Magnesium Citrate Alternative Options

Answer

You are correct that magnesium citrate has had some recent supply issues. Vi-Jon, LLC, the manufacturer of a number of different private label brands of magnesium citrate, recalled all lots of all flavors of 'Magnesium Citrate Saline Laxative Oral Solution' due to testing showing the presence of the bacteria Gluconacetobacter liquefaciens.

You can find the full FDA announcement here.

Unfortunately, there is no estimated date for when it will again be available, which brings us to your question about alternative options.

What Is Magnesium Citrate Used For?

The first consideration for alternative options is what you are using magnesium citrate for.

Magnesium citrate is a laxative, used primarily for two purposes:

• Colonoscopy preparation
• Laxative for occasional constipation

Appropriate alternatives will be based on the reason you are using the drug.

Let's start first with use as a colonoscopy preparation.

Magnesium Citrate Colonoscopy Preparation Alternatives

Magnesium citrate, although rarely used alone as a colonoscopy preparation (and increasingly not at all based on guidelines from the American Society for Gastrointestinal Endoscopy), is still sometimes utilized for some individuals.

First and foremost, if your doctor has directed you to take magnesium citrate as part of your bowel preparation for a colonoscopy and you can't find the product anywhere, be sure to reach out to them.

There are plenty of alternative options for colonoscopy prep, but your doctor may have a preference.

Alternative options include

• Polyethylene glycol (PEG) without electrolytes: Miralax, Clearlax, Gavilax
• Polyethylene glycol (PEG) with electrolytes: GaviLyte, GoLytely, NuLytely, TriLyte, MoviPrep, Plenvu
  
• Oral sodium sulfate: Suprep
• Osmoprep

PEG (polyethylene glycol) preparations are the most commonly used. Some are available OTC (over the counter) while others are only available via a prescription.

PEG without electrolytes generally taste better than PEG with electrolytes, but since these laxatives cause fluid and electrolyte loss, they are often recommended to be mixed with Gatorade or a similar drink with electrolytes.

Again, talk to your doctor about your colonoscopy prep options if magnesium citrate isn't available where you are.

Magnesium Citrate Laxative For Constipation Alternatives

If you occasionally use magnesium citrate for constipation, there are options that will give you a similar effect.

Magnesium citrate is classified as a saline laxative, which works by drawing water into the intestines and colon by osmosis, which increases how quickly things move through the gastrointestinal tract. 

Magnesium citrate is sometimes an attractive option to treat constipation since it works so quickly compared to other options. The onset of action is generally 30 minutes to a few hours after dosing.

However, it does come with its negatives in that it can easily cause cramping, dehydration, and electrolyte disturbances.

The most similar alternative to magnesium citrate that is available over the counter is magnesium hydroxide, which is the active ingredient in Milk of Magnesia.

Outside of using an enema (e.g., Fleet sodium phosphate), which works almost immediately, magnesium hydroxide products are going to be most similar to magnesium hydroxide in terms of overall effect and onset of action.

Other options, that don't work as quickly, but are nonetheless effective, are:

• Polyethylene glycol (e.g., Miralax)
• Stimulant laxatives (e.g., bisacodyl)
• Senna
• Lactulose

The above options tend to have an onset of action around six to ten hours, but sometimes take longer to work.

You'll notice polyethylene glycol is listed here, and it was also listed in the section above for colonoscopy preparations. When used for occasional constipation, the dose is far less (~17 grams mixed with liquid versus ~240 grams for colonoscopy preparation).

It is worth mentioning that bisacodyl, a stimulant laxative, is available as a suppository too, and works quickly, around 15-60 minutes after use.

Finally, lactulose is another option, but that is prescription only.

I do want to point out that Milk of Magnesia cannot be used for colonoscopy preparation due to the fact it is not a clear solution.

Final Words

I hope you found this helpful.

To sum it all up, your closest alternative to magnesium citrate is magnesium hydroxide (e.g., Milk of Magnesia), but there are plenty of other options as well.