Medications That May Deplete PHOSPHATE SALTS
See which medications carry a reported association, how strong the evidence is, and what to discuss with your pharmacist.
Phosphate salts are mineral compounds used mainly to correct low phosphate levels, as laxatives, and sometimes by athletes. Most people who eat a normal diet already get plenty of phosphate and do not need a supplement. Because too much phosphate can be dangerous—especially for people with kidney disease—use these products only under the guidance of a doctor or pharmacist.
Commonly used for: Low blood phosphate levels (hypophosphatemia), Bowel preparation/laxative use, Athletic performance ('phosphate loading'), Preventing certain kidney stones, Calcium supplementation balance.
HelloPharmacist pharmacist-reviewed education. The medication records below are licensed clinical data, shown as published.
Deep dive: Phosphate Salts — uses, safety & drug interactions
Medications associated with PHOSPHATE SALTS depletion
Each record is shown as published in our licensed clinical database. Open a medication for its full nutrient report.
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Cholestyramine
Insignificant DepletionBrand names include Questran
Cholestyramine can bind phosphate in the gut. It also reduces absorption of vitamin D which normally acts to increase gastrointestinal absorption and kidney reabsorption of phosphate. There are reports of reduced serum phosphate levels, and occasional hypophosphatemia, in people taking large doses of cholestyramine for more than a year. Cholestyramine doses of 0.2-1.1 grams/kg daily in children and 12-16 grams daily in adults have been associated with reduced phosphate levels. However, most people taking cholestyramine are unlikely to need phosphate supplements unless their dietary intake is low.
Phosphate is a mineral your bones, muscles, and cells depend on for energy and structure. Cholestyramine works by binding to things in your gut, and it can grab onto phosphate before your body gets a chance to absorb it. It also reduces how well you absorb vitamin D, which normally helps your body hold onto phosphate. That said, this is rated as insignificant for most people, so unless you are taking very high doses for a long time or your diet is already low in phosphate, this is generally not something to worry about. If you have questions about your specific situation, your pharmacist or doctor is a great place to start.
References (2)
- West RJ, Lloyd JK. The effect of cholestyramine on intestinal absorption. Gut 1975;16:93-8. PubMed
- Heaton KW, Lever JV, Barnard RE. Osteomalacia associated with cholestyramine therapy for post-ileectomy diarrhea. Gastroenterology 1972;62:642-6.
Colestipol
Insignificant DepletionBrand names include Colestid
Colestipol can bind phosphate in the gut. It also reduces absorption of vitamin D, which normally acts to increase gastrointestinal absorption and kidney reabsorption of phosphate. In most people taking colestipol, serum phosphate levels remain within normal limits. Most people taking colestipol are unlikely to need phosphate supplements unless their dietary intake is low.
Phosphate is a mineral your muscles, bones, and cells need for energy and structure. Colestipol works by binding things in your gut to lower cholesterol, and it can grab onto phosphate and vitamin D along the way, which may slightly reduce how much phosphate your body absorbs. That said, research shows blood phosphate levels stay normal for most people taking this medication, so this is considered an insignificant concern for the average patient. If your diet is already low in phosphate-rich foods, it is worth mentioning to your pharmacist or doctor just to be sure.
References (2)
- West RJ, Lloyd JK. The effect of cholestyramine on intestinal absorption. Gut 1975;16:93-8. PubMed
- Schwarz KB, Goldstein PD, Witztum JL, et al. Fat-soluble vitamin concentrations in hypercholestrolemic children treated with colestipol. Pediatrics 1980;65:243-50.
Mineral Oil
Insignificant DepletionBrand names include Kondremul Plain
Mineral oil reduces absorption of vitamin D, which normally acts to increase phosphate absorption in the gastrointestinal tract and reabsorption in the kidney tubules. However, occasional or short-term use of mineral oil isn't likely to have a clinically significant effect on phosphate levels.
Phosphate is a mineral your body uses for strong bones, energy production, and keeping cells working properly. Mineral oil can interfere with how your gut absorbs vitamin D, and since vitamin D normally helps your intestines and kidneys hold onto phosphate, there is a theoretical chain that could nudge phosphate levels down. That said, this effect is considered insignificant for most people, especially with occasional use, so there is no reason to worry or reach for a supplement. If you use mineral oil regularly over a long period, it is worth mentioning to your pharmacist just to be sure.
References (2)
- Hardman JG, Limbird LL, Molinoff PB, eds. Goodman and Gillman's The Pharmacological Basis of Therapeutics, 9th ed. New York, NY: McGraw-Hill, 1996.
- Becker GL. The case against mineral oil. Am J Digestive Dis 1952;19:344-8. PubMed
Niacin (prescription drug)
Insignificant DepletionBrand names include Niaspan, Niacor
There is some evidence that niacin reduces plasma phosphate levels by interfering with active transport in the intestine. In people with metabolic syndrome and hyperlipidemia, taking slow-release prescription niacin (Niaspan, Abbott Labs) 2 grams orally daily for 8 weeks reduced plasma phosphate levels by approximately 15%. However, most people taking prescription niacin are unlikely to need phosphate supplements unless their dietary intake is low.
Phosphate is a mineral your bones, muscles, and cells depend on for energy and structure. Prescription niacin appears to interfere with how the intestine actively absorbs phosphate, and one study found it lowered blood phosphate levels by roughly 15% over 8 weeks. That said, the evidence is rated insignificant, meaning most people on prescription niacin are unlikely to need a phosphate supplement. If your diet is already low in dairy or other phosphate-rich foods, it is worth mentioning to your pharmacist or doctor just to be sure.
References (1)
- Hu, S, Shearer, GC, Steffes, MW, Harris, WS, and Bostom, AG. Once-daily extended-release niacin lowers serum phosphorus concentrations in patients with metabolic syndrome dyslipidemia. Am J Kidney Dis 2011;57(1):181-2. PubMed
Niacin, Lovastatin
Insignificant DepletionBrand names include Advicor
There is some evidence that niacin reduces plasma phosphate levels by interfering with active transport in the intestine. In people with metabolic syndrome and hyperlipidemia, taking slow-release prescription niacin (Niaspan, Abbott Labs) 2 grams orally daily for 8 weeks reduced plasma phosphate levels by approximately 15%. However, most people taking prescription niacin are unlikely to need phosphate supplements unless their dietary intake is low.
Phosphate is a mineral your body uses for bone strength, energy production, and cell function. There is some research showing that niacin may modestly reduce phosphate levels in the blood, possibly by interfering with how the intestine absorbs it. That said, this combination carries an insignificant depletion rating, meaning most people taking niacin do not need to worry about this or take a phosphate supplement. If you eat a varied diet and your levels have never run low, this likely is not something that needs action, but your pharmacist or doctor can give you personal guidance.
References (1)
- Hu, S, Shearer, GC, Steffes, MW, Harris, WS, and Bostom, AG. Once-daily extended-release niacin lowers serum phosphorus concentrations in patients with metabolic syndrome dyslipidemia. Am J Kidney Dis 2011;57(1):181-2. PubMed
Niacin, Simvastatin
Insignificant DepletionBrand names include Simcor
There is some evidence that niacin reduces plasma phosphate levels by interfering with active transport in the intestine. In people with metabolic syndrome and hyperlipidemia, taking slow-release prescription niacin (Niaspan, Abbott Labs) 2 grams orally daily for 8 weeks reduced plasma phosphate levels by approximately 15%. However, most people taking prescription niacin are unlikely to need phosphate supplements unless their dietary intake is low.
Phosphate is a mineral your body needs for strong bones, energy production, and keeping your cells working properly. There is some research showing that niacin may modestly lower phosphate levels in the blood, possibly by interfering with how the intestine absorbs it. That said, for most people on prescription niacin, this is rated as an insignificant concern, and a phosphate supplement is not something most people need. If you have questions about your diet or any symptoms, it is worth a quick chat with your pharmacist or doctor.
References (1)
- Hu, S, Shearer, GC, Steffes, MW, Harris, WS, and Bostom, AG. Once-daily extended-release niacin lowers serum phosphorus concentrations in patients with metabolic syndrome dyslipidemia. Am J Kidney Dis 2011;57(1):181-2. PubMed
Teriparatide
Insignificant DepletionBrand names include Forteo, Bonsity
Teriparatide is a fragment of human parathyroid hormone which increases urinary phosphate excretion and decreases serum phosphate similarly to the naturally occurring hormone. After a single dose of teriparatide, serum phosphate levels fall for about 2 hours and then recover to baseline. This recovery also seems to continue even with several years of treatment, with patients having either no change in serum phosphate levels, or a small decrease which remains within the normal range. Phosphate supplements are not necessary with teriparatide.
Phosphate is a mineral your body uses for bone strength, energy production, and cell function. Teriparatide works like a fragment of the body's natural parathyroid hormone, and one of that hormone's known effects is telling the kidneys to release more phosphate into the urine, which briefly dips blood phosphate levels for roughly two hours after each dose. The good news is that levels bounce back on their own, and even with years of use, most patients stay comfortably in the normal range. This one is rated insignificant, so a phosphate supplement is not something most people need to think about while on this medication.
References (6)
- Heaney RP, Nordin BE. Calcium effects on phosphorus absorption: implications for the prevention and co-therapy of osteoporosis. J Am Coll Nutr 2002;21:239-44.. PubMed
- Lindsay R, Nieves J, Henneman E, et al. Subcutaneous administration of the amino-terminal fragment of human parathyroid hormone-(1-34): kinetics and biochemical response in estrogenized osteoporotic patients. J Clin Endocrinol Metab 1993;77:1535-9. PubMed
- Winer KK, Yanovski JA, Cutler GB Jr. Synthetic human parathyroid hormone 1-34 vs calcitriol and calcium in the treatment of hypoparathyroidism. JAMA 1996;276:631-6. DOI
- Lindsay R, Nieves J, Formica C, et al. Randomized controlled study of the effect of parathyroid hormone on vertebral-bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis. Lancet 1997;350:550-5.
- Winer KK, Ko CW, Reynolds JC, et al. Long-term treatment of hypoparathyroidism: A randomized controlled study comparing parathyroid hormone (1-34) versus calcitriol and calcium. J Clin Endocrinol Metab 2003;88:4214-20.
- Finkelstein JS, Klibanski A, Arnold AL, et al. Prevention of estrogen deficiency-related bone loss with human parathyroid hormone-(1-34): a randomized controlled trial. JAMA 1998;280:1067-73. PubMed
Alginic Acid, Aluminum Hydroxide
Moderate DepletionBrand names include Rafton
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your bones, muscles, and cells depend on for energy and structure. The aluminum in this antacid can latch onto phosphate in your digestive tract before your body gets a chance to absorb it, essentially carrying it out in your stool instead. This matters most for people who use high doses over a long period of time, and it is the reason doctors sometimes use aluminum-containing antacids on purpose to lower phosphate in kidney disease patients. If you take this antacid regularly, it is worth asking your pharmacist or doctor whether your phosphate levels should be checked.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Aluminum Hydroxide
Moderate DepletionBrand names include Amphojel, Gaviscon, Alu-Cap
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your bones, muscles, and cells depend on for energy and structure. Aluminum hydroxide works as an antacid by binding to phosphate right inside your gut, which means less of it gets absorbed into your bloodstream. For most people taking normal doses short-term this is not a big concern, but long-term use of high doses has been linked to genuinely low phosphate levels and bone problems in some patients. If you have been on this medication for a while, it is worth asking your pharmacist or doctor whether your phosphate levels should be checked.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide
Moderate DepletionBrand names include Ascriptin Codeine #2
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your bones, muscles, and cells depend on for energy and structure. The aluminum and magnesium in this antacid combination can grab onto phosphate in your digestive tract and carry it out of the body before it gets a chance to be absorbed. At normal doses taken short-term, this is rarely a problem, but people who use antacids like this at high doses or for many years may see phosphate levels fall low enough to affect bone health. If you take this regularly, it is worth asking your pharmacist or doctor whether your phosphate level should be checked.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Full nutrient report for Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide →
Aluminum Hydroxide, Aspirin, Magnesium Hydroxide
Moderate DepletionBrand names include Ascriptin
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your bones, muscles, and cells depend on for energy and structure. The aluminum and magnesium in this antacid combination can grab onto phosphate in your gut and carry it out of your body before it ever gets absorbed, which is the real concern here. At normal doses for a short time this is unlikely to be a problem, but people using high doses of antacids over many months or years may be worth monitoring. If you rely on this medication regularly, it is worth asking your pharmacist or doctor whether your phosphate levels should be checked.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Full nutrient report for Aluminum Hydroxide, Aspirin, Magnesium Hydroxide →
Aluminum Hydroxide, Magnesium Hydroxide (OTC drug)
Moderate DepletionBrand names include Maalox, Mucogel
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your bones, muscles, and energy systems depend on. The aluminum and magnesium in this antacid can latch onto phosphate right in your gut, preventing it from being absorbed into your bloodstream. For most people taking a normal dose occasionally, this is not a concern. But if you have been taking large amounts of this antacid regularly for a long time, it is worth mentioning to your pharmacist or doctor, since significant depletion over time has been linked to bone and kidney problems.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Full nutrient report for Aluminum Hydroxide, Magnesium Hydroxide (OTC drug) →
Aluminum Hydroxide, Magnesium Hydroxide, Simethicone (OTC drug)
Moderate DepletionBrand names include Mylanta
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your bones, muscles, and cells depend on for energy and strength. The aluminum and magnesium in this antacid can latch onto phosphate right in your gut, blocking it from being absorbed into your body. This is mostly a concern for people who use high doses for many months or years, not for occasional heartburn relief. If you take this antacid regularly over the long term, it is worth mentioning to your pharmacist or doctor, and try to space it at least two hours apart from any phosphate-containing foods or supplements.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Full nutrient report for Aluminum Hydroxide, Magnesium Hydroxide, Simethicone (OTC drug) →
Aluminum, Magnesium (OTC drug)
Moderate DepletionBrand names include Almagel
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your bones, muscles, and cells depend on for energy and structure. The aluminum and magnesium in antacids like Maalox can latch onto phosphate right in your gut, carrying it out of your body before it ever gets absorbed. In practice, this becomes a real concern mainly for people taking very high doses for many months or years, so occasional normal use is not usually worrying. If you rely on antacids regularly, it is worth a conversation with your pharmacist or doctor about timing your doses and whether your levels should be checked.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Aspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium Hydroxide
Moderate DepletionBrand names include Ascriptin Codeine #3
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your body uses for strong bones, energy production, and healthy cell function. The aluminum and magnesium in this antacid combination can grab onto phosphate in your gut during digestion, preventing it from being absorbed into your bloodstream. This is usually only a real concern with very high antacid doses taken over a long period of time, but it is worth monitoring if you use this product regularly. Ask your pharmacist or doctor whether your phosphate levels should be checked, especially with long-term use.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Full nutrient report for Aspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium Hydroxide →
Aspirin, Calcium Carbonate, Magnesium Carbonate, Magnesium Oxide
Moderate DepletionBrand names include Bufferin
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your body uses to build strong bones and keep your muscles and nerves working properly. The calcium and magnesium in these antacids can grab onto phosphate right in the gut, so less of it gets absorbed into your bloodstream. For most people taking a normal dose occasionally, this is not a concern, but long-term use of higher doses has been linked to genuinely low phosphate levels over time. If you rely on these antacids regularly, it is worth bringing up with your pharmacist or doctor, especially since separating your antacid from phosphate-rich foods or supplements by a couple of hours may help.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Full nutrient report for Aspirin, Calcium Carbonate, Magnesium Carbonate, Magnesium Oxide →
Aspirin, Citric Acid, Sodium Bicarbonate
Moderate DepletionBrand names include Alka-Seltzer Pain Reliever and Antacid
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your bones, muscles, and cells depend on for energy and structure. The sodium bicarbonate in this effervescent formula acts as an antacid, and antacids can grab onto phosphate in the digestive tract before your body has a chance to absorb it. This is mainly a concern with heavy, long-term antacid use rather than occasional doses, but a "Moderate Depletion" rating means it is worth keeping an eye on. If you use this product regularly, ask your pharmacist or doctor whether your phosphate levels should be checked.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Full nutrient report for Aspirin, Citric Acid, Sodium Bicarbonate →
Bismuth Subcarbonate, Calcium Carbonate, Opium
Moderate DepletionBrand names include Diabismul
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Calcium carbonate in this combination product can latch onto phosphate in your digestive tract and carry it out of your body before it gets absorbed, so less of it makes it into your bloodstream. Phosphate is something your bones, muscles, and cells depend on to work properly, so low levels over a long period can be a real concern. At typical doses for a short time most people do fine, but if you use this product regularly or at higher amounts, it is worth asking your pharmacist or doctor whether your phosphate levels should be checked.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Full nutrient report for Bismuth Subcarbonate, Calcium Carbonate, Opium →
Calcium Carbonate
Moderate DepletionBrand names include Tums, Os-Cal, Adcal
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your bones, muscles, and cells depend on for energy and structure. Calcium carbonate, when taken regularly, can grab onto phosphate in your digestive tract and carry it out of the body before it gets absorbed, which is actually the same reason doctors sometimes use it intentionally in kidney patients who have too much phosphate. For most people taking a normal dose occasionally, this is not a real concern, but long-term use of higher doses has been linked to genuinely low phosphate levels in some patients. If you use calcium carbonate often or for extended periods, it is worth checking in with your pharmacist or doctor about whether your phosphate levels should be monitored.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Dihydroxyaluminum Sodium Carbonate
Moderate DepletionBrand names include Rolaids
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your bones, muscles, and cells need to make energy and stay strong. Dihydroxyaluminum sodium carbonate is an antacid that contains aluminum, and aluminum has a strong tendency to latch onto phosphate inside the gut before your body can absorb it, essentially carrying it out with the stool. At normal doses used short-term this is unlikely to be a problem, but people who rely on high doses for months or years may see phosphate levels drop low enough to affect bones and overall health. If you use this antacid regularly, it is worth bringing up with your pharmacist or doctor, who can check whether your phosphate levels and your bones are doing fine.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Full nutrient report for Dihydroxyaluminum Sodium Carbonate →
Lanthanum Carbonate
Moderate DepletionBrand names include Fosrenol
Lanthanum carbonate binds phosphate in the gut. It is used therapeutically to reduce elevated phosphate levels in patients with kidney failure.
Lanthanum carbonate is actually designed to grab onto phosphate in the digestive tract and carry it out of the body, which is exactly how it helps people with kidney failure who build up too much phosphate in their blood. The catch is that if phosphate levels drop too low, that becomes its own problem, since phosphate is something your bones, muscles, and cells all depend on for energy and structure. Because this effect is rated as a moderate concern, your levels genuinely do need watching, and some people taking this medication end up needing a supplement to keep things balanced. It is worth asking your doctor or pharmacist how often your phosphate is being checked.
References (1)
- Loghman-Adham M. Safety of new phosphate binders for chronic renal failure. Drug Saf 2003;26:1093-115. PubMed
Magaldrate
Moderate DepletionBrand names include Riopan
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your bones, muscles, and cells depend on for energy and structure. Magaldrate is an antacid that contains magnesium and aluminum, and those minerals can latch onto phosphate right inside your gut before your body has a chance to absorb it. That said, real problems tend to show up mainly in people who use very high doses of antacids for months or even years, so occasional or normal use is far less concerning. If you take magaldrate regularly, it is worth mentioning to your pharmacist or doctor so they can keep an eye on things.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Magnesium Sulfate (prescription drug)
Moderate DepletionBrand names include Bilagog, Magnesium Sulfate
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your bones, muscles, and cells depend on for energy and structure. When magnesium sulfate is given, the magnesium itself can grab onto phosphate in the gut and block it from being absorbed into the bloodstream, much like a sponge soaking it up before it can get through. With short-term or typical use this may not be a big concern, but if you are receiving this medication for a longer stretch, your care team may want to keep an eye on your phosphate levels. Ask your doctor or pharmacist whether any monitoring makes sense for your situation.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Full nutrient report for Magnesium Sulfate (prescription drug) →
Sevelamer
Moderate DepletionBrand names include Renagel
Sevelamer binds phosphate in the gut by an ion exchange mechanism. It is used to reduce elevated phosphate levels in patients with kidney failure.
Phosphate is a mineral your bones, muscles, and cells depend on for energy and structure. Sevelamer works by grabbing onto phosphate in your gut and carrying it out of your body before it can be absorbed, which is exactly what makes it useful for people with kidney failure who have too much phosphate. For anyone whose phosphate levels are already normal, though, this same action can pull levels too low. Because the risk is real and well-documented, your doctor should be monitoring your phosphate with blood tests, and some people do end up needing a supplement, so it is worth bringing up at your next visit.
References (1)
- Loghman-Adham M. Safety of new phosphate binders for chronic renal failure. Drug Saf 2003;26:1093-115. PubMed
Sodium Bicarbonate (OTC Drug)
Moderate DepletionBrand names include Sodium Bicarbonate
Aluminum, calcium, and magnesium contained in antacids can bind phosphate in the gut and prevent its absorption. Antacids are sometimes used therapeutically to decrease high phosphate levels in people with chronic kidney disease. In people with normal kidney function, use of higher-than-recommended doses of antacids for prolonged periods (e.g. over 100 mL daily of Maalox for several months, or 30 mL daily for over 10 years) can cause hypophosphatemia, potentially leading to osteomalacia, fractures, nephrolithiasis, and ureter obstruction.
Phosphate is a mineral your bones, muscles, and energy systems depend on, and here is something worth knowing if you use sodium bicarbonate regularly as an antacid: antacids can grab onto phosphate in your digestive tract and carry it out of the body before it gets a chance to absorb. Sodium bicarbonate itself is less likely to do this than antacids containing aluminum, calcium, or magnesium, but heavy or prolonged antacid use in general has been linked to low phosphate levels over time. For occasional, normal-dose use this is unlikely to be a concern, but if you rely on antacids daily or in large amounts, it is worth asking your pharmacist or doctor whether your phosphate levels should be checked.
References (4)
- Harmelin DL, Martin FR, Wark JD. Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis. Aust NZ J Med 1990;20:803-5. PubMed
- Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
- Insogna KL, Bordley DR, Caro JF, Lockwood DH. Osteomalacia and weakness from excessive antacid ingestion. JAMA 1980;244:2544-6. DOI
- Saadeh G, Bauer T, Licata A, Sheeler L. Antacid-induced osteomalacia. Cleve Clin J Med 1987;54:214-6. PubMed
Sucralfate
Moderate DepletionBrand names include Carafate, Antepsin
Sucralfate has phosphate binding properties. Doses of 6-17 grams daily have been used to reduce elevated phosphate levels in patients with kidney failure. In people with normal kidney function, there is a risk of hypophosphatemia if large doses of 6 grams daily or more are used for prolonged periods.
Sucralfate works in the gut by binding to certain substances, and phosphate, a mineral your bones, muscles, and energy systems depend on, is one of them. At the higher doses sometimes used in kidney disease (6 grams a day or more), that binding action can pull phosphate out of your digestive tract before your body gets a chance to absorb it. For most people taking a standard short-term course, this is unlikely to be a real concern, but if you use sucralfate long-term or at higher doses, it is worth asking your pharmacist or doctor whether your phosphate levels should be checked.
References (2)
- Roxe DM, Mistovich M, Barch DH. Phosphate-binding effects of sucralfate in patients with chronic renal failure. Am J Kidney Dis 1989;13:194-9. PubMed
- Leung AC, Henderson IS, Halls DJ, Dobbie JW. Aluminium hydroxide versus sucralfate as a phosphate binder in uraemia. Br Med J (Clin Res Ed) 1983;286:1379-81. PubMed
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.
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.
PHOSPHATE SALTS & medications: FAQs
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Other commonly implicated nutrients
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Sources & How We Checked
Medication associations with PHOSPHATE SALTS are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for drug-induced nutrient depletions, supplements, and interactions — the basis for this page.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for medication overviews across the site.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.