pill appears to push magnesium out of the bloodstream and into soft tissues and bones, which can leave circulating levels lower than they should be. Because this is rated a moderate depletion, it is worth paying attention to, especially if you have been on this medication long-term. Ask your pharmacist or doctor whether checking your magnesium level, or adding a supplement, makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Norethindrone Acetate, Ethinyl Estradiol, Ferrous Fumarate →

Oestrogen

Moderate Depletion
Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Oestrogen? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and oestrogen therapy has a notable and well-documented effect on it. Rather than blocking absorption in the gut, oestrogen appears to push magnesium out of the bloodstream and into soft tissues and bone, so blood levels drop even if your diet stays the same. This is rated a moderate depletion, meaning it is worth paying attention to, especially for long-term users. If you have been on oestrogen therapy for a while, it is a reasonable thing to bring up with your pharmacist or doctor to see whether your levels should be checked.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Oestrogen →

Brand names include Ryaltris

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Olopatadine Hydrochloride, Mometasone Furoate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and bones depend on to work properly. The mometasone in this combination product is a corticosteroid, and long-term corticosteroid use can cause the kidneys to release more magnesium into the urine than usual, partly because these medicines can break down bone tissue and free up extra magnesium for the kidneys to flush out. That said, this effect usually does not drop blood levels enough to show up on a standard test for most people. If you use this medication regularly over a long period, it is worth mentioning to your pharmacist or doctor so they can decide whether your levels need to be checked.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Olopatadine Hydrochloride, Mometasone Furoate →

Panitumumab

Moderate Depletion

Brand names include Vectibix

Panitumumab increases excretion of magnesium in the urine.

Panitumumab causes renal magnesium wasting, leading to lowered magnesium levels in 39% of patients. Hypomagnesemia severe enough to require treatment occurs in 2% to 4% of cases. For information on foods that are rich in magnesium, see our chart.
Taking Panitumumab? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Panitumumab works by blocking a receptor on cancer cells, but that same receptor plays a role in how the kidneys hold onto magnesium. Because of this, the kidneys can end up releasing too much magnesium into the urine rather than keeping it in the body, where it is needed for muscle function, nerve signaling, and heart rhythm. This happens often enough that your care team will likely check your magnesium levels regularly, and some patients do end up needing a supplement. If you are on this medication, it is worth asking your doctor or pharmacist how your levels look.

References (1)
  1. Vectibix (panitumumab) product information. Amgen Inc., Thousand Oaks, CA. June 2007.

Full nutrient report for Panitumumab →

Penicillamine

Moderate Depletion

Brand names include Cuprimine, Depen Titratable

Penicillamine can reduce magnesium absorption by chelating magnesium in the gut.

Penicillamine chelates magnesium, although with lower affinity than other metals such as copper, iron, and zinc. It can potentially contribute to hypomagnesemia, especially in people with other factors which lower serum magnesium. Magnesium supplements should be taken several hours apart from penicillamine to avoid forming non-absorbable chelates in the gut. For information on foods that are rich in magnesium, see our chart.
Taking Penicillamine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Penicillamine has a unique chemical property: it latches onto certain minerals in your digestive tract before your body can absorb them, and magnesium, which helps your muscles, nerves, and heart rhythm work properly, is one of those minerals. Because of this binding effect in the gut, long-term users can end up with lower magnesium levels, and this is rated as a moderate concern, meaning some people genuinely do need a supplement. If you take magnesium separately, timing matters a lot, so please ask your pharmacist or doctor how to space it safely from your penicillamine dose.

References (2)
  1. Cantilena LR, Klaassen CD. The effect of chelating agents on the excretion of endogenous metals. Toxicol Appl Pharmacol 1982;63:344-50.
  2. Seelig MS. Auto-immune complications of D-penicillamine - A possible result of zinc and magnesium depletion and of pyridoxine inactivation. J Am Coll Nutr 1982;1:207-14. PubMed

Full nutrient report for Penicillamine →

Plazomicin Sulfate

Moderate Depletion

Brand names include Zemdri

Increased urinary magnesium loss occurs with nephrotoxicity caused by aminoglycosides.

Nephrotoxicity caused by aminoglycosides may lead to increased urinary losses of various electrolytes, including magnesium. Monitor patients closely to detect declining renal function and electrolyte disturbances. The aminoglycoside may need to be discontinued and intravenous electrolyte replacement given.
Taking Plazomicin Sulfate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, heart rhythm, and nerves working properly, so keeping enough of it on board really does matter. Plazomicin belongs to the aminoglycoside antibiotic family, and these drugs can be hard on the kidneys. When the kidneys are stressed this way, they can start spilling magnesium into the urine instead of holding onto it. Because this is a real, documented concern rather than just a theoretical one, patients on plazomicin are typically watched closely with blood tests, and some do end up needing replacement. If you or a loved one is being treated with this medication, ask the care team what monitoring is planned.

References (1)
  1. L'Hommedieu CS, Nicholas D, Armes DA, et al. Potentiation of magnesium sulfate--induced neuromuscular weakness by gentamicin, tobramycin, and amikacin. J Pediatr 1983;102:629-31..

Full nutrient report for Plazomicin Sulfate →

Polythiazide

Moderate Depletion

Brand names include Renese

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Polythiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly. Polythiazide is a thiazide diuretic, and thiazides can nudge the kidneys to flush out more magnesium in the urine than usual, which over time may gradually lower your body's levels. The 'Moderate Depletion' rating means this is a real enough concern that some long-term users do need a supplement, though not everyone will. It is worth bringing up with your pharmacist or doctor, especially if you have been on this medication for a while.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Polythiazide →

Polythiazide, Prazosin

Moderate Depletion

Brand names include Minizide

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Polythiazide, Prazosin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Polythiazide, the thiazide diuretic in this combination, works partly by telling your kidneys to pass more fluid out through urine, and magnesium, a mineral your muscles and nerves depend on, can get swept out along with it. Because thiazides reduce how well the kidneys reclaim magnesium before urine is formed, long-term use can gradually bring magnesium levels down. This is rated as a moderate concern, meaning it does not affect everyone but is worth watching, especially if you take this medication regularly. Ask your pharmacist or doctor whether periodic monitoring or a dietary adjustment makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Polythiazide, Prazosin →

Polythiazide, Reserpine

Moderate Depletion

Brand names include Renese R

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Polythiazide, Reserpine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. The thiazide diuretic component of this combination works in the kidneys, and one of its side effects is that it allows more magnesium than normal to slip out in the urine rather than being held onto. This is a moderate concern, so long-term users are worth watching: some people need a supplement, and some do not. It is worth asking your pharmacist or doctor whether your magnesium level should be checked, especially if you notice muscle cramps or unusual fatigue.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Polythiazide, Reserpine →

Prasterone (prescription drug)

Moderate Depletion

Brand names include Intrarosa

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Prasterone (prescription drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Prasterone is a prescription form of DHEA that your body converts into estrogen, and higher estrogen levels appear to pull magnesium, a mineral your muscles and heart rhythm depend on, out of your blood and into soft tissues and bone. Because of this shift, serum magnesium levels can run lower while you're on this therapy. The evidence here is rated moderate, meaning it's a real enough concern that some patients do end up needing a supplement. If you've been using prasterone long-term, it's worth bringing up magnesium levels with your doctor or pharmacist at your next visit.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Prasterone (prescription drug) →

Prednisolone

Moderate Depletion

Brand names include Sterane, Delta Cortef, Cortalone

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Prednisolone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Long-term prednisolone use can cause the kidneys to flush more magnesium out in the urine, partly because corticosteroids break down bone tissue and release magnesium into the bloodstream where it becomes easier to excrete. The good news is that actual blood levels often stay in the normal range for many people, but this is still rated as moderate depletion, so it is worth mentioning to your pharmacist or doctor if you have been on prednisolone for a while.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Prednisolone →

Prednisone

Moderate Depletion

Brand names include Deltasone, Cortan, Orasone

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Prednisone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles contract, keeps your heart rhythm steady, and supports strong bones, so it plays a quiet but important role all over the body. Long-term prednisone use can cause your kidneys to flush more magnesium out in the urine, likely because the drug breaks down bone tissue over time and releases stored magnesium into the bloodstream, where the kidneys then filter it out. The reassuring part is that blood levels often stay in the normal range despite this, but with a 'Moderate Depletion' rating, it is worth checking in with your doctor or pharmacist if you have been on prednisone for a long stretch of time.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Prednisone →

Quinethazone

Moderate Depletion

Brand names include Hydromox

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Quinethazone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working properly, supports a steady heartbeat, and plays a role in hundreds of chemical reactions your body runs every day. Quinethazone is a thiazide-type diuretic, and like others in that family, it can cause your kidneys to spill more magnesium into the urine than they normally would, gradually lowering the amount circulating in your blood. With a moderate depletion rating, this is a real enough concern that some long-term users do end up needing a supplement. It is worth asking your pharmacist or doctor whether your magnesium levels should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Quinethazone →

Quinethazone, Reserpine

Moderate Depletion

Brand names include Hydromox R

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Quinethazone, Reserpine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Quinethazone is a thiazide-type diuretic, and one side effect of this drug class is that the kidneys end up releasing more magnesium in the urine than they normally would, gradually lowering the amount your body has on hand. Magnesium is a mineral your muscles, heart, and nerves all depend on to work properly. Because this is rated as a moderate depletion concern, long-term users have a real reason to bring it up with their doctor or pharmacist, since some people do end up needing a supplement while others stay in a healthy range with dietary sources alone.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Quinethazone, Reserpine →

Brand names include Myfembree

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Relugolix, Estradiol, Norethindrone Acetate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and the estradiol in this combination medication may gradually pull it down by pushing more magnesium out of the bloodstream and into body tissues like soft tissue and bone. Because this is rated a moderate depletion, it is a real enough concern that some people on long-term therapy do end up needing a supplement. It is worth bringing up with your pharmacist or doctor, especially if you notice muscle cramps, fatigue, or irregular heartbeats.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Relugolix, Estradiol, Norethindrone Acetate →

Reserpine, Trichlormethiazide

Moderate Depletion

Brand names include Naquival, Metatensin #2, Metatensin #4

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Reserpine, Trichlormethiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Trichlormethiazide is a thiazide diuretic, and one thing thiazide diuretics do is cause the kidneys to release more magnesium into the urine than usual, which over time can nudge magnesium levels lower. Magnesium is a mineral your muscles, nerves, and heart rhythm depend on, so a sustained drop matters. Because this combination carries a moderate depletion rating, long-term users have a reasonable reason to ask their pharmacist or doctor whether their magnesium level should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Reserpine, Trichlormethiazide →

Sacubitril, Valsartan

Moderate Depletion

Brand names include Entresto

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Sacubitril, Valsartan? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Sacubitril/valsartan contains a diuretic component that works partly through the kidneys, and one known trade-off is that it can prompt the kidneys to flush out more magnesium than usual in the urine rather than holding onto it. Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so losing more of it over time is worth keeping an eye on. The moderate rating here means this is a real, documented concern for long-term users, not just a theoretical one. If you have been on this medication for a while, it is worth asking your doctor or pharmacist whether your magnesium levels have been checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Sacubitril, Valsartan →

Brand names include Annovera

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Segesterone Acetate, Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and the estrogen component of this contraceptive ring may gradually pull your circulating magnesium levels down by pushing more of it into soft tissues and bone rather than keeping it in the bloodstream. This is rated moderate, meaning it is a real enough concern that some long-term users do need to address it, even if not everyone will. If you have been using this ring for a while, it is worth asking your pharmacist or doctor whether checking your magnesium level or adding a supplement makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Segesterone Acetate, Ethinyl Estradiol →

Sodium Phosphate (OTC drug)

Moderate Depletion

Brand names include Fleet Phospho-Soda, Fleet Accu-Prep

High doses of sodium phosphates deplete magnesium.

Use of high doses of sodium phosphates, such as those used for bowel cleansing before surgery, can cause hypomagnesemia. Advise people to avoid using high doses of these products for self-treatment of constipation.
Taking Sodium Phosphate (OTC drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles, heart rhythm, and nerves work properly, so keeping your levels healthy really does matter. When sodium phosphate is taken in the large doses used for bowel prep before a colonoscopy or surgery, it can pull magnesium out of the body fairly quickly, and low levels have been reported in some people after those cleanses. Because this is rated a moderate concern, it is mostly relevant to high-dose use rather than an occasional small dose for constipation. If you are preparing for a procedure or have been using these products frequently, it is worth a conversation with your pharmacist or doctor about whether your magnesium should be checked.

References (2)
  1. Schwarz RE, Zagala-Nevarez K. Significant hypomagnesemia after celiotomy: implications of preoperative bowel cleansing with sodium phosphate purgative. Surgery 2002;131:236. PubMed
  2. Ehrenpreis ED, Wieland JM, Cabral J, et al. Symptomatic hypocalcemia, hypomagnesemia, and hyperphosphatemia sceondary to Fleet's Phospho-Soda colonoscopy preparation in a patient with a jejunoileal bypass. Dig Dis Sci 1997;42:858-60.

Full nutrient report for Sodium Phosphate (OTC drug) →

Brand names include Visicol

High doses of sodium phosphates deplete magnesium.

Use of high doses of sodium phosphates, such as those used for bowel cleansing before surgery, can cause hypomagnesemia. Advise people to avoid using high doses of these products for self-treatment of constipation.
Taking Sodium Phosphate (prescription drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles, heart rhythm, and nerves work properly, so keeping levels in a healthy range really does matter. When sodium phosphate is used in large doses, such as for a bowel prep before a procedure, it can pull magnesium out of the body quickly, and levels can drop low enough to cause noticeable symptoms. Because this is a well-recognized concern with high-dose use, your care team will likely keep an eye on your magnesium and may recommend a supplement depending on your situation. If you have any questions about whether you need one, your pharmacist or doctor is the right person to ask.

References (2)
  1. Schwarz RE, Zagala-Nevarez K. Significant hypomagnesemia after celiotomy: implications of preoperative bowel cleansing with sodium phosphate purgative. Surgery 2002;131:236. PubMed
  2. Ehrenpreis ED, Wieland JM, Cabral J, et al. Symptomatic hypocalcemia, hypomagnesemia, and hyperphosphatemia sceondary to Fleet's Phospho-Soda colonoscopy preparation in a patient with a jejunoileal bypass. Dig Dis Sci 1997;42:858-60.

Full nutrient report for Sodium Phosphate (prescription drug) →

Spironolactone

Moderate Depletion

Brand names include Aldactone, Spiroton, Carospir

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Spironolactone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so keeping levels in a healthy range genuinely matters. Here is the interesting twist with spironolactone: unlike most diuretics, it actually tends to spare magnesium rather than waste it, meaning the kidneys hold onto more of it instead of flushing it out in the urine. Because of that, the 'moderate depletion' label here reflects caution around the diuretic class as a whole, not a strong signal that spironolactone itself is the problem. Still, if you have been on this medication long-term, it is worth asking your pharmacist or doctor whether your magnesium level has been checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Spironolactone →

Streptomycin

Moderate Depletion
Increased urinary magnesium loss occurs with nephrotoxicity caused by aminoglycosides.

Nephrotoxicity caused by aminoglycosides may lead to increased urinary losses of various electrolytes, including magnesium. Monitor patients closely to detect declining renal function and electrolyte disturbances. The aminoglycoside may need to be discontinued and intravenous electrolyte replacement given.
Taking Streptomycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles, heart rhythm, and nerves working properly, so your body depends on steady levels of it. Streptomycin belongs to a class of antibiotics that can be hard on the kidneys, and when the kidneys are stressed this way, they may lose their ability to hold onto magnesium, letting too much spill out in the urine. This is rated a moderate concern, meaning some patients on streptomycin do need monitoring or replacement, even if not everyone is affected. If you are on this antibiotic, it is worth asking your doctor or pharmacist how your kidney function and electrolyte levels are being watched.

References (1)
  1. L'Hommedieu CS, Nicholas D, Armes DA, et al. Potentiation of magnesium sulfate--induced neuromuscular weakness by gentamicin, tobramycin, and amikacin. J Pediatr 1983;102:629-31..

Full nutrient report for Streptomycin →

Theobromine

Moderate Depletion
Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Theobromine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so keeping levels in a healthy range genuinely matters. Theobromine has mild diuretic properties, meaning it nudges your kidneys to produce more urine, and that extra urine can carry magnesium out of the body before it gets the chance to be held onto. With a moderate depletion rating, this is not something to brush off, especially for long-term users. It is worth asking your pharmacist or doctor whether your magnesium levels should be checked or whether a supplement makes sense for you.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Theobromine →

Tibolone

Moderate Depletion

Brand names include Livial

Estrogens reduce serum levels of magnesium by increasing its uptake into body tissues.

Estrogens enhance magnesium uptake by soft tissues and bones, lowering serum levels. There appears to be an inverse relationship between estrogen levels and magnesium serum levels. Estrogen therapy, including the use of oral contraceptives, lowers serum magnesium levels and can cause hypomagnesemia, which may contribute to thromboembolic complications associated with estrogens. For information on foods that are rich in magnesium, see our chart.
Taking Tibolone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Tibolone has estrogenic activity in the body, and estrogens appear to pull magnesium out of the bloodstream and push it into soft tissues and bone, leaving less circulating in the blood. Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so a meaningful drop matters. This is rated a moderate depletion, meaning it is worth paying attention to, especially for long-term users. Ask your pharmacist or doctor whether your magnesium levels should be checked or whether a supplement makes sense for you.

References (4)
  1. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990;3:197-215..
  2. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993;12:442-58.. PubMed
  3. Muneyyirci-Delale O, Nacharaju VL, Dalloul M, et al. Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium. Fertil Steril 1999;71:869-72.. PubMed
  4. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987;6:313-9.. PubMed

Full nutrient report for Tibolone →

Tobramycin

Moderate Depletion

Brand names include Nebcin, Tobi Podhaler, Bethkis

Increased urinary magnesium loss occurs with nephrotoxicity caused by aminoglycosides.

Nephrotoxicity caused by aminoglycosides may lead to increased urinary losses of various electrolytes, including magnesium. Monitor patients closely to detect declining renal function and electrolyte disturbances. The aminoglycoside may need to be discontinued and intravenous electrolyte replacement given.
Taking Tobramycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps your muscles contract, your heart stay in rhythm, and your nerves send signals properly. Tobramycin belongs to a family of antibiotics that can stress the kidneys, and when the kidneys are stressed, they can start spilling magnesium into the urine instead of holding onto it. Because this is a real, documented concern, people receiving tobramycin are typically watched closely, and some do need replacement. If you are on this antibiotic or have recently finished a course, it is worth asking your doctor or pharmacist whether your magnesium and kidney function have been checked.

References (1)
  1. L'Hommedieu CS, Nicholas D, Armes DA, et al. Potentiation of magnesium sulfate--induced neuromuscular weakness by gentamicin, tobramycin, and amikacin. J Pediatr 1983;102:629-31..

Full nutrient report for Tobramycin →

Torsemide

Moderate Depletion

Brand names include Demadex, Soaanz

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Torsemide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, heart, and nerves depend on to work properly. Torsemide is a loop diuretic, meaning it works in the kidneys to pull extra fluid out of your body through urine, and unfortunately magnesium gets swept out along with that fluid because the drug interferes with how the kidneys reclaim it. With a moderate depletion rating, this is a real concern for long-term users, not just a theory. If you take torsemide regularly, it is worth asking your pharmacist or doctor whether your magnesium level should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Torsemide →

Triamcinolone

Moderate Depletion

Brand names include Aristocort, Kenacort, Adcortyl Intra-articular / Intradermal

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Triamcinolone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, so it matters to keep levels in a healthy range. Long-term triamcinolone use can cause the kidneys to spill more magnesium into the urine than usual, likely because corticosteroids break down bone tissue and release stored magnesium into the bloodstream, where it becomes available for the kidneys to flush out. The good news is that blood magnesium levels often stay normal despite this, but the 'moderate depletion' rating means long-term users are worth keeping an eye on. If you have been taking triamcinolone for an extended period, it is worth asking your pharmacist or doctor whether your magnesium levels should be checked.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Triamcinolone →

Triamcinolone Acetonide

Moderate Depletion

Brand names include Zilretta, Xipere

Taking corticosteroids chronically increases excretion of magnesium in the urine.

Chronic use of corticosteroids increases the amount of magnesium excreted in the urine. This is thought to be due to catabolism of bone, releasing magnesium and increasing the amount available for excretion. Generally, there is not a significant effect on serum levels. For information on foods that are rich in magnesium, see our chart.
Taking Triamcinolone Acetonide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working properly, supports nerve signals, and plays a role in bone strength. Long-term use of triamcinolone acetonide, a corticosteroid, can cause the body to break down bone tissue faster, and as that happens, magnesium gets released into the bloodstream and the kidneys then flush more of it out in the urine. The good news is that actual blood levels often stay in the normal range for many people, but because this is rated as moderate depletion, it is worth bringing up with your pharmacist or doctor if you use this medication regularly.

References (5)
  1. Quamme GA. Renal handling of magnesium: drug and hormone interactions. Magnesium 1986;5:248-72..
  2. Kleeman CR, Levi J, Better O. Kidney and adrenocortical hormones. Nephron 1975;15:261-78.. PubMed
  3. Rolla G, Bucca C, Bugiani M, et al. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem 1990;9:132-6..
  4. Lund B, Storm TL, Lund B, et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 1985;4:143-9.. PubMed
  5. Rickers H, Deding A, Christiansen C, Rodbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984;36:269-73.. PubMed

Full nutrient report for Triamcinolone Acetonide →

Trichlormethiazide

Moderate Depletion

Brand names include Metahydrin, Naqua, Marazide II

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Trichlormethiazide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on. Trichlormethiazide is a thiazide diuretic, and this class of water pill can cause the kidneys to flush out more magnesium than usual in the urine rather than holding onto it. That steady loss is real enough that some long-term users do end up needing a supplement, so if you have been on this medication for a while, it is worth asking your pharmacist or doctor whether your magnesium level should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Trichlormethiazide →

Urea

Moderate Depletion

Brand names include Ureaphil

Some diuretics increase the amount of magnesium excreted in the urine.

Loop diuretics and, to a lesser extent thiazide diuretics, interfere with magnesium reabsorption in the kidneys, increasing urinary losses and reducing serum magnesium levels. Potassium-sparing diuretics, such as amiloride, triamterene, or spironolactone, are also magnesium-sparing, and can therefore counteract the magnesium losses seen with loop diuretics and thiazides. For information on foods that are rich in magnesium, see our chart.
Taking Urea? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Magnesium helps keep your muscles working properly, supports a steady heartbeat, and plays a role in hundreds of chemical reactions in the body. Urea is a diuretic, meaning it works by making your kidneys produce more urine, and that extra urine can carry magnesium out of the body before it gets a chance to be reabsorbed. The evidence here is rated moderate, so this is a real concern worth paying attention to, especially for long-term users. If you take urea regularly, it is worth asking your pharmacist or doctor whether your magnesium level should be checked.

References (4)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Ryan MP. Diuretics and potassium/magnesium depletion. Directions for treatment. Am J Med 1987;82:38-47.. PubMed
  3. Hollifield JW. Magnesium depletion, diuretics, and arrhythmias. Am J Med 1987;82:30-7.. PubMed
  4. Heidenreich O. Mode of action of conventional and potassium-sparing diuretics--aspects with relevance to Mg-sparing effects. Magnesium 1984;3:248-56..

Full nutrient report for Urea →

Important

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.
Understand the basics

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.

Common questions

MAGNESIUM & medications: FAQs

Which medications can lower MAGNESIUM?
In our licensed clinical database, 223 medications have been associated with MAGNESIUM depletion, including Albuterol, Albuterol Sulfate, Aldesleukin and Amoxicillin, Omeprazole Magnesium, Rifabutin. Each entry above shows the evidence rating and the published details. An association is not a guarantee — dose, duration, diet, and your own health all matter.
I take one of these medications — am I deficient in MAGNESIUM?
Not necessarily. These entries describe reported associations, not certainties. Many people take these medications without developing a meaningful MAGNESIUM problem. If you take one long-term, the reasonable step is to ask your healthcare provider whether checking your MAGNESIUM status is appropriate for you.
Should I start a MAGNESIUM supplement?
Not without checking first. Supplements are not risk-free — some interact with medications, and for certain nutrients (like potassium or magnesium) supplementation can be genuinely risky with kidney disease or particular drug combinations. Food-first strategies and clinician-guided testing usually come before a supplement.
Where does this information come from?
The depletion records come from the Natural Medicines (Therapeutic Research Center) database — an evidence-graded clinical reference — and are displayed as published, with their citations. The plain-English education is written and reviewed by licensed HelloPharmacist pharmacists.

Wondering about your MAGNESIUM levels?

Ask a licensed pharmacist — free, no appointment needed.

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Sources

Sources & How We Checked

Medication associations with MAGNESIUM are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations.

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