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Complementary Medicine - Cam

Magnesium

Magnesium

Uses

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

This supplement has been used in connection with the following health conditions:

Used for Why
3 Stars
Cardiac Arrhythmia
384 mg daily
Supplementing with magnesium may help reduce the number of arrhythmic episodes.

A double-blind trial investigated the effect of oral magnesium supplementation on arrhythmic episodes in people with congestive heart failure . Those people taking 3.2 grams per day of magnesium chloride (equivalent to 384 mg per day of elemental magnesium) had between 23% and 52% fewer occurrences of specific types of arrhythmia during the six-week study, compared with those taking placebo.1 Lower serum concentrations of magnesium were found to be associated with a higher incidence of arrhythmia in a large population study.2 The anti-arrhythmic properties of magnesium appear to be specific. For example, magnesium is clearly able to prevent a drug-induced arrhythmia called torsade de pointes,3 but it does not appear to prevent atrial fibrillation.4 A doctor should supervise any use of magnesium for cardiac arrhythmia.

3 Stars
Congestive Heart Failure
300 mg daily with a doctor's supervision
Supplementing with this essential mineral can prevent a deficiency that can lead to heart arrhythmias.

Magnesium deficiency frequently occurs in people with CHF, and such a deficiency may lead to heart arrhythmias . Magnesium supplements have reduced the risk of these arrhythmias.5 People with CHF are often given drugs that deplete both magnesium and potassium ; a deficiency of either of these minerals may lead to an arrhythmia.6 Many doctors suggest magnesium supplements of 300 mg per day.

3 Stars
Dysmenorrhea
360 mg daily
Supplementing with magnesium may help keep uterine muscles relaxed.

Magnesium plays a role in controlling muscle tone and could be important in preventing menstrual cramps.7 , 8 Magnesium supplements have been reported in preliminary and double-blind European research to reduce symptoms of dysmenorrhea.9 , 10 , 11 In one of these double-blind trials, women took 360 mg per day of magnesium for three days beginning on the day before menses began.12

3 Stars
Gestational Hypertension
300 mg daily
Taking magnesium may prevent gestational hypertension or reduce its severity.

Magnesium deficiency has also been implicated as a possible cause of GH.13 , 14 , 15 Dietary intake of magnesium is below recommended levels for many women during pregnancy.16 , 17 Magnesium supplementation has been reported to reduce the incidence of GH in preliminary18 and many double-blind trials.19 , 20 In addition to preventing GH, magnesium supplementation has also been reported to reduce the severity of established GH in one study.21 Amounts used in studies on GH range from 165 to 365 mg of supplemental magnesium per day.

3 Stars
Migraine Headache
360 to 600 mg daily
Compared with healthy people, migraine sufferers have been found to have lower magnesium levels. Supplementing with magnesium may reduce migraine frequency and relieve symptoms.

Compared with healthy people, people with migraines have been found to have lower blood and brain levels of magnesium .22 , 23 , 24 , 25 Preliminary research in a group of women (mostly premenopausal) showed that supplementing with magnesium (usually 200 mg per day) reduced the frequency of migraines in 80% of those treated.26 In a double-blind trial of 81 people with migraines, 600 mg of magnesium per day was significantly more effective than placebo at reducing the frequency of migraines.27 Another double-blind trial found that taking 360 mg of magnesium per day decreased the number of days on which premenstrual migraines occurred.28 One double-blind trial found no benefit from 486 mg of magnesium per day for three months. However, that study defined improvement according to extremely strict criteria, and even some known anti-migraine drugs have failed to show benefit when tested using those criteria.29 Intravenous magnesium has been reported to produce marked and sometimes complete symptom relief during acute migraines, usually within 15 minutes or less.30

3 Stars
Mitral Valve Prolapse
If deficient: 500 mg daily
Magnesium deficiency may be one cause of the symptoms that occur in association with MVP. In one study, people taking magnesium experienced a significant reduction in weakness, chest pain, anxiety, shortness of breath, and palpitations.

Magnesium deficiency has been proposed as one cause of the symptoms that occur in association with MVP.31 In a study of people with severe MVP symptoms, blood levels of magnesium were low in 60% of cases. Those people with low magnesium levels participated in a double-blind trial, in which they received a placebo or magnesium (500 mg per day for one week, then about 335 mg per day for four weeks). People receiving magnesium experienced a significant reduction in symptoms of weakness, chest pain, anxiety , shortness of breath, and palpitations.32

3 Stars
Type 1 Diabetes
200 to 600 mg daily
People with type 1 diabetes tend to have low magnesium levels, supplementing with the mineral may reduce the risk of deficiency-related problems, such as eye damage and neuropathy.
People with type 1 diabetes tend to have low magnesium levels, and magnesium given orally or by injection partially overcomes the reduction in magnesium levels.33 In one preliminary trial, insulin requirements were lower in people with type 1 diabetes who were given magnesium.34 Diabetes-induced damage to the eyes is more likely to occur in magnesium-deficient people with type 1 diabetes.35 In magnesium-deficient pregnant women with type 1 diabetes, the lack of magnesium may even account for the high rate of spontaneous abortion and birth defects associated with type 1 diabetes.36 A double-blind trial found that giving 300 mg per day of magnesium to magnesium-deficient type 1 diabetics for five years slowed the development of diabetic nerve damage (neuropathy). The American Diabetes Association acknowledges strong associations between magnesium deficiency and insulin resistance but has not said magnesium deficiency is a risk factor.37 Many doctors, however, recommend that adults with diabetes and normal kidney function supplement with 200 to 600 mg of magnesium per day (those amounts would be lower for children).
3 Stars
Type 2 Diabetes
200 to 600 mg daily
People with type 2 diabetes tend to have low magnesium levels, supplementing with the mineral may restore levels and improve insulin production.

People with type 2 diabetes tend to have low magnesium levels.38 Double-blind research indicates that supplementing with magnesium overcomes this problem.39 Magnesium supplementation has improved insulin production in elderly people with type 2 diabetes.40 However, one double-blind trial found no effect from 500 mg magnesium per day in people with type 2 diabetes, although twice that amount led to some improvement.41 Elders without diabetes can also produce more insulin as a result of magnesium supplements, according to some,42 but not all, trials.43 However, in people with type 2 diabetes who nonetheless require insulin, Dutch researchers have reported no improvement in blood sugar levels from magnesium supplementation.44 The American Diabetes Association acknowledges strong associations between magnesium deficiency and insulin resistance but has not said magnesium deficiency is a risk factor45 Many doctors, however, recommend that people with diabetes and normal kidney function supplement with 200 to 600 mg of magnesium per day.

Diabetes-induced damage to the eyes is more likely to occur in magnesium-deficient people with type 1 diabetes.46 In magnesium-deficient pregnant women with type 1 diabetes, the lack of magnesium may even account for the high rate of spontaneous abortion and birth defects associated with type 1 diabetes.47 The American Diabetes Association admits “strong associations...between magnesium deficiency and insulin resistance” but will not say magnesium deficiency is a risk factor.48 Many doctors, however, recommend that people with diabetes and normal kidney function supplement with 200–600 mg of magnesium per day.

3 Stars
Urinary Incontinence (urge incontinence )
150 mg twice daily
In a double blind study, women with urge incontinence reported improvement after supplementing with magnesium.
In a double blind study, women with urge incontinence took approximately 150 mg of magnesum twice daily for one month, and reported improvement, including fewer episodes of urge incontinence, less frequent urination, and fewer awakenings at night to urinate.49 This confirmed an earlier double-blind study showing that a similar amount of magnesium reduced symptoms of urge incontinence.50
2 Stars
Angina
365 mg twice per day
Taking magnesium may reduce the risk of exercise-induced chest pain.

Magnesium deficiency may be a contributing factor for spasms that occur in coronary arteries, particularly in variant angina.51 , 52 While studies have used injected magnesium to stop such attacks effectively,53 , 54 it is unclear whether oral magnesium would be effective in preventing or treating blood vessel spasms. One double-blind study of patients with exercise-induced angina, however, showed that oral magnesium supplementation (365 mg twice a day) for 6 months significantly reduced the incidence of exercise-induced chest pain, compared with a placebo.55

2 Stars
Asthma
300 to 400 mg daily
People with asthma frequently have low magnesium levels. Supplementing with the mineral might help prevent asthma attacks because magnesium can prevent bronchial spasms.

Magnesium levels are frequently low in asthmatics.56 Current evidence suggests that high dietary magnesium intake may be associated with better lung function and reduced bronchial reactivity. Intravenous injection of magnesium has been reported in most,57 , 58 , 59 , 60 but not all,61 double-blind trials to rapidly halt acute asthma attacks. Magnesium supplements might help prevent asthma attacks because magnesium can prevent spasms of the bronchial passages. In a preliminary trial, 18 adults with asthma took 300 mg of magnesium per day for 30 days and experienced decreased bronchial reactivity.62 However, a double-blind trial investigated the effects of 400 mg per day for three weeks and found a significant improvement in symptoms, but not in objective measures of airflow or airway reactivity.63 The amount of magnesium used in these trials was 300 to 400 mg per day. Children usually take proportionately less based on their body weight, but one study of asthmatic children between the ages of 17 and 19 used 300 mg of magnesium per day.64

2 Stars
Attention Deficit–Hyperactivity Disorder
If deficient: 200 mg daily
Some children with ADHD have low magnesium levels. In one trial, children with ADHD and low magnesium status who were given magnesium had a significant decrease in hyperactive behavior.

Some children with ADHD have lowered levels of magnesium . In a preliminary, controlled trial, children with ADHD and low magnesium status were given 200 mg of magnesium per day for six months.65 Compared with 25 other magnesium-deficient ADHD children, those given magnesium supplementation had a significant decrease in hyperactive behavior.

2 Stars
Celiac Disease
Consult a qualified healthcare practitioner
The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. Supplementing with magnesium may correct a deficiency.

The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. The most common nutritional problems in people with celiac disease include deficiencies of essential fatty acids, iron , vitamin D , vitamin K , calcium , magnesium , and folic acid .66 Zinc malabsorption also occurs frequently in celiac disease67 and may result in zinc deficiency, even in people who are otherwise in remission.68 People with newly diagnosed celiac disease should be assessed for nutritional deficiencies by a doctor. Celiac patients who have not yet completely recovered should supplement with a high-potency multivitamin-mineral . Some patients may require even higher amounts of some of these vitamins and minerals—an issue that should be discussed with their healthcare practitioner. Evidence of a nutrient deficiency in a celiac patient is a clear indication for supplementation with that nutrient.

After commencement of a gluten-free diet, overall nutritional status gradually improves. However, deficiencies of some nutrients may persist, even in people who are strictly avoiding gluten. For example, magnesium deficiency was found in 8 of 23 adults with celiac disease who had been following a gluten-free diet and were symptom-free. When these adults were supplemented with magnesium for two years, their bone mineral density increased significantly.69

2 Stars
Chronic Fatigue Syndrome
Refer to label instructions
Some researchers have reported that magnesium deficiency is common in people with chronic fatigue syndrome. Supplementing can help make up for a deficiency.

NADH (nicotinamide adenine dinucleotide) helps make ATP, the energy source the body runs on. In a double-blind trial, people with CFS received 10 mg of NADH or a placebo each day for four weeks.70 Of those receiving NADH, 31% reported improvements in fatigue, decreases in other symptoms, and improved overall quality of life, compared with only 8% of those in the placebo group. Further double-blind research is needed to confirm these findings.

Magnesium levels have been reported to be low in CFS sufferers. In a double-blind trial, injections with magnesium improved symptoms for most people.71 Oral magnesium supplementation has improved symptoms in those people with CFS who previously had low magnesium levels, according to a preliminary report, although magnesium injections were sometimes necessary.72 These researchers report that magnesium deficiency appears to be very common in people with CFS. Nonetheless, several other researchers report no evidence of magnesium deficiency in people with CFS.73 , 74 , 75 The reason for this discrepancy remains unclear. If people with CFS do consider magnesium supplementation, they should have their magnesium status checked by a doctor before undertaking supplementation. It appears that only people with magnesium deficiency benefit from this therapy.

2 Stars
Hypertension
350 to 500 mg daily
Taking magnesium may lower blood pressure, especially in people who are taking potassium-depleting diuretics.
Some,76 but not all,77 trials show that magnesium supplements—typically 350–500 mg per day—lower blood pressure. Magnesium appears to be particularly effective in people who are taking potassium-depleting diuretics.78 Potassium-depleting diuretics also deplete magnesium. Therefore, the drop in blood pressure resulting from magnesium supplementation in people taking these drugs may result from overcoming a mild magnesium deficiency.
2 Stars
Menopause
250 to 500 mg per day 
In a preliminary trial, supplementing with magnesium significantly decreased the frequency of hot flashes in women experiencing menopausal symptoms after breast cancer treatment.
In a preliminary trial, supplementation with magnesium (250 to 500 mg per day for 4 weeks) significantly decreased the frequency of hot flashes by 47% in women who were experiencing menopausal symptoms after treatment for breast cancer.79
2 Stars
Osteoporosis
Adults: 250 mg up to 750 mg daily; for girls: 150 mg daily
Supplementing with magnesium has been shown to stop bone loss or increased bone mass in people with osteoporosis.

In a preliminary study, people with osteoporosis were reported to be at high risk for magnesium malabsorption.80 Both bone81 and blood82 levels of magnesium have been reported to be low in people with osteoporosis. Supplemental magnesium has reduced markers of bone loss in men.83 Supplementing with 250 mg up to 750 mg per day of magnesium arrested bone loss or increased bone mass in 87% of people with osteoporosis in a two-year, preliminary trial.84 Supplementing with magnesium (150 mg per day for one year) also increased bone mass in pre-adolescent and adolescent girls in a double-blind study.85 Some doctors recommend that people with osteoporosis supplement with 350 mg of magnesium per day.

One trial studying postmenopausal women combined hormone replacement therapy with magnesium (600 mg per day), calcium (500 mg per day), vitamin C , B vitamins , vitamin D, zinc, copper, manganese, boron , and other nutrients for an eight- to nine-month period.86 In addition, participants were told to avoid processed foods, limit protein intake, emphasize vegetable over animal protein, and limit consumption of salt, sugar, alcohol, coffee, tea, chocolate, and tobacco. Bone density increased a remarkable 11%, compared to only 0.7% in women receiving hormone replacement alone.

2 Stars
Premenstrual Syndrome
200 to 400 mg daily
Supplementing with magnesium may help reduce the risk of mood swings, bloating, breast tenderness, headaches, and other symptoms.

Women with PMS have been reported to be at increased risk of magnesium deficiency.87 , 88 Supplementing with magnesium may help reduce symptoms.89 , 90 In one double-blind trial using only 200 mg per day for two months, a significant reduction was reported for several symptoms related to PMS ( fluid retention , weight gain, swelling of extremities, breast tenderness, and abdominal bloating).91 Magnesium has also been reported to be effective in reducing the symptoms of menstrual migraine headaches.92 While the ideal amount of magnesium has yet to be determined, some doctors recommend 400 mg per day.93 Effects of magnesium may begin to appear after two to three months.

2 Stars
Thalassemia
7.2 mg per 2.2 lbs (1 kg) of body weight daily
Magnesium has been reported to be low in thalassemia patients. One study reported that magnesium supplements improved some red blood cell abnormalities in thalassemia patients.

Test tube studies have shown that propionyl-L-carnitine (a form of L-carnitine ) protects red blood cells of people with thalassemia against free radical damage.94 In a preliminary study, children with beta thalassemia major who took 100 mg of L-carnitine per 2.2 pounds of body weight per day for three months had a significantly decreased need for blood transfusions.95 Some studies have found people with thalassemia to be frequently deficient in folic acid , vitamin B12 ,96 and zinc .97 , 98 Researchers have reported improved growth rates in zinc-deficient thalassemic children who were given zinc supplements of 22.5 to 90 mg per day, depending on age.99 , 100 Magnesium has been reported to be low in thalassemia patients in some,101 , 102 but not all,103 studies. A small, preliminary study reported that oral supplements of magnesium, 7.2 mg per 2.2 pounds of body weight per day, improved some red blood cell abnormalities in thalassemia patients.104

1 Star
Alcohol Withdrawal
Refer to label instructions
Alcoholics are sometimes deficient in magnesium, and some researchers believe that symptoms of withdrawal may result in part from this deficiency.

Alcoholics are sometimes deficient in magnesium , and some researchers believe that symptoms of withdrawal may result in part from this deficiency.105 Nonetheless, a double-blind trial reported that magnesium injections did not reduce symptoms of alcohol withdrawal.106

1 Star
Anxiety
Refer to label instructions
Many years ago, magnesium was reported to be relaxing for people with mild anxiety. Some doctors recommend soaking in a hot bathtub containing magnesium sulfate crystals (Epsom salts).

Many years ago, magnesium was reported to be relaxing for people with mild anxiety.107 Typically, 200 to 300 mg of magnesium are taken two to three times per day. Some doctors recommend soaking in a hot tub containing 1–2 cups of magnesium sulfate crystals (Epsom salts) for 15 to 20 minutes, though support for this approach remains anecdotal.

1 Star
Athletic Performance
Refer to label instructions
Magnesium deficiency can reduce exercise performance and contribute to muscle cramps. Studies suggest that taking magnesium might improve performance, although possibly only for those who are deficient or who are not highly trained athletes.
Magnesium deficiency can reduce exercise performance and contribute to muscle cramps, but sub-optimal intake does not appear to be a problem among most groups of athletes.108 , 109 Controlled trials suggest that magnesium supplementation might improve some aspects of physiology important to sports performance in some athletes,110 , 111 but controlled and double-blind trials focusing on performance benefits of 212 to 500 mg per day of magnesium have been inconsistent.112 , 113 , 114 , 115 , 116 , 117 It is possible that magnesium supplementation benefits only those who are deficient or who are not highly trained athletes. 118 , 119
1 Star
Autism
Refer to label instructions
Some researchers have added magnesium to vitamin B6, reporting that taking both nutrients may have better effects than B6 alone. Doctors will often try this combination for at least three months to see whether these nutrients help autistic children.

Some researchers have added magnesium to vitamin B6, reporting that taking both nutrients may have better effects than taking B6 alone.120 The amount of magnesium—10 to 15 mg per 2.2 pounds of body weight—is high enough to cause diarrhea in some people and should be administered by a doctor. Doctors will often try vitamin B6 or the combination of B6 and magnesium for at least three months to see whether these nutrients help autistic children. In a preliminary trial, one group of researchers found that relatively small daily amounts of magnesium (6 mg per 2.2 pounds of body weight) and vitamin B6 (0.6 mg per 2.2 pounds of body weight) improved symptoms by about 50% in children with autism or a related condition (pervasive developmental disorder).121

1 Star
Chronic Obstructive Pulmonary Disease
Refer to label instructions
Magnesium is needed for normal function, supplementing with it can make up for the magnesium deficiency commonly caused by prescription drugs taken by people with COPD.

Many prescription drugs commonly taken by people with COPD have been linked to magnesium deficiency, a potential problem because magnesium is needed for normal lung function.122 One group of researchers reported that 47% of people with COPD had a magnesium deficiency.123 In this study, magnesium deficiency was also linked to increased hospital stays. Thus, it appears that many people with COPD may be magnesium deficient, a problem that might worsen their condition; moreover, the deficiency is not easily diagnosed.

Intravenous magnesium has improved breathing capacity in people experiencing an acute exacerbation of COPD.124 In this double-blind study, the need for hospitalization also was reduced in the magnesium group (28% versus 42% with placebo), but this difference was not statistically significant. Intravenous magnesium is known to be a powerful bronchodilator.125 The effect of oral magnesium supplementation in people with COPD has yet to be investigated.

1 Star
Cluster Headache
Refer to label instructions
People who suffer from cluster headaches often have low blood levels of magnesium, magnesium injections have been shown to bring relief.

People who suffer from cluster headaches often have low blood levels of magnesium , and preliminary trials126 , 127 show that intravenous magnesium injections may relieve a cluster headache episode. However, no trials have investigated the effects of oral magnesium supplementation on cluster headaches.

1 Star
Fibromyalgia
Refer to label instructions
A preliminary trial found that a combination of magnesium and malic acid might lessen muscle pain in people with fibromyalgia.

A preliminary trial found that a combination of magnesium and malic acid might lessen muscle pain in people with fibromyalgia.128 The amounts used in this trial were 300–600 mg of elemental magnesium and 1,200–2,400 mg of malic acid per day, taken for eight weeks. A double-blind trial by the same research group using 300 mg magnesium and 1,200 mg malic acid per day found no reduction in symptoms, however.129 Though these researchers claimed that magnesium and malic acid appeared to have some effect at higher levels (up to 600 mg magnesium and 2,400 mg malic acid), the positive effects were not demonstrated under blinded study conditions. Therefore, the evidence supporting the use of these supplements for people with fibromyalgia remains weak and inconclusive.

1 Star
Glaucoma
Refer to label instructions
In one study, supplementing with magnesium improved vision in people with glaucoma, apparently by enhancing blood flow to the eyes.

Magnesium can dilate blood vessels. One study looked at whether magnesium might improve vision in people with glaucoma by enhancing blood flow to the eyes. In that trial, participants were given 245 mg of magnesium per day. Improvement in vision was noted after four weeks, but the change did not reach statistical significance.130

1 Star
High Cholesterol
Refer to label instructions
In a preliminary study, magnesium supplementation lowered total cholesterol and increased HDL ("good") cholesterol levels.
Magnesium is needed by the heart to function properly. Although the mechanism is unclear, magnesium supplements (430 mg per day) lowered cholesterol in a preliminary trial.131 Another preliminary study reported that magnesium deficiency is associated with a low HDL cholesterol level.132 Intravenous magnesium has reduced death following heart attacks in some, but not all, clinical trials.133 Though these outcomes would suggest that people with high cholesterol levels should take magnesium supplements, an isolated double-blind trial reported that people with a history of heart disease assigned to magnesium supplementation experienced an increased number of heart attacks.134 More information is necessary before the scientific community can clearly evaluate the role magnesium should play for people with elevated cholesterol.
1 Star
Hypoglycemia
Refer to label instructions
Research has shown that supplementing with or magnesium can prevent blood sugar levels from falling excessively in people with hypoglycemia.

Research has shown that supplementing with chromium (200 mcg per day)135 or magnesium (340 mg per day)136 can prevent blood sugar levels from falling excessively in people with hypoglycemia. Niacinamide (vitamin B3) has also been found to be helpful for hypoglycemic people.137 Other nutrients, including vitamin C , vitamin E , zinc , copper , manganese , and vitamin B6 , may help control blood sugar levels in diabetics .138 Since there are similarities in the way the body regulates high and low blood sugar levels, these nutrients might be helpful for hypoglycemia as well, although the amounts needed for that purpose are not known.

1 Star
Insomnia
Refer to label instructions
People with period limb movements during sleep or restless legs syndrome often have sleep problems. In one trial, insomniacs with these conditions slept better after supplementing with magnesium.

Some people have difficulty sleeping because of a problem known as period limb movements during sleep (PLMS) or another condition called restless legs syndrome (RLS). In a preliminary trial, people with PLMS or RLS who suffered from insomnia had a significant improvement in sleep efficiency after supplementing with magnesium (about 300 mg each evening for four to six weeks).139

1 Star
Insulin Resistance Syndrome
Refer to label instructions
Magnesium deficiency can reduce insulin sensitivity, and low magnesium levels have been associated with greater insulin resistance in nondiabetic people, leading some doctors to believe that supplementing with magnesium may improve IRS.

Magnesium deficiency can reduce insulin sensitivity,140 and low dietary intake141 and low blood levels142 of magnesium have been associated with greater insulin resistance in nondiabetic people. However, no studies of magnesium supplementation in people with IRS have been done.

1 Star
Intermittent Claudication
Refer to label instructions
Magnesium may increase blood flow by helping to dilate blood vessels. One trial found that taking magnesium may increase walking distance in people with intermittent claudication.

Magnesium may increase blood flow by helping to dilate blood vessels. A preliminary trial found that magnesium supplementation may increase walking distance in people with intermittent claudication.143 Many doctors suggest that people with atherosclerosis , including those with intermittent claudication, take approximately 250 to 400 mg of magnesium per day.

In a preliminary trial, supplementing with evening primrose oil (approximately 1,600 mg per day) led to a 10% increase in exercise tolerance in people with intermittent claudication.144

1 Star
Multiple Sclerosis
Refer to label instructions
Magnesium levels have been reported to be low in people with MS. In one trial, a combination of magnesium, cod liver oil, and calcium helped reduce the number of MS attacks.

In a small preliminary trial, people with MS were given 20 grams of cod liver oil , as well as approximately 680 mg of magnesium and 1,100 mg of calcium per day in the form of dolomite tablets.145 After one year, the average number of MS attacks decreased significantly for each person. Unlike fish oil capsules, the cod liver oil in this trial contained not only eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), but 5,000 IU of vitamin D . Therefore, it is not known whether the vitamin D or fatty acids were responsible for the cod liver oil’s effects. (One preliminary study found that giving vitamin D-like drugs to animals with MS was helpful.)146 It is also possible that the magnesium and/or calcium given to these people reduced MS attacks. Magnesium147 and calcium148 levels have been reported to be lower in the nerve tissue of people with MS compared with healthy people.

1 Star
Preeclampsia
Refer to label instructions
Magnesium supplementation has been shown to reduce the incidence of preeclampsia in high-risk women in one trial.

Magnesium deficiency has been implicated as a possible cause of preeclampsia.149 , 150 , 151 , 152 , 153 Magnesium supplementation has been shown to reduce the incidence of preeclampsia in high-risk women in one trial,154 but not in another double-blind trial.155

1 Star
Raynaud’s Disease
Refer to label instructions
Abnormalities of magnesium metabolism have been reported in people with Raynaud’s disease. Magnesium deficiency results in blood-vessel spasm, which may be helped with supplementation.

Abnormalities of magnesium metabolism have been reported in people with Raynaud’s disease.156 Symptoms similar to those seen with Raynaud’s disease occur in people with magnesium deficiency,157 probably because a deficiency of this mineral results in spasm of blood vessels.158 Some doctors recommend that people with Raynaud’s disease supplement with 200–600 mg of magnesium per day, although no clinical trials support this treatment.

1 Star
Restless Legs Syndrome
Refer to label instructions
Supplementing with magnesium may help relieve insomnia in people with restless leg syndrome.

In a preliminary trial, people with period limb movements during sleep (PLMS) or RLS who suffered from insomnia had a significant improvement in sleep efficiency after supplementing with magnesium (about 300 mg each evening for four to six weeks).159

1 Star
Retinopathy
Refer to label instructions
Low magnesium levels have been found to be a risk factor for retinopathy in white people with diabetes. Supplementing with magnesium may improve blood levels of the mineral.

Low blood levels of magnesium have been found to be a risk factor for retinopathy in white people with diabetes ,160 , 161 but not in black people with diabetes.162 So far, no studies have determined whether supplementing with magnesium would help prevent the development of retinopathy.

1 Star
Sickle Cell Anemia
Refer to label instructions
In one trial, supplementing with magnesium dramatically reduced the number of painful days for people with sickle cell anemia.

Low concentrations of red blood cell magnesium have been noted in patients with sickle cell anemia.163 , 164 Low magnesium, in turn, is thought to contribute to red blood cell dehydration and a concomitant increase in symptoms. In a preliminary trial, administration of 540 mg of magnesium per day for six months to sickle cell anemia patients reversed some of the characteristic red blood cell abnormalities and dramatically reduced the number of painful days for these patients.165 The form of magnesium used in this trial, magnesium pidolate, is not supplied by most magnesium supplements; it is unknown whether other forms of magnesium would produce similar results.

1 Star
Stroke
Refer to label instructions
Magnesium appears to reduce high blood pressure, which may in turn reduce stroke risk.

Researchers have found an association between diets low in magnesium and increased risk of stroke, an effect explained partially, but not completely, by the ability of magnesium to reduce high blood pressure .166 Protection from stroke associated with drinking water high in magnesium has also been reported.167 Intravenous magnesium given immediately after a stroke has been proposed as a treatment for reducing stroke deaths,168 but results so far have been inconclusive.169

1 Star
Tinnitus
532 mg per day
In a preliminary study, supplementation with magnesium resulted in a statistically significant improvement in symptoms in adults with tinnitus.
In a preliminary study, supplementation with magnesium (532 mg per day for 3 months) resulted in a statistically significant improvement in symptoms in adults with tinnitus.170 Double-blind trials are needed to confirm the results of this study.

How It Works

How to Use It

Most people don’t consume enough magnesium in their diets. Many nutritionally oriented doctors recommend 250–350 mg per day of supplemental magnesium for adults.

Where to Find It

Nuts and grains are good sources of magnesium. Beans, dark green vegetables, fish, and meat also contain significant amounts.

Possible Deficiencies

Magnesium deficiency is common in people taking “ potassium -depleting” prescription diuretics. Taking too many laxatives can also lead to deficiency. Alcoholism , severe burns , diabetes , and heart failure are other potential causes of deficiency. In a study of urban African-American people (predominantly female), the overall prevalence of magnesium deficiency was 20%. People with a history of alcoholism were six times more likely to have magnesium deficiency than were people without such a history.171 The low magnesium status seen in alcoholics with liver cirrhosis contributes to the development of hypertension in these people.172

Almost two-thirds of people in intensive care hospital units have been found to be magnesium deficient.173 Deficiency may also occur in people with chronic diarrhea , pancreatitis, and other conditions associated with malabsorption .

Fatigue, abnormal heart rhythms , muscle weakness and spasm, depression , loss of appetite, listlessness, and potassium depletion can all result from a magnesium deficiency. People with these symptoms should be evaluated by a doctor before taking magnesium supplements.

As previously mentioned, magnesium levels have been found to be low in people with chronic fatigue syndrome .

Deficiencies of magnesium that are serious enough to cause symptoms should be treated by medical doctors, as they might require intravenous administration of magnesium.174

Interactions

Interactions with Supplements, Foods, & Other Compounds

Vitamin B6 increases the amount of magnesium that can enter cells. As a result, these two nutrients are often taken together. Magnesium may compete for absorption with other minerals, particularly calcium . Taking a multimineral supplement avoids this potential problem.

Interactions with Medicines

Certain medicines interact with this supplement.

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • Albuterol

    Therapeutic amounts of intravenous salbutamol (albuterol) in four healthy people were associated with decreased plasma levels of calcium , magnesium , phosphate, and potassium .175 Decreased potassium levels have been reported with oral,176 intramuscular, and subcutaneous albuterol administration.177 How frequently this effect occurs is not known; whether these changes are preventable through diet or supplementation is also unknown.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Amphotericin B

    Amphotericin B has been reported to increase urinary excretion of magnesium.178 It remains unclear whether it is important for people taking this drug to supplement magnesium.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Bendroflumethiazide

    Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,179 although this deficiency may not be reflected by a low blood level of magnesium.180 Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.181

    People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.182 A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.183 Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

    Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.184 Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.185

  • Bumetanide

    Potassium-depleting diuretics, including loop diuretics, cause the body to lose potassium. Loop diuretics may also cause cellular magnesium depletion,186 although this deficiency may not be reflected by a low blood level of magnesium.187 Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including loop diuretics, should supplement both potassium and magnesium.188

    People taking loop diuretics should be monitored by their doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.189 Fruit is high in potassium, and increasing fruit intake is another way of supplementing potassium. Magnesium supplementation is typically 300–400 mg per day.

  • Busulfan

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.190 , 191 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.192 , 193 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.194 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Capecitabine

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.195 , 196 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.197 , 198 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.199 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Carboplatin

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.200 , 201 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.202 , 203 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.204 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Carmustine

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.205 , 206 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.207 , 208 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.209 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Chlorambucil

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.210 , 211 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.212 , 213 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.214 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Chlorothiazide

    Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,215 although this deficiency may not be reflected by a low blood level of magnesium.216 Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.217

    People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.218 A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.219 Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

    Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.220 Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.221

  • Chlorthalidone

    Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,222 although this deficiency may not be reflected by a low blood level of magnesium.223 Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.224

    People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.225 A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.226 Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

    Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.227 Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.228

    >
  • Cisplatin

    Cisplatin may cause excessive loss of magnesium and potassium in the urine.229 , 230 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.231 , 232 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.233 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Cladribine

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.234 , 235 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.236 , 237 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.238 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Cycloserine

    Cycloserine may interfere with calcium and magnesium absorption.239 The clinical significance of these interactions is unclear.

    Cycloserine may interfere with the absorption and/or activity of folic acid, vitamin B6, and vitamin B12.240 , 241 The clinical importance of this interaction is unclear.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Cyclosporine

    Cyclosporine has been associated with low blood magnesium levels and undesirable side effects.242 , 243 , 244 Some doctors suggest monitoring the level of magnesium in red blood cells, rather than in serum, as the red blood cell test may be more sensitive for evaluating magnesium status.

  • Cytarabine

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.245 , 246 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.247 , 248 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.249 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Desogestrel-Ethinyl Estradiol

    Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.250 In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.251 Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Dexlansoprazole
    In a case report, a man developed severe magnesium deficiency after long-term treatment with a proton pump inhibitor (pantoprazole or lansoprazole).[REF] Severe magnesium deficiency as a result of the use of proton pump inhibitors appears to be rare among people who have no other risk factors for magnesium deficiency. However, in a study of hospitalized patients, the prevalence of low serum magnesium levels was significantly greater among users of proton pump inhibitors than among nonusers (23% vs. 11%).252 People taking proton pump inhibitors (PPIs) should ask their doctor whether to take a magnesium supplement or whether to have their magnesium levels monitored.253
    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Docetaxel

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.254 , 255 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.256 , 257 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.258 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

    Glutathione , the main antioxidant found within cells, is frequently depleted in individuals on chemotherapy and/or radiation. Preliminary studies have found that intravenously injected glutathione may decrease some of the adverse effects of chemotherapy and radiation, such as diarrhea .259

  • Docusate

    A woman and her newborn infant experienced low blood levels of magnesium, which was possibly due to chronic use of docusate throughout and after pregnancy.260 Controlled research is necessary to determine whether people taking docusate for long periods of time need to supplement magnesium.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Erlotinib

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.261 , 262 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.263 , 264 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.265 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Erythromycin

    Erythromycin may interfere with the absorption and/or activity of calcium , folic acid , magnesium , vitamin B6 and vitamin B12 ,266 which may cause problems, especially with long-term erythromycin treatment. Until more is known, it makes sense for people taking erythromycin for longer than two weeks to supplement with a daily multivitamin-multimineral .

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Esomeprazole
    In a case report, a man developed severe magnesium deficiency after long-term treatment with a proton pump inhibitor (pantoprazole or lansoprazole).[REF] Severe magnesium deficiency as a result of the use of proton pump inhibitors appears to be rare among people who have no other risk factors for magnesium deficiency. However, in a study of hospitalized patients, the prevalence of low serum magnesium levels was significantly greater among users of proton pump inhibitors than among nonusers (23% vs. 11%).267 People taking proton pump inhibitors (PPIs) should ask their doctor whether to take a magnesium supplement or whether to have their magnesium levels monitored.268
    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Ethinyl Estradiol and Levonorgestrel

    Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.269 In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.270 Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Ethinyl Estradiol and Norethindrone

    Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.271 In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.272 Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Ethinyl Estradiol and Norgestimate

    Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.273 In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.274 Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Ethinyl Estradiol and Norgestrel

    Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.275 In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.276 Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Etoposide

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.277 , 278 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.279 , 280 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.281 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Felodipine

    Increased magnesium excretion has been observed in studies of individuals taking felodipine.282 Therefore, some physicians may recommend magnesium supplementation to their patients taking felodipine.

  • Floxuridine

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.284 , 285 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.286 , 287 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.288 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Fludarabine

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.289 , 290 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.291 , 292 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.293 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Furosemide

    Potassium-depleting diuretics, including loop diuretics, cause the body to lose potassium. Loop diuretics may also cause cellular magnesium depletion,294 although this deficiency may not be reflected by a low blood level of magnesium.295 Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including loop diuretics, should supplement both potassium and magnesium.296

    People taking loop diuretics should be monitored by their doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.297 Fruit is high in potassium, and increasing fruit intake is another way of supplementing potassium. Magnesium supplementation is typically 300–400 mg per day.

  • Gentamicin

    Gentamicin has been associated with urinary loss of magnesium, resulting in hypomagnesemia (low magnesium levels) in humans.298 , 299

  • Hydrochlorothiazide

    Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,301 although this deficiency may not be reflected by a low blood level of magnesium.302 Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.303

    People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.304 A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.305 Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

    Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.306 Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.307

  • Hydroflumethiazide

    Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,308 although this deficiency may not be reflected by a low blood level of magnesium.309 Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.310

    People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.311 A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.312 Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

    Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.313 Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.314

  • Hydroxyurea

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.315 , 316 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.317 , 318 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.319 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Ifosfamide

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.320 , 321 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.322 , 323 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.324 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Indapamide

    Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,325 although this deficiency may not be reflected by a low blood level of magnesium.326 Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.327

    People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.328 A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.329 Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

    Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.330 Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.331

  • Irinotecan

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.332 , 333 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.334 , 335 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.336 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Isoniazid

    Isoniazid may interfere with the activity of other nutrients, including vitamin B3 (niacin) , vitamin B12 , vitamin D , and vitamin E , folic acid , calcium , and magnesium .337 , 338 Supplementation with vitamin B6 is thought to help prevent isoniazid-induced niacin deficiency; however, small amounts of vitamin B6 (e.g. 10 mg per day) appear to be inadequate in some cases.339 People should consider using a daily multivitamin-mineral supplement during isoniazid therapy.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Lansoprazole
    In a case report, a man developed severe magnesium deficiency after long-term treatment with a proton pump inhibitor (pantoprazole or lansoprazole).340 Severe magnesium deficiency as a result of the use of proton pump inhibitors appears to be rare. However, people taking proton pump inhibitors (PPIs) should ask their doctor whether to take a magnesium supplement or whether to have their magnesium levels monitored.341
    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Levonorgestrel

    Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.342 In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.343 Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Levonorgestrel-Ethinyl Estrad

    Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.344 In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.345 Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Lomustine

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.346 , 347 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.348 , 349 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.350 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Mechlorethamine

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.351 , 352 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.353 , 354 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.355 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Melphalan

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.356 , 357 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.358 , 359 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.360 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Mercaptopurine

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.361 , 362 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.363 , 364 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.365 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

    Many chemotherapy drugs can cause diarrhea , lack of appetite, vomiting, and damage to the gastrointestinal tract. Recent anti-nausea prescription medications are often effective. Nonetheless, nutritional deficiencies still occur.366 People undergoing chemotherapy should talk to their doctor about whether supplementing with a multivitamin-mineral will protect them against deficiencies.

  • Mestranol and Norethindrone

    Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.367 In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.368 Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Methotrexate

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.369 , 370 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.371 , 372 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.373 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Methyclothiazide

    Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,374 although this deficiency may not be reflected by a low blood level of magnesium.375 Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.376

    People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.377 A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.378 Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

    Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.379 Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.380

  • Metolazone

    Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,3 although this deficiency may not be reflected by a low blood level of magnesium.4 Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.5

    People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.6 A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.7 Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

    Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.8 Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.9

  • Neomycin

    Neomycin can decrease absorption or increase elimination of many nutrients, including calcium , carbohydrates, beta-carotene , fats, folic acid , iron , magnesium , potassium , sodium, and vitamin A , vitamin B12 , vitamin D , and vitamin K .381 , 382 Surgery preparation with oral neomycin is unlikely to lead to deficiencies. It makes sense for people taking neomycin for more than a few days to also take a multivitamin-mineral supplement.

  • Norgestimate-Ethinyl Estradiol

    Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.383 In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.384 Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Omeprazole
    In a case report, a man developed severe magnesium deficiency after long-term treatment with a proton pump inhibitor (pantoprazole or lansoprazole).[REF] Severe magnesium deficiency as a result of the use of proton pump inhibitors appears to be rare among people who have no other risk factors for magnesium deficiency. However, in a study of hospitalized patients, the prevalence of low serum magnesium levels was significantly greater among users of proton pump inhibitors than among nonusers (23% vs. 11%).385 People taking proton pump inhibitors (PPIs) should ask their doctor whether to take a magnesium supplement or whether to have their magnesium levels monitored.386
    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Pantoprazole
    In a case report, a man developed severe magnesium deficiency after long-term treatment with a proton pump inhibitor (pantoprazole or lansoprazole).[REF] Severe magnesium deficiency as a result of the use of proton pump inhibitors appears to be rare among people who have no other risk factors for magnesium deficiency. However, in a study of hospitalized patients, the prevalence of low serum magnesium levels was significantly greater among users of proton pump inhibitors than among nonusers (23% vs. 11%).388 People taking proton pump inhibitors (PPIs) should ask their doctor whether to take a magnesium supplement or whether to have their magnesium levels monitored.389
    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Polifeprosan 20 with Carmustine

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.390 , 391 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.392 , 393 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.394 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Polythiazide

    Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,395 although this deficiency may not be reflected by a low blood level of magnesium.396 Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.397

    People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.398 A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.399 Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

    Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.400 Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.401

  • Rabeprazole
    In a case report, a man developed severe magnesium deficiency after long-term treatment with a proton pump inhibitor (pantoprazole or lansoprazole).[REF] Severe magnesium deficiency as a result of the use of proton pump inhibitors appears to be rare among people who have no other risk factors for magnesium deficiency. However, in a study of hospitalized patients, the prevalence of low serum magnesium levels was significantly greater among users of proton pump inhibitors than among nonusers (23% vs. 11%).403 People taking proton pump inhibitors (PPIs) should ask their doctor whether to take a magnesium supplement or whether to have their magnesium levels monitored.404
    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Sulfamethoxazole

    Sulfonamides, including sulfamethoxazole, can decrease absorption of calcium, magnesium, and vitamin B12.407 This is generally not a problem when taking sulfamethoxazole for two weeks or less. People taking sulfamethoxazole for longer than two weeks should ask their doctor about nutrient monitoring and supplementation.

    Note: Since sulfamethoxazole is often prescribed in combination with trimethoprim (for example, in Bactrim or Septra), it may be easy to associate this interaction with trimethoprim. However, this interaction is not known to occur with trimethoprim alone.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Theophylline

    Preliminary evidence indicates that theophylline can promote potassium and magnesium deficiency.408 , 409 Some doctors have noted a tendency for persons on theophylline to become deficient in these minerals. Therefore, supplementing with these minerals may be necessary during theophylline therapy. Consult with a doctor to make this determination.

  • Thioguanine

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.410 , 411 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.412 , 413 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.414 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Thiotepa

    Cisplatin may cause excessive loss of magnesium and potassium in the urine.415 , 416 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.417 , 418 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.419 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Tobramycin

    Calcium , magnesium , and potassium depletion requiring prolonged replacement were reported in a child with tetany who had just completed a three-week course of i.v. tobramycin.420 The authors suggest this may have been due to kidney damage related to the drug. Seventeen patients with cancer developed calcium, magnesium, and potassium depletion after treatment with aminoglycoside antibiotics, including tobramycin.421 The authors suggested a possible potentiating action of tobramycin-induced mineral depletion by chemotherapy drugs, especially doxorubicin (Adriamycin®).

    Until more is known, people receiving i.v. tobramycin should ask their doctor about monitoring calcium, magnesium, and potassium levels and the possibility of mineral replacement.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Torsemide

    Potassium-depleting diuretics, including loop diuretics, cause the body to lose potassium. Loop diuretics may also cause cellular magnesium depletion,422 although this deficiency may not be reflected by a low blood level of magnesium.423 Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including loop diuretics, should supplement both potassium and magnesium.424

    People taking loop diuretics should be monitored by their doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.425 Fruit is high in potassium, and increasing fruit intake is another way of supplementing potassium. Magnesium supplementation is typically 300–400 mg per day.

  • Trichlormethiazide

    Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion,426 although this deficiency may not be reflected by a low blood level of magnesium.427 Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.428

    People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels.429 A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death.430 Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

    Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.431 Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.432

  • Trimethoprim/ Sulfamethoxazole

    Sulfonamides, including sulfamethoxazole , can decrease absorption of calcium, magnesium, and vitamin B12.433 This is generally not a problem when taking sulfamethoxazole for two weeks or less. People taking sulfamethoxazole for longer than two weeks should ask their doctor about nutrient monitoring and supplementation.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Uracil Mustard

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.434 , 435 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.436 , 437 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.438 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Vinblastine

    The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.439

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.440 , 441 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.442 , 443 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.444 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Vincristine

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine.445 , 446 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.447 , 448 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.449 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

    Many chemotherapy drugs can cause diarrhea , lack of appetite, vomiting, and damage to the gastrointestinal tract. Recent anti-nausea prescription medications are often effective. Nonetheless, nutritional deficiencies still occur.450 People undergoing chemotherapy should talk to their doctor about whether supplementing with a multivitamin-mineral will protect them against deficiencies.

Reduce Side Effects

  • Oxaliplatin
    In a double-blind trial, intravenous administration of calcium and magnesium before and after administration of oxaliplatin prevented the development of oxaliplatin-induced nerve damage.387 It is not known whether oral administration of these minerals would also be beneficial.
  • Quinidine

    People taking potassium-depleting diuretics may develop low potassium and magnesium blood levels. Prolonged diarrhea and vomiting might also result in low blood potassium levels. People with low potassium or magnesium blood levels who take quinidine might develop serious drug side effects.402 Therefore, people taking quinidine should have their blood potassium and magnesium levels checked regularly and might need to supplement with both minerals, especially when taking potassium-depleting diuretics.

  • Sotalol

    Two individuals taking sotalol developed a side effect of the drug (a heart arrhythmia known as torsades de pointes) which was effectively treated with intravenous magnesium.405 , 406 Additional research is needed to determine whether people taking sotalol might be able to prevent this side effect by taking supplemental magnesium.

Support Medicine

  • Fentanyl

    One double-blind study showed that giving magnesium intravenously before surgery dramatically reduced the amount of fentanyl needed to control pain during and after an operation.283 Further research is needed to determine whether people using fentanyl patches might benefit from supplementing with oral magnesium.

  • Glimepiride

    Supplementing magnesium may enhance the blood-sugar-lowering effects of sulfonylurea drugs.300 Though no current studies have investigated whether glimepiride increases the risk of developing hypoglycemia , individuals should closely monitor their blood glucose while taking glimepiride together with magnesium supplements.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduces Effectiveness

  • Cimetidine

    In healthy volunteers, a magnesium hydroxide / aluminum hydroxide antacid, taken with cimetidine, decreased cimetidine absorption by 20 to 25%.453 People can avoid this interaction by taking cimetidine two hours before or after any aluminum/magnesium-containing antacids, including magnesium hydroxide found in some vitamin/mineral supplements. However, the available studies do not clearly indicate if magnesium hydroxide was the problem and may not need to be avoided.

  • Ciprofloxacin

    Minerals such as aluminum, calcium , copper , iron , magnesium , manganese , and zinc can bind to ciprofloxacin, greatly reducing the absorption of the drug.454 , 455 , 456 , 457 Because of the mineral content, people are advised to take ciprofloxacin two hours after consuming dairy products (milk, cheese, yogurt, ice cream, and others), antacids (Maalox®, Mylanta®, Tums®, Rolaids®, and others), and mineral-containing supplements.458

  • Demeclocycline

    Taking mineral supplements or antacids that contain aluminum, calcium , iron , magnesium , or zinc at the same time as tetracyclines inhibits the absorption of the drug.459 Therefore, individuals should take tetracyclines at least two hours before or after products containing minerals.

  • Doxycycline

    Many minerals can decrease the absorption and reduce effectiveness of doxycycline, including calcium , magnesium , iron , zinc , and others.462 To avoid these interactions, doxycycline should be taken two hours before or two hours after dairy products (high in calcium) and mineral-containing antacids or supplements.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Folic Acid

    One controlled study showed that taking folic acid together with an antacid containing aluminum and magnesium hydroxide reduced the absorption of the vitamin.463 Therefore, individuals should take folic acid one hour before or two hours after taking antacids containing aluminum and magnesium hydroxide.

  • Gemifloxacin

    One study showed that taking an antacid containing magnesium and aluminum ten minutes before gemifloxacin results in an 85% reduction in the absorption of the drug.464 Consequently, gemifloxacin and supplements containing magnesium should not be taken at the same time.

  • Hydroxychloroquine

    Magnesium supplementation may reduce blood levels of chloroquine, a compound similar to hydroxychloroquine, and decrease its effectiveness.465 Until more is known, people taking hydroxychloroquine for arthritis who are also using magnesium supplements and are not experiencing relief might try avoiding the supplements or taking them at separate times.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Levofloxacin

    Taking magnesium supplements at the same time as levofloxacin can reduce the intestinal absorption—and thus the effectiveness—of the drug.466 Consequently, nutritional supplements or antacids containing magnesium, if used, should be taken two hours before or after taking levofloxacin.

  • Nitrofurantoin

    In six healthy men, nitrofurantoin absorption was reduced by also taking magnesium trisilicate.468 Another magnesium compound, magnesium oxide (commonly found in supplements) was shown to bind with nitrofurantoin in a test tube.469

    In a study of 11 people, the rate of nitrofurantoin absorption was delayed despite the fact that the amount of nitrofurantoin ultimately absorbed remained the same when the drug was administered in a colloidal magnesium aluminum silicate suspension.470 It remains unclear whether this interaction is clinically important or if typical magnesium supplements would have the same effect.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Ofloxacin

    Minerals including calcium , iron , magnesium , and zinc can bind to fluoroquinolones, including ofloxacin, greatly reducing drug absorption.471 Ofloxacin should be taken four hours before or two hours after consuming antacids (Maalox®, Mylanta®, Tumms®, Rolaids® and others) that may contain these minerals and mineral-containing supplements .472

  • Tetracycline

    Many minerals can decrease the absorption of tetracycline, thus reducing its effectiveness. These minerals include aluminum (in antacids), calcium (in antacids, dairy products, and supplements), magnesium (in antacids and supplements), iron (in food and supplements), zinc (in food and supplements), and others.

  • Warfarin

    Iron , magnesium , and zinc may bind with warfarin, potentially decreasing their absorption and activity.475 People on warfarin therapy should take warfarin and iron/magnesium/zinc-containing products at least two hours apart.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Potential Negative Interaction

  • Amiloride

    Preliminary research in animals suggests that amiloride may reduce the urinary excretion of magnesium.451 It is unknown if this same effect would occur in humans. Nevertheless, persons taking more than 300 mg of magnesium per day and amiloride should consult with a doctor, as this combination may lead to potentially dangerous elevations in levels of magnesium in the body. The combination of amiloride and hydrochlorothiazide would likely eliminate this problem, as hydrochlorothiazide may deplete magnesium.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Calcium Acetate

    Calcium-containing antacids, when taken together with calcium acetate, may result in abnormally high blood levels of calcium.452 Consequently, people taking calcium acetate should avoid taking calcium-containing antacids.

  • Dexamethasone

    Corticosteroids may increase the body’s loss of magnesium.460 Some doctors recommend that people taking corticosteroids for more than two weeks supplement with 300–400 mg of magnesium per day. Magnesium has also been reported to interfere with the absorption of dexamethasone.461

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Misoprostol

    A common side effect of misoprostol is diarrhea , which is aggravated by taking magnesium.467 Consequently, individuals who experience diarrhea while taking misoprostol should avoid magnesium supplementation.

  • Spironolactone

    Preliminary research in animals suggests that amiloride , a drug similar to spironolactone, may inhibit the urinary excretion of magnesium.473 It is unknown if this same effect would occur in humans or with spironolactone. Persons taking more than 300 mg of magnesium per day and spironolactone should consult with a doctor as this combination may lead to potentially dangerous increases in the level of magnesium in the body. The combination of spironolactone and hydrochlorothiazide would likely eliminate this problem, as hydrochlorothiazide may deplete magnesium.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Triamterene

    Preliminary research in animals suggests that triamterene may inhibit the urinary excretion of magnesium.474 It is unknown if this same effect would occur in humans. Persons taking more than 300 mg of magnesium per day and triamterene should consult with a doctor as this combination may lead to potentially dangerous increases in the level of magnesium in the body. The combination of triamterene and hydrochlorothiazide would likely eliminate this problem, as hydrochlorothiazide may deplete magnesium.

Explanation Required

  • Alendronate

    Absorption of tiludronate, a drug related to alendronate, is reduced when taken with magnesium and/or aluminum -containing antacids.476 This interaction has not yet been reported with alendronate. Until more is known, alendronate should be taken two hours before or after magnesium and/or aluminum-containing antacids.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Atorvastatin

    A magnesium- and aluminum-containing antacid was reported to interfere with atorvastatin absorption.477 People can avoid this interaction by taking atorvastatin two hours before or after any aluminum/magnesium-containing antacids. Some magnesium supplements such as magnesium hydroxide are also antacids.

  • Azithromycin

    A magnesium- and aluminum-containing antacid was reported to interfere with azithromycin absorption in a study of ten healthy people.478 People can avoid this interaction by taking azithromycin two hours before or after any aluminum/magnesium-containing products. It has not yet been shown that magnesium compounds typically found in supplements affect absorption of this drug.

  • Cortisone

    Corticosteroids may increase the body’s loss of magnesium.479 Some doctors recommend that people taking corticosteroids for more than two weeks supplement with 300–400 mg of magnesium per day. Magnesium has also been reported to interfere with the absorption of dexamethasone.480

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Digoxin

    People needing digoxin may have low levels of potassium or magnesium,481 increasing the risk for digoxin toxicity. Digoxin therapy may increase magnesium elimination from the body.482 People taking digoxin may benefit from magnesium supplementation.483 Medical doctors do not commonly check magnesium status, and when they do, they typically use an insensitive indicator of magnesium status (serum or plasma levels). The red blood cell magnesium level may be a more sensitive indicator of magnesium status, although evidence is conflicting. It has been suggested that 300–500 mg of magnesium per day is a reasonable amount to supplement.484

  • Epinephrine

    Intravenous administration of epinephrine to human volunteers reduced plasma concentrations of vitamin C .485 Epinephrine and other “stress hormones” may reduce intracellular concentrations of potassium and magnesium .486 Although there are no clinical studies in humans, it seems reasonable that individuals using epinephrine should consume a diet high in vitamin C, potassium, and magnesium, or should consider supplementing with these nutrients.

  • Etidronate

    Absorption of tiludronate, a drug related to alendronate, is reduced when taken with magnesium and/or aluminum -containing antacids.487 This interaction has not yet been reported with alendronate. Until more is known, alendronate should be taken two hours before or after magnesium and/or aluminum-containing antacids.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Famotidine

    In healthy people, a magnesium hydroxide / aluminum hydroxide antacid, taken with famotidine, decreased famotidine absorption by 20–25%.488 People can avoid this interaction by taking famotidine two hours before or after any aluminum/magnesium-containing antacids. Some magnesium supplements such as magnesium hydroxide are also antacids.

  • Glipizide

    In a study of people with poorly controlled type 2 diabetes and low blood levels of magnesium, treatment with glipizide was associated with a significant rise in magnesium levels.489 In a randomized trial with eight healthy people, 850 mg magnesium hydroxide increased glipizide absorption and activity.490 In theory, such changes could be therapeutic or detrimental under varying circumstances. Therefore, people taking glipizide should consult with their doctor before taking magnesium supplements.

  • Medroxyprogesterone

    In a group of 37 postmenopausal women treated with conjugated estrogens and medroxyprogesterone for 12 months, urinary zinc and magnesium loss was reduced in those women who began the study with signs of osteoporosis and elevated zinc and magnesium excretion.491 The clinical significance of this interaction remains unclear.

  • Metformin

    In a study of patients with poorly controlled type 2 diabetes , low blood levels of magnesium, and high urine magnesium loss, metformin therapy was associated with reduced urinary magnesium losses but no change in low blood levels of magnesium.492 Whether this interaction has clinical importance remains unclear.

  • Methylprednisolone

    Corticosteroids may increase the body’s loss of magnesium.493 Some doctors recommend that people taking corticosteroids for more than two weeks supplement with 300–400 mg of magnesium per day. Magnesium has also been reported to interfere with the absorption of dexamethasone.494

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Minocycline

    Taking calcium, iron, magnesium, or zinc at the same time as minocycline can decrease the absorption of both the drug495 , 496 and the mineral. Therefore, calcium, iron, magnesium, or zinc supplements, if used, should be taken an hour before or after the drug.

  • Nizatidine

    In healthy people, a magnesium hydroxide / aluminum hydroxide antacid, taken with nizatidine, decreased nizatidine absorption by 12%.497 People can avoid this interaction by taking nizatidine two hours before or after any aluminum/magnesium-containing antacids. Some magnesium supplements such as magnesium hydroxide are also antacids.

  • Omeprazole
    In a case report, a man developed severe magnesium deficiency after long-term treatment with a proton pump inhibitor (pantoprazole or lansoprazole).[REF] Severe magnesium deficiency as a result of the use of proton pump inhibitors appears to be rare. However, people taking proton pump inhibitors (PPIs) should ask their doctor whether to take a magnesium supplement or whether to have their magnesium levels monitored.498
    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Pamidronate

    Absorption of tiludronate, a drug related to alendronate, is reduced when taken with magnesium and/or aluminum -containing antacids.499 This interaction has not yet been reported with alendronate. Until more is known, alendronate should be taken two hours before or after magnesium and/or aluminum-containing antacids.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Prednisolone

    Corticosteroids may increase the body’s loss of magnesium.500 Some doctors recommend that people taking corticosteroids for more than two weeks supplement with 300–400 mg of magnesium per day. Magnesium has also been reported to interfere with the absorption of dexamethasone.[REF]

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Prednisone

    Corticosteroids may increase the body’s loss of magnesium.501 Some doctors recommend that people taking corticosteroids for more than two weeks supplement with 300–400 mg of magnesium per day. Magnesium has also been reported to interfere with the absorption of dexamethasone.502

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Risedronate

    Taking risedronate at the same time as iron , zinc , or magnesium may reduce the amount of drug absorbed.503 Therefore, people taking risedronate who wish to supplement with these minerals should take them an hour before or two hours after the drug.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Troleandomycin

    A magnesium- and aluminum-containing antacid was reported to interfere with absorption of azithromycin, another macrolide drug, in a study of ten healthy people.504 People can avoid this interaction by taking azithromycin two hours before or after any aluminum/magnesium-containing products. It has not yet been shown that magnesium compounds typically found in supplements affect absorption of azithromycin or other similar drugs.

The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.

Side Effects

Side Effects

Comments in this section are limited to effects from taking oral magnesium. Side effects from intravenous use of magnesium are not discussed.

Taking too much magnesium often leads to diarrhea . For some people this can happen with amounts as low as 350–500 mg per day. More serious problems can develop with excessive magnesium intake from magnesium-containing laxatives. However, the amounts of magnesium found in nutritional supplements are unlikely to cause such problems. People with kidney disease should not take magnesium supplements without consulting a doctor.

References

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209. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

210. Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984;144:2347.

211. Threlkeld DS, ed. Antineoplastics, Alkylating Agents, Cisplatin (CDDP). In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1999, 652a–2d.

212. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

213. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

214. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

215. Martin B, Milligan K. Diuretic-associated hypomagnesiumia in the elderly. Arch Intern Med 1987;147:1768–71.

216. Kroenke K, Wood DR, Hanley JF. The value of serum magnesium determination in hypertensive patients receiving diuretics. Arch Intern Med 1987;147:1553–6.

217. Whang R, Whang DD, Ryan MP. Refractory potassium repletion—a consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

218. Wahr JA, Parks R, Boisvert D, et al. Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. JAMA 1999;281:2203–10.

219. Franse LV, Pahor M, Di Bari M, et al. Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program. Hypertension 2000;35:1025–30.

220. Ruml LA, Gonzalez G, Taylor R, et al. Effect of varying doses of potassium-magnesium citrate on thiazide-induced hypokalemia and magnesium loss. Am J Ther 1999;6:45–50.

221. Ruml LA, Pak CYO. Effect of potassium magnesium citrate on thiazide-induced hypokalemia and magnesium loss. Am J Kidney Dis 1999;34:107–13.

222. Martin B, Milligan K. Diuretic-associated hypomagnesiumia in the elderly. Arch Intern Med 1987;147:1768–71.

223. Kroenke K, Wood DR, Hanley JF. The value of serum magnesium determination in hypertensive patients receiving diuretics. Arch Intern Med 1987;147:1553–6.

224. Whang R, Whang DD, Ryan MP. Refractory potassium repletion—a consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

225. Wahr JA, Parks R, Boisvert D, et al. Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. JAMA 1999;281:2203–10.

226. Franse LV, Pahor M, Di Bari M, et al. Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program. Hypertension 2000;35:1025–30.

227. Ruml LA, Gonzalez G, Taylor R, et al. Effect of varying doses of potassium-magnesium citrate on thiazide-induced hypokalemia and magnesium loss. Am J Ther 1999;6:45–50.

228. Ruml LA, Pak CYO. Effect of potassium magnesium citrate on thiazide-induced hypokalemia and magnesium loss. Am J Kidney Dis 1999;34:107–13.

229. Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984;144:2347.

230. Threlkeld DS, ed. Antineoplastics, Alkylating Agents, Cisplatin (CDDP). In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1999, 652a–2d.

231. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

232. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

233. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

234. Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984;144:2347.

235. Threlkeld DS, ed. Antineoplastics, Alkylating Agents, Cisplatin (CDDP). In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1999, 652a–2d.

236. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

237. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

238. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

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246. Threlkeld DS, ed. Antineoplastics, Alkylating Agents, Cisplatin (CDDP). In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1999, 652a–2d.

247. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

248. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

249. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

250. Olatunbosum DA, Adeniyi FA, Adadevoh BK. Effect of oral contraceptives on serum magnesium levels. Int J Fertil 1974;19:224–6.

251. Blum M, Kitai E, Ariel Y, et al. Oral contraceptive lowers serum magnesium. Harefuah 1991;121:363–4 [in Hebrew].

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253. U.S. Food and Drug Administration. FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of Proton Pump Inhibitor drugs (PPIs). U.S. Food and Drug Administration Web site. Accessed at http://www.fda.gov/drugs/drugsafety/ucm245011.htm#Additional_Information_for_Patients on September 13, 2011

254. Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984;144:2347.

255. Threlkeld DS, ed. Antineoplastics, Alkylating Agents, Cisplatin (CDDP). In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1999, 652a–2d.

256. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

257. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

258. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

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261. Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984;144:2347.

262. Threlkeld DS, ed. Antineoplastics, Alkylating Agents, Cisplatin (CDDP). In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1999, 652a–2d.

263. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

264. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

265. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

266. Holt GA. Food and Drug Interactions. Chicago: Precept Press, 1998, 107–8.

267. Gau JT, Yang YX, Chen R, Kao TC. Uses of proton pump inhibitors and hypomagnesemia. Pharmacoepidemiol Drug Saf 2012;21:553–9.

268. U.S. Food and Drug Administration. FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of Proton Pump Inhibitor drugs (PPIs). U.S. Food and Drug Administration Web site. Accessed at http://www.fda.gov/drugs/drugsafety/ucm245011.htm#Additional_Information_for_Patients on September 13, 2011

269. Olatunbosum DA, Adeniyi FA, Adadevoh BK. Effect of oral contraceptives on serum magnesium levels. Int J Fertil 1974;19:224–6.

270. Blum M, Kitai E, Ariel Y, et al. Oral contraceptive lowers serum magnesium. Harefuah 1991;121:363–4 [in Hebrew].

271. Olatunbosum DA, Adeniyi FA, Adadevoh BK. Effect of oral contraceptives on serum magnesium levels. Int J Fertil 1974;19:224–6.

272. Blum M, Kitai E, Ariel Y, et al. Oral contraceptive lowers serum magnesium. Harefuah 1991;121:363–4 [in Hebrew].

273. Olatunbosum DA, Adeniyi FA, Adadevoh BK. Effect of oral contraceptives on serum magnesium levels. Int J Fertil 1974;19:224–6.

274. Blum M, Kitai E, Ariel Y, et al. Oral contraceptive lowers serum magnesium. Harefuah 1991;121:363–4 [in Hebrew].

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276. Blum M, Kitai E, Ariel Y, et al. Oral contraceptive lowers serum magnesium. Harefuah 1991;121:363–4 [in Hebrew].

277. Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984;144:2347.

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279. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

280. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

281. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

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284. Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984;144:2347.

285. Threlkeld DS, ed. Antineoplastics, Alkylating Agents, Cisplatin (CDDP). In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1999, 652a–2d.

286. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

287. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

288. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

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291. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

292. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

293. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

294. Martin B, Milligan K. Diuretic-associated hypomagnesiumia in the elderly. Arch Intern Med 1987;147:1768–71.

295. Kroenke K, Wood DR, Hanley JF. The value of serum magnesium determination in hypertensive patients receiving diuretics. Arch Intern Med 1987;147:1553–6.

296. Whang R, Whang DD, Ryan MP. Refractory potassium repletion—a consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

297. Wahr JA, Parks R, Boisvert D, et al. Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. JAMA 1999;281:2203–10.

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301. Martin B, Milligan K. Diuretic-associated hypomagnesiumia in the elderly. Arch Intern Med 1987;147:1768–71.

302. Kroenke K, Wood DR, Hanley JF. The value of serum magnesium determination in hypertensive patients receiving diuretics. Arch Intern Med 1987;147:1553–6.

303. Whang R, Whang DD, Ryan MP. Refractory potassium repletion—a consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

304. Wahr JA, Parks R, Boisvert D, et al. Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. JAMA 1999;281:2203–10.

305. Franse LV, Pahor M, Di Bari M, et al. Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program. Hypertension 2000;35:1025–30.

306. Ruml LA, Gonzalez G, Taylor R, et al. Effect of varying doses of potassium-magnesium citrate on thiazide-induced hypokalemia and magnesium loss. Am J Ther 1999;6:45–50.

307. Ruml LA, Pak CYO. Effect of potassium magnesium citrate on thiazide-induced hypokalemia and magnesium loss. Am J Kidney Dis 1999;34:107–13.

308. Martin B, Milligan K. Diuretic-associated hypomagnesiumia in the elderly. Arch Intern Med 1987;147:1768–71.

309. Kroenke K, Wood DR, Hanley JF. The value of serum magnesium determination in hypertensive patients receiving diuretics. Arch Intern Med 1987;147:1553–6.

310. Whang R, Whang DD, Ryan MP. Refractory potassium repletion—a consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

311. Wahr JA, Parks R, Boisvert D, et al. Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. JAMA 1999;281:2203–10.

312. Franse LV, Pahor M, Di Bari M, et al. Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program. Hypertension 2000;35:1025–30.

313. Ruml LA, Gonzalez G, Taylor R, et al. Effect of varying doses of potassium-magnesium citrate on thiazide-induced hypokalemia and magnesium loss. Am J Ther 1999;6:45–50.

314. Ruml LA, Pak CYO. Effect of potassium magnesium citrate on thiazide-induced hypokalemia and magnesium loss. Am J Kidney Dis 1999;34:107–13.

315. Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984;144:2347.

316. Threlkeld DS, ed. Antineoplastics, Alkylating Agents, Cisplatin (CDDP). In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1999, 652a–2d.

317. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

318. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

319. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

320. Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984;144:2347.

321. Threlkeld DS, ed. Antineoplastics, Alkylating Agents, Cisplatin (CDDP). In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1999, 652a–2d.

322. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

323. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

324. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

325. Martin B, Milligan K. Diuretic-associated hypomagnesiumia in the elderly. Arch Intern Med 1987;147:1768–71.

326. Kroenke K, Wood DR, Hanley JF. The value of serum magnesium determination in hypertensive patients receiving diuretics. Arch Intern Med 1987;147:1553–6.

327. Whang R, Whang DD, Ryan MP. Refractory potassium repletion—a consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

328. Wahr JA, Parks R, Boisvert D, et al. Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. JAMA 1999;281:2203–10.

329. Franse LV, Pahor M, Di Bari M, et al. Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program. Hypertension 2000;35:1025–30.

330. Ruml LA, Gonzalez G, Taylor R, et al. Effect of varying doses of potassium-magnesium citrate on thiazide-induced hypokalemia and magnesium loss. Am J Ther 1999;6:45–50.

331. Ruml LA, Pak CYO. Effect of potassium magnesium citrate on thiazide-induced hypokalemia and magnesium loss. Am J Kidney Dis 1999;34:107–13.

332. Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984;144:2347.

333. Threlkeld DS, ed. Antineoplastics, Alkylating Agents, Cisplatin (CDDP). In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1999, 652a–2d.

334. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

335. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

336. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

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341. U.S. Food and Drug Administration. FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of Proton Pump Inhibitor drugs (PPIs). U.S. Food and Drug Administration Web site. Accessed at http://www.fda.gov/drugs/drugsafety/ucm245011.htm#Additional_Information_for_Patients on September 13, 2011

342. Olatunbosum DA, Adeniyi FA, Adadevoh BK. Effect of oral contraceptives on serum magnesium levels. Int J Fertil 1974;19:224–6.

343. Blum M, Kitai E, Ariel Y, et al. Oral contraceptive lowers serum magnesium. Harefuah 1991;121:363–4 [in Hebrew].

344. Olatunbosum DA, Adeniyi FA, Adadevoh BK. Effect of oral contraceptives on serum magnesium levels. Int J Fertil 1974;19:224–6.

345. Blum M, Kitai E, Ariel Y, et al. Oral contraceptive lowers serum magnesium. Harefuah 1991;121:363–4 [in Hebrew].

346. Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984;144:2347.

347. Threlkeld DS, ed. Antineoplastics, Alkylating Agents, Cisplatin (CDDP). In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1999, 652a–2d.

348. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

349. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

350. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

351. Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984;144:2347.

352. Threlkeld DS, ed. Antineoplastics, Alkylating Agents, Cisplatin (CDDP). In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1999, 652a–2d.

353. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

354. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

355. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

356. Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984;144:2347.

357. Threlkeld DS, ed. Antineoplastics, Alkylating Agents, Cisplatin (CDDP). In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1999, 652a–2d.

358. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

359. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

360. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

361. Buckley JE, Clark VL, Meyer TJ, Pearlman NW+O3186+O3190. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984;144:2347.

362. Threlkeld DS, ed. Antineoplastics, Alkylating Agents, Cisplatin (CDDP). In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1999, 652a–2d.

363. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

364. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

365. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

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367. Olatunbosum DA, Adeniyi FA, Adadevoh BK. Effect of oral contraceptives on serum magnesium levels. Int J Fertil 1974;19:224–6.

368. Blum M, Kitai E, Ariel Y, et al. Oral contraceptive lowers serum magnesium. Harefuah 1991;121:363–4 [in Hebrew].

369. Buckley JE, Clark VL, Meyer TJ, Pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984;144:2347.

370. Threlkeld DS, ed. Antineoplastics, Alkylating Agents, Cisplatin (CDDP). In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1999, 652a–2d.

371. Rodriguez M, Solanki DL, Whang R. Refractory potassium repletion due to Cisplatin-induced magnesium depletion. Arch Intern Med 1989;149:2592–4.

372. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

373. van de Loosdrecht AA, Gietema JA, van der Graaf WT. Seizures in a patient with disseminated testicular cancer due to cisplatin-induced hypomagnesaemia. Acta Oncol 2000;39:239–40.

374. Martin B, Milligan K. Diuretic-associated hypomagnesiumia in the elderly. Arch Intern Med 1987;147:1768–71.

375. Kroenke K, Wood DR, Hanley JF. The value of serum magnesium determination in hypertensive patients receiving diuretics. Arch Intern Med 1987;147:1553–6.

376. Whang R, Whang DD, Ryan MP. Refractory potassium repletion—a consequence of magnesium deficiency. Arch Intern Med 1992;152:40–5.

377. Wahr JA, Parks R, Boisvert D, et al. Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. JAMA 1999;281:2203–10.

378. Franse LV, Pahor M, Di Bari M, et al. Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program. Hypertension 2000;35:1025–30.

379. Ruml LA, Gonzalez G, Taylor R, et al. Effect of varying doses of potassium-magnesium citrate on thiazide-induced hypokalemia and magnesium loss. Am J Ther 1999;6:45–50.

380. Ruml LA, Pak CYO. Effect of potassium magnesium citrate on thiazide-induced hypokalemia and magnesium loss. Am J Kidney Dis 1999;34:107–13.

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