Gefitinib: (Major) Avoid coadministration of antacids with gefitinib if possible due to decreased exposure to gefitinib, which may lead to reduced efficacy. In general, it would be illogical to concurrently administer these drugs at the same time. Doxycycline: (Moderate) Separate administration of oral doxycycline and antacids by 2 to 3 hours. Emtricitabine; Rilpivirine; Tenofovir alafenamide: (Moderate) Concurrent administration of rilpivirine and antacids may significantly decrease rilpivirine plasma concentrations, potentially resulting in treatment failure. Rifampin: (Moderate) Concomitant use of antacids and rifampin may decrease the absorption of rifampin. No effect was observed on the other three major metabolites of capecitabine (5'-DFUR, fluorouracil, FBAL). Separating adminisration times may help limit any possible interaction. Lactulose: (Major) In general, other laxatives should not be used concurrently with lactulose, especially during the initial phase of therapy for portal-systemic encephalopathy, because the loose stools resulting from their use may falsely suggest that adequate lactulose dosage has been achieved. 
Examples of compounds that may interfere with quinolone bioavailability include antacids that contain magnesium hydroxide. Closely monitor patients for changing analgesic requirements or adverse events. Erlotinib displays pH-dependent solubility with decreased solubility at a higher pH; the increased gastric pH resulting from antacid therapy may reduce the bioavailability of erlotinib. Coadministration may result in decreased plasma concentrations of raltegravir, which may lead to HIV treatment failure or the development of viral resistance. Magnesium hydroxide (milk of magnesia) is a saline laxative that rapidly reacts with gastric acid to form water and magnesium chloride, which neutralizes gastric acid. Iron Salts: (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Valproic Acid, Divalproex Sodium: (Minor) Antacids containing magnesium and aluminum hydroxide have been shown to increase valproic acid AUC by an average of 12%. Separate the administration of atazanavir and antacids to avoid the potential for interaction; give atazanavir 2 hours before or 1 hour after the antacid. 3 to 6 tablets/day PO as a single dose or in divided doses. Coadministration with another drug to maintain gastric pH above 5 decreased gefitinib exposure by 47%. The chemical structure of these GI drugs that contain polyvalent cations, such as magnesium hydroxide, can bind dolutegravir in the GI tract. Antacids may decrease the absorption of oral iron preparations. Diflunisal: (Moderate) Concurrent use of diflunisal with antacids may reduce plasma diflunisal concentrations. Budesonide; Formoterol: (Moderate) Enteric-coated budesonide granules dissolve at a pH more than 5.5. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability. When chronic use of high doses is avoided, magnesium hydroxide appears to be safe and effective to use during breast-feeding to relieve occasional constipation, dyspepsia, and pyrosis. This document does not contain all possible interactions. Not for non-prescription use. Magnesium hydroxide should be used cautiously in patients with renal impairment or renal disease because of the increased risk of developing hypermagnesemia and magnesium toxicity. Quinidine: (Major) Alkalinizing agents such as antacids can increase renal tubular reabsorption of quinidine by alkalinizing the urine; higher quinidine serum concentrations and quinidine toxicity are possible. Examples of compounds that may interfere with quinolone bioavailability include antacids that contain magnesium hydroxide. Ethotoin: (Major) Magnesium hydroxide inhibits the absorption of ethotoin. Approximately 1530% of the magnesium chloride is absorbed and rapidly excreted by the kidneys in patients with normal renal function. To decrease the risk of virologic failure, avoid use of antacids for at least 2 hours before and at least 4 hours after administering rilpivirine. Serious interactions of magnesium hydroxide include: Moderate interactions of magnesium hydroxide include: Magnesium Hydroxide has mild interactions with at least 42 different drugs. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Separate administration of elvitegravir and antacids by at least 2 hours. Raltegravir: (Major) Coadministration or staggered administration of aluminum and/or magnesium-containing antacids is not recommended during treatment with raltegravir. Although this finding is of marginal clinical significance, patients should be monitored for adverse effects in this situation. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy. 
Use in nursing mothers appears to be safe. The effect of the antacids in this regard is not expected to have a significant effect on the ability of ezetimibe to lower cholesterol. Mycophenolate: (Major) Coadministration of mycophenolate mofetil with antacids decreases the bioavailability of mycophenolate mofetil. This medication contains magnesium hydroxide. Dosage should be modified depending on clinical response and degree of renal impairment. Acetaminophen; Pamabrom; Pyrilamine: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. Guaifenesin; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. Taking these drugs simultaneously may result in reduced bioavailability of dolutegravir. Glipizide: (Moderate) Antacids have been reported to increase the absorption of glipizide, enhancing its hypoglycemic effects. Daily doses of rifampin should be given at least 1 hour before the ingestion of antacids. Of note, a study demonstrated no significant difference in hydroxychloroquine serum concentration in patients taking concomitant antacids (n = 14) compared to those not taking antacids (n = 495). Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. Polyethylene Glycol; Electrolytes; Bisacodyl: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. The need to stagger doses of propranolol has not been established, but may be prudent. Chlorpheniramine; Hydrocodone; Phenylephrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. Elvitegravir: (Moderate) Separate administration of elvitegravir and antacids by at least 2 hours. Magnesium hydroxide is used to treat constipation and acid indigestion. The dose of digoxin may need to be adjusted. Drugs used to treat constipation, such as laxatives, would counteract the effect of antidiarrheals. The chemical structure of these antacids contains aluminum or magnesium which can bind cabotegravir in the GI tract. Bumetanide: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives.
Guaifenesin; Hydrocodone; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. to a friend, relative, colleague or yourself. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy. What Are Side Effects Associated with Using Magnesium Hydroxide? Fexofenadine: (Moderate) Coadministration with antacids (containing aluminum or magnesium) within 15 minutes decreases the AUC and Cmax of fexofenadine by 41% and 43%, respectively. This may lead to increased amphetamine concentrations. Calcium carbonate is generally considered the first choice for antacid use during breast-feeding, but magnesium hydroxide is also considered compatible. The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of medications in residents of long-term care facilities. Closely monitor patients for changing analgesic requirements or adverse events.
In the stomach magnesium hydroxide reacts with hydrochloric acid to form magnesium chloride. Concomitant use of oral budesonide and antacids, milk, or other drugs that increase gastric pH levels can cause the coating of the granules to dissolve prematurely, possibly affecting release properties and absorption of the drug in the duodenum. In general, it may be prudent to avoid drugs such as antacids in combination with enteric-coated budesonide. Mesalamine, 5-ASA: (Moderate) Do not coadminister mesalamine extended-release capsules (Apriso) with antacids. Ciprofloxacin: (Moderate) Administer oral ciprofloxacin at least 2 hours before or 6 hours after magnesium hydroxide. Ezetimibe: (Minor) Antacids may decrease the peak plasma concentration (Cmax) of total ezetimibe by 30%. ". muramed Fosinopril: (Moderate) Coadministration of antacids with fosinopril may impair absorption of fosinopril. Atazanavir: (Major) It is recommended that antacids not be given at the some time as atazanavir because of potential interference with absorption of atazanavir. Separate administration by at least 1 hour. US-based MDs, DOs, NPs and PAs in full-time patient practice can register for free on PDR.net. When used occasionally at recommended doses, magnesium hydroxide has not been found to produce teratogenic effects. Norfloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. There is also evidence that magnesium, and other saline laxatives, stimulate the release of the hormone cholecystokinin-pancreozymin, which favors accumulation of fluid and electrolytes within the intestinal lumen. Ofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Daily doses of rifampin should be given at least 1 hour before the ingestion of antacids. Hydrocodone; Potassium Guaiacolsulfonate: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. Zalcitabine, ddC: (Moderate) The absorption of zalcitabine, ddC is moderately reduced, by approximately 25%, when coadministered with magnesium hydroxide-containing antacids. Ketoconazole: (Moderate) Administer antacids at least 1 hour before or 2 hours after taking ketoconazole. Cefditoren: (Major) Separate the administration of cefditoren and magnesium- or aluminum-containing antacids by at least 2 hours. Antacids containing alkalinizing agents such as sodium bicarbonate can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. The laxative effects of magnesium hydroxide can aggravate ulcerative colitis; use in these patients is relatively contraindicated. Potassium-sparing diuretics: (Moderate) Long-term use of potassium-sparing diuretics has been found to increase renal tubular reabsorption of magnesium which may cause hypermagnesemia in patients also receiving magnesium supplements, especially in patients with renal insufficiency. If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Ofloxacin: (Moderate) Administer magnesium hydroxide at least 2 hours before or 2 hours after ofloxacin. Infigratinib: (Moderate) Separate the administration of infigratinib and locally acting antacids if concomitant use is necessary. However, to limit any potential interaction, it would be prudent to administer ezetimibe at least 1 hour before or 2 hours after administering antacids. The chemical structure of these GI drugs that contain polyvalent cations, such as magnesium hydroxide, can bind dolutegravir in the GI tract. Simultaneous administration should be avoided; separate dosing by at least 2 hours to limit an interaction.
Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration of antacids with fosinopril may impair absorption of fosinopril. This decrease in bioavailability was about 5% when gabapentin was administered 2 hours after the antacid.bb Gastrointestinal Enzymes: (Major) The effectiveness of gastrointestinal enzymes can be diminished with concurrent administration of antacids. It is recommended to separate times of administration. Although the exact mechanism is not known, theoretically it may be due to alterations in gastric pH. Instruct patients to avoid using antacids containing aluminum hydroxide or magnesium hydroxide within 2 hours of taking sotalol. Coadministration may impair absorption of tetracycline which may decrease its efficacy. Methenamine; Sodium Acid Phosphate: (Major) The therapeutic action of methenamine requires an acidic urine. Brompheniramine; Hydrocodone; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. Riociguat: (Major) Separate administration of riociguat from antacids by at least 1 hour. Do not take magnesium hydroxide within 2 hours of taking risedronate. Diazepam: (Moderate) The coadministration of diazepam with antacids results in delayed diazepam absorption due to the fact that antacids delay gastric emptying. Moxifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Max: 6 tablets/day. No specific dosage adjustment is needed for hepatic impairment, unless the patient also has renal dysfunction. Closely monitor patients for changing analgesic requirements or adverse events. 15 to 60 mL PO per day, preferably at bedtime, or the daily dose may be given in divided doses or as directed by a prescriber. Dasatinib: (Moderate) Separate the administration of dasatinib and antacids by at least 2 hours if these agents are used together. Increasing the dose of erlotinib without modifying the administration schedule is unlikely to compensate for loss of exposure. Acetaminophen; Pentazocine: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. Separate the administration of atazanavir and antacids to avoid the potential for interaction; give atazanavir 2 hours before or 1 hour after the antacid. If coadministration with antacids is necessary, administer sotorasib 4 hours before or 10 hours after an antacid. Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. Magnesium hydroxide is relatively contraindicated in patients with colostomy, diverticulitis, or ileostomy because it increases the risk of developing electrolyte imbalance. Chelation of divalent cations with levofloxacin is less than with other quinolones. The magnesium that is not absorbed remains in the GI tract and is excreted in the feces. Captopril: (Major) Antacids can decrease the GI absorption of captopril if administered simultaneously. It may be advisable for elderly patients to have their renal function assessed prior to magnesium hydroxide administration, if the drug will be used regularly versus on an as-needed basis. Tacrolimus: (Major) Monitor tacrolimus whole blood trough concentration and reduce tacrolimus dose if needed during concurrent use of antacids. Torsemide: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Major) The therapeutic action of methenamine requires an acidic urine. Sucralfate: (Moderate) Antacids can interfere with the binding capacity of sucralfate to the GI mucosa, decreasing its effectiveness. Octreotide: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Acetaminophen; Chlorpheniramine; Phenylephrine : (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. Side effects of magnesium hydroxide include: This document does not contain all possible side effects and others may occur. 0.5 mL/kg/day PO as a single dose. Naproxen; Esomeprazole: (Minor) Concomitant administration of antacids can delay the absorption of naproxen. Closely monitor patients for changing analgesic requirements or adverse events. Studies suggest that oral, nonabsorbable antacids and/or laxatives like magnesium hydroxide can interfere with the decrease in colon pH necessary for lactulose's action and these alterations may make it challenging to titrate an accurate dose of lactulose during treatment of hepatic encephalopathy. Velpatasvir solubility decreases as pH increases; therefore, drugs that increase gastric pH are expected to decrease the concentrations of velpatasvir, potentially resulting in loss of antiviral efficacy. Likewise, the dissolution of the coating of extended-release budesonide tablets (Uceris) is pH dependent. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. If antacids must be used while a patient is taking glyburide, give the glyburide at least 2 hours prior to the antacid. Coadministration may decrease the absorption of azithromycin which may decrease its efficacy. Penicillamine: (Moderate) Because penicillamine chelates heavy metals, it is possible that antacids could reduce penicillamine bioavailability, which can decrease the therapeutic effects of penicillamine. mil par lubricates ease merck discomfort The simultaneous administration of an antacid with dasatinib decreased the Cmax and AUC of dasatinib by 58% and 55%, respectively. However, doses may be divided throughout the day if needed.Do not administer concurrently with other oral medications due to possible interference with absorption; clinicians are advised to review drug interactions and advised times of dose separation to limit drug-drug interactions. Magnesium Hydroxide is available under the following different brand names: Milk of Magnesia. The effect of the antacids in this regard is not expected to have a significant effect on the ability of ezetimibe to lower cholesterol. Antacids have been shown to reduce the oral bioavailability of gabapentin by roughly 20%. If these drugs must be used together, give glipizide at least 2 hours prior to the antacid. As these compounds enter the small intestine, they react with bicarbonate, forming magnesium carbonate and calcium carbonate, which are insoluble. Polysaccharide-Iron Complex: (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction.
Acalabrutinib solubility decreases with increasing pH values; therefore, coadministration may result in decreased acalabrutinib exposure and effectiveness. Capecitabine: (Minor) Monitor for an increase in capecitabine-related adverse reactions if coadministration with magnesium hydroxide is necessary. Acetaminophen; Chlorpheniramine: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. 10 Things People With Depression Wish You Knew, Magnesium hydroxide (400 mg/5 mL): 30-60 mL/day orally at bedtime or in divided doses, Magnesium hydroxide (800 mg/5 mL): 15-30 mL/day orally at bedtime or in divided doses, Chewable tablet: 8 tablets/day orally at bedtime or in divided doses, Magnesium hydroxide (400 mg/5 mL): 5-15 mL orally every 4 hours; no more than 4 doses per 24-hour period, Chewable tablet: 2-4 tablets orally every 4 hours; no more than 4 doses per 24-hour period, 2-6 years: 5-15 mL/day of regular-strength liquid orally at bedtime or in divided doses, 6-12 years: 15-30 mL/day (400 mg/5 mL) or 7.5-15 mL/day (800 mg/5 mL) orally at bedtime or in divided doses, 12 years and older: 30-60 mL/day (400 mg/5 mL) or 15-30 mL/day (800 mg/5 mL) orally at bedtime or in divided doses, 3-6 years: 2 tablets orally once daily or in divided doses, 6-12 years: 4 tablets orally once daily or in divided doses, 12 years and older: 8 tablets orally once daily or in divided doses, 12 years and older: 5-15 mL (400 mg/5 mL) orally every 4 hours; no more than 4 doses per 24-hour period, 12 years and older: 2-4 tablets orally every 4 hours; no more than 4 doses per 24-hour period, See "What Are Side Effects Associated with Using Magnesium Hydroxide? Hydroxychloroquine: (Moderate) Hydroxychloroquine absorption may be reduced by antacids as has been observed with the structurally similar chloroquine. Lansoprazole; Naproxen: (Minor) Concomitant administration of antacids can delay the absorption of naproxen. The chemical structure of these antacids contains aluminum or magnesium which can bind cabotegravir in the GI tract. Magnesium citrate should not be used chronically as a laxative due to the risk of hypermagnesemia. Coadministration of aluminum/magnesium hydroxide and bazedoxifene decreased Cmax of bazedoxifene by 8% and increased AUC of bazedoxifene by 7%. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid. Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. Carbinoxamine; Hydrocodone; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. Homatropine; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. Acetaminophen; Aspirin, ASA; Caffeine: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. If using as an antacid, administration with a little water is advised.May be more palatable if refrigerated prior to administration. Trospium: (Moderate) Antacids may inhibit the oral absorption of antimuscarinics. Levofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Ethacrynic Acid: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Neratinib: (Major) Administer neratinib at least 3 hours after administration of antacids if concomitant use is necessary due to decreased absorption and systemic exposure of neratinib; the solubility of neratinib decreases with increasing pH of the GI tract. Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate: (Moderate) Concurrent administration of rilpivirine and antacids may significantly decrease rilpivirine plasma concentrations, potentially resulting in treatment failure.
Examples of compounds that may interfere with quinolone bioavailability include antacids that contain magnesium hydroxide. Closely monitor patients for changing analgesic requirements or adverse events. Erlotinib displays pH-dependent solubility with decreased solubility at a higher pH; the increased gastric pH resulting from antacid therapy may reduce the bioavailability of erlotinib. Coadministration may result in decreased plasma concentrations of raltegravir, which may lead to HIV treatment failure or the development of viral resistance. Magnesium hydroxide (milk of magnesia) is a saline laxative that rapidly reacts with gastric acid to form water and magnesium chloride, which neutralizes gastric acid. Iron Salts: (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Valproic Acid, Divalproex Sodium: (Minor) Antacids containing magnesium and aluminum hydroxide have been shown to increase valproic acid AUC by an average of 12%. Separate the administration of atazanavir and antacids to avoid the potential for interaction; give atazanavir 2 hours before or 1 hour after the antacid. 3 to 6 tablets/day PO as a single dose or in divided doses. Coadministration with another drug to maintain gastric pH above 5 decreased gefitinib exposure by 47%. The chemical structure of these GI drugs that contain polyvalent cations, such as magnesium hydroxide, can bind dolutegravir in the GI tract. Antacids may decrease the absorption of oral iron preparations. Diflunisal: (Moderate) Concurrent use of diflunisal with antacids may reduce plasma diflunisal concentrations. Budesonide; Formoterol: (Moderate) Enteric-coated budesonide granules dissolve at a pH more than 5.5. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability. When chronic use of high doses is avoided, magnesium hydroxide appears to be safe and effective to use during breast-feeding to relieve occasional constipation, dyspepsia, and pyrosis. This document does not contain all possible interactions. Not for non-prescription use. Magnesium hydroxide should be used cautiously in patients with renal impairment or renal disease because of the increased risk of developing hypermagnesemia and magnesium toxicity. Quinidine: (Major) Alkalinizing agents such as antacids can increase renal tubular reabsorption of quinidine by alkalinizing the urine; higher quinidine serum concentrations and quinidine toxicity are possible. Examples of compounds that may interfere with quinolone bioavailability include antacids that contain magnesium hydroxide. Ethotoin: (Major) Magnesium hydroxide inhibits the absorption of ethotoin. Approximately 1530% of the magnesium chloride is absorbed and rapidly excreted by the kidneys in patients with normal renal function. To decrease the risk of virologic failure, avoid use of antacids for at least 2 hours before and at least 4 hours after administering rilpivirine. Serious interactions of magnesium hydroxide include: Moderate interactions of magnesium hydroxide include: Magnesium Hydroxide has mild interactions with at least 42 different drugs. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Separate administration of elvitegravir and antacids by at least 2 hours. Raltegravir: (Major) Coadministration or staggered administration of aluminum and/or magnesium-containing antacids is not recommended during treatment with raltegravir. Although this finding is of marginal clinical significance, patients should be monitored for adverse effects in this situation. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy. Guaifenesin; Hydrocodone; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. to a friend, relative, colleague or yourself. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy. What Are Side Effects Associated with Using Magnesium Hydroxide? Fexofenadine: (Moderate) Coadministration with antacids (containing aluminum or magnesium) within 15 minutes decreases the AUC and Cmax of fexofenadine by 41% and 43%, respectively. This may lead to increased amphetamine concentrations. Calcium carbonate is generally considered the first choice for antacid use during breast-feeding, but magnesium hydroxide is also considered compatible. The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of medications in residents of long-term care facilities. Closely monitor patients for changing analgesic requirements or adverse events.
In the stomach magnesium hydroxide reacts with hydrochloric acid to form magnesium chloride. Concomitant use of oral budesonide and antacids, milk, or other drugs that increase gastric pH levels can cause the coating of the granules to dissolve prematurely, possibly affecting release properties and absorption of the drug in the duodenum. In general, it may be prudent to avoid drugs such as antacids in combination with enteric-coated budesonide. Mesalamine, 5-ASA: (Moderate) Do not coadminister mesalamine extended-release capsules (Apriso) with antacids. Ciprofloxacin: (Moderate) Administer oral ciprofloxacin at least 2 hours before or 6 hours after magnesium hydroxide. Ezetimibe: (Minor) Antacids may decrease the peak plasma concentration (Cmax) of total ezetimibe by 30%. ". muramed Fosinopril: (Moderate) Coadministration of antacids with fosinopril may impair absorption of fosinopril. Atazanavir: (Major) It is recommended that antacids not be given at the some time as atazanavir because of potential interference with absorption of atazanavir. Separate administration by at least 1 hour. US-based MDs, DOs, NPs and PAs in full-time patient practice can register for free on PDR.net. When used occasionally at recommended doses, magnesium hydroxide has not been found to produce teratogenic effects. Norfloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. There is also evidence that magnesium, and other saline laxatives, stimulate the release of the hormone cholecystokinin-pancreozymin, which favors accumulation of fluid and electrolytes within the intestinal lumen. Ofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Daily doses of rifampin should be given at least 1 hour before the ingestion of antacids. Hydrocodone; Potassium Guaiacolsulfonate: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. Zalcitabine, ddC: (Moderate) The absorption of zalcitabine, ddC is moderately reduced, by approximately 25%, when coadministered with magnesium hydroxide-containing antacids. Ketoconazole: (Moderate) Administer antacids at least 1 hour before or 2 hours after taking ketoconazole. Cefditoren: (Major) Separate the administration of cefditoren and magnesium- or aluminum-containing antacids by at least 2 hours. Antacids containing alkalinizing agents such as sodium bicarbonate can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. The laxative effects of magnesium hydroxide can aggravate ulcerative colitis; use in these patients is relatively contraindicated. Potassium-sparing diuretics: (Moderate) Long-term use of potassium-sparing diuretics has been found to increase renal tubular reabsorption of magnesium which may cause hypermagnesemia in patients also receiving magnesium supplements, especially in patients with renal insufficiency. If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Ofloxacin: (Moderate) Administer magnesium hydroxide at least 2 hours before or 2 hours after ofloxacin. Infigratinib: (Moderate) Separate the administration of infigratinib and locally acting antacids if concomitant use is necessary. However, to limit any potential interaction, it would be prudent to administer ezetimibe at least 1 hour before or 2 hours after administering antacids. The chemical structure of these GI drugs that contain polyvalent cations, such as magnesium hydroxide, can bind dolutegravir in the GI tract. Simultaneous administration should be avoided; separate dosing by at least 2 hours to limit an interaction.
Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration of antacids with fosinopril may impair absorption of fosinopril. This decrease in bioavailability was about 5% when gabapentin was administered 2 hours after the antacid.bb Gastrointestinal Enzymes: (Major) The effectiveness of gastrointestinal enzymes can be diminished with concurrent administration of antacids. It is recommended to separate times of administration. Although the exact mechanism is not known, theoretically it may be due to alterations in gastric pH. Instruct patients to avoid using antacids containing aluminum hydroxide or magnesium hydroxide within 2 hours of taking sotalol. Coadministration may impair absorption of tetracycline which may decrease its efficacy. Methenamine; Sodium Acid Phosphate: (Major) The therapeutic action of methenamine requires an acidic urine. Brompheniramine; Hydrocodone; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. Riociguat: (Major) Separate administration of riociguat from antacids by at least 1 hour. Do not take magnesium hydroxide within 2 hours of taking risedronate. Diazepam: (Moderate) The coadministration of diazepam with antacids results in delayed diazepam absorption due to the fact that antacids delay gastric emptying. Moxifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Max: 6 tablets/day. No specific dosage adjustment is needed for hepatic impairment, unless the patient also has renal dysfunction. Closely monitor patients for changing analgesic requirements or adverse events. 15 to 60 mL PO per day, preferably at bedtime, or the daily dose may be given in divided doses or as directed by a prescriber. Dasatinib: (Moderate) Separate the administration of dasatinib and antacids by at least 2 hours if these agents are used together. Increasing the dose of erlotinib without modifying the administration schedule is unlikely to compensate for loss of exposure. Acetaminophen; Pentazocine: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. Separate the administration of atazanavir and antacids to avoid the potential for interaction; give atazanavir 2 hours before or 1 hour after the antacid. If coadministration with antacids is necessary, administer sotorasib 4 hours before or 10 hours after an antacid. Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. Magnesium hydroxide is relatively contraindicated in patients with colostomy, diverticulitis, or ileostomy because it increases the risk of developing electrolyte imbalance. Chelation of divalent cations with levofloxacin is less than with other quinolones. The magnesium that is not absorbed remains in the GI tract and is excreted in the feces. Captopril: (Major) Antacids can decrease the GI absorption of captopril if administered simultaneously. It may be advisable for elderly patients to have their renal function assessed prior to magnesium hydroxide administration, if the drug will be used regularly versus on an as-needed basis. Tacrolimus: (Major) Monitor tacrolimus whole blood trough concentration and reduce tacrolimus dose if needed during concurrent use of antacids. Torsemide: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Major) The therapeutic action of methenamine requires an acidic urine. Sucralfate: (Moderate) Antacids can interfere with the binding capacity of sucralfate to the GI mucosa, decreasing its effectiveness. Octreotide: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Acetaminophen; Chlorpheniramine; Phenylephrine : (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. Side effects of magnesium hydroxide include: This document does not contain all possible side effects and others may occur. 0.5 mL/kg/day PO as a single dose. Naproxen; Esomeprazole: (Minor) Concomitant administration of antacids can delay the absorption of naproxen. Closely monitor patients for changing analgesic requirements or adverse events. Studies suggest that oral, nonabsorbable antacids and/or laxatives like magnesium hydroxide can interfere with the decrease in colon pH necessary for lactulose's action and these alterations may make it challenging to titrate an accurate dose of lactulose during treatment of hepatic encephalopathy. Velpatasvir solubility decreases as pH increases; therefore, drugs that increase gastric pH are expected to decrease the concentrations of velpatasvir, potentially resulting in loss of antiviral efficacy. Likewise, the dissolution of the coating of extended-release budesonide tablets (Uceris) is pH dependent. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. If antacids must be used while a patient is taking glyburide, give the glyburide at least 2 hours prior to the antacid. Coadministration may decrease the absorption of azithromycin which may decrease its efficacy. Penicillamine: (Moderate) Because penicillamine chelates heavy metals, it is possible that antacids could reduce penicillamine bioavailability, which can decrease the therapeutic effects of penicillamine. mil par lubricates ease merck discomfort The simultaneous administration of an antacid with dasatinib decreased the Cmax and AUC of dasatinib by 58% and 55%, respectively. However, doses may be divided throughout the day if needed.Do not administer concurrently with other oral medications due to possible interference with absorption; clinicians are advised to review drug interactions and advised times of dose separation to limit drug-drug interactions. Magnesium Hydroxide is available under the following different brand names: Milk of Magnesia. The effect of the antacids in this regard is not expected to have a significant effect on the ability of ezetimibe to lower cholesterol. Antacids have been shown to reduce the oral bioavailability of gabapentin by roughly 20%. If these drugs must be used together, give glipizide at least 2 hours prior to the antacid. As these compounds enter the small intestine, they react with bicarbonate, forming magnesium carbonate and calcium carbonate, which are insoluble. Polysaccharide-Iron Complex: (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Acalabrutinib solubility decreases with increasing pH values; therefore, coadministration may result in decreased acalabrutinib exposure and effectiveness. Capecitabine: (Minor) Monitor for an increase in capecitabine-related adverse reactions if coadministration with magnesium hydroxide is necessary. Acetaminophen; Chlorpheniramine: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. 10 Things People With Depression Wish You Knew, Magnesium hydroxide (400 mg/5 mL): 30-60 mL/day orally at bedtime or in divided doses, Magnesium hydroxide (800 mg/5 mL): 15-30 mL/day orally at bedtime or in divided doses, Chewable tablet: 8 tablets/day orally at bedtime or in divided doses, Magnesium hydroxide (400 mg/5 mL): 5-15 mL orally every 4 hours; no more than 4 doses per 24-hour period, Chewable tablet: 2-4 tablets orally every 4 hours; no more than 4 doses per 24-hour period, 2-6 years: 5-15 mL/day of regular-strength liquid orally at bedtime or in divided doses, 6-12 years: 15-30 mL/day (400 mg/5 mL) or 7.5-15 mL/day (800 mg/5 mL) orally at bedtime or in divided doses, 12 years and older: 30-60 mL/day (400 mg/5 mL) or 15-30 mL/day (800 mg/5 mL) orally at bedtime or in divided doses, 3-6 years: 2 tablets orally once daily or in divided doses, 6-12 years: 4 tablets orally once daily or in divided doses, 12 years and older: 8 tablets orally once daily or in divided doses, 12 years and older: 5-15 mL (400 mg/5 mL) orally every 4 hours; no more than 4 doses per 24-hour period, 12 years and older: 2-4 tablets orally every 4 hours; no more than 4 doses per 24-hour period, See "What Are Side Effects Associated with Using Magnesium Hydroxide? Hydroxychloroquine: (Moderate) Hydroxychloroquine absorption may be reduced by antacids as has been observed with the structurally similar chloroquine. Lansoprazole; Naproxen: (Minor) Concomitant administration of antacids can delay the absorption of naproxen. The chemical structure of these antacids contains aluminum or magnesium which can bind cabotegravir in the GI tract. Magnesium citrate should not be used chronically as a laxative due to the risk of hypermagnesemia. Coadministration of aluminum/magnesium hydroxide and bazedoxifene decreased Cmax of bazedoxifene by 8% and increased AUC of bazedoxifene by 7%. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid. Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. Carbinoxamine; Hydrocodone; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. Homatropine; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. Acetaminophen; Aspirin, ASA; Caffeine: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. If using as an antacid, administration with a little water is advised.May be more palatable if refrigerated prior to administration. Trospium: (Moderate) Antacids may inhibit the oral absorption of antimuscarinics. Levofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Ethacrynic Acid: (Moderate) Loop diuretics may increase the risk of hypokalemia especially in patients receiving prolonged therapy with laxatives. Neratinib: (Major) Administer neratinib at least 3 hours after administration of antacids if concomitant use is necessary due to decreased absorption and systemic exposure of neratinib; the solubility of neratinib decreases with increasing pH of the GI tract. Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate: (Moderate) Concurrent administration of rilpivirine and antacids may significantly decrease rilpivirine plasma concentrations, potentially resulting in treatment failure.