magnesium oxide (OTC)

Recommended Daily Intake (Elemental Mg)

Females

• 19-30 yr: 310 mg/day PO
• 19-30 yr (pregnant): 350 mg/day PO
• >31 yr: 320 mg/day PO
• >31 yr (pregnant): 360 mg/day PO

Males

• 19-30 yr: 400 mg/day PO
• >31 yr: 420 mg/day PO

Magnesium Supplementation

Tablet (Mag-Ox): 1-2 tablets PO qDay

Capsule (Uro-Mag): 1-5 capsules PO qDay

Antacid

Tablet (Mag-Ox): 1 tablet PO qDay or q12hr; not to exceed 2 tablets/day

Renal Impairment

CrCl <30 mL/min: Caution; monitor for hypermagnesemia

Administration

Take with food

Recommended Daily Intake (Elemental Mg)

1-3 years: 80 mg/day PO

4-8 years: 130 mg/day PO

9-13 years: 240 mg/day PO

14-18 years

• Females: 360 mg/day PO
• Pregnant females: 400 mg/day PO
• Males: 410 mg/day PO

Renal Impairment

CrCl <30 mL/min: Caution; monitor for hypermagnesemia

Administration

Take with food

Contraindicated (0)

Serious - Use Alternative (12)

• atazanavir

  magnesium oxide will decrease the level or effect of atazanavir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Atazanavir solubility decreases as pH increases. Reduced plasma concentrations of atazanavir are expected if antacids or buffered medications are coadministered. Administer atazanavir 2 hr before or 1 hr after these medications.

• baloxavir marboxil

  magnesium oxide will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. Avoid or Use Alternate Drug. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Human studies not conducted.

• demeclocycline

  magnesium oxide decreases levels of demeclocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• dolutegravir

  magnesium oxide will decrease the level or effect of dolutegravir by cation binding in GI tract. Avoid or Use Alternate Drug. Administer dolutegravir 2 hr before or 6 hr after taking medications containing polyvalent cations

• doxycycline

  magnesium oxide decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• eltrombopag

  magnesium oxide decreases levels of eltrombopag by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Separate by at least 4 hours.

• infigratinib

  magnesium oxide will decrease the level or effect of infigratinib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer infigratinib 2 hr before and after administration of a locally-acting antacid.

• minocycline

  magnesium oxide decreases levels of minocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• oxytetracycline

  magnesium oxide decreases levels of oxytetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• ponatinib

  magnesium oxide decreases levels of ponatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• sotorasib

  magnesium oxide will decrease the level or effect of sotorasib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer sotorasib 4 hr before or 10 hr after administration of a locally-acting antacid.

• tetracycline

  magnesium oxide decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

Monitor Closely (34)

• acalabrutinib

  magnesium oxide decreases levels of acalabrutinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Acalabrutinib solubility decreases with increasing gastric pH. Separate dosing by at least 2 hr between administration of antacids and acalabrutinib.

• bictegravir

  magnesium oxide will decrease the level or effect of bictegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Bictegravir can be taken under fasting conditions 2 hr before antacids containing Al, Mg, or Ca. Routine administration of bictegravir simultaneously with, or 2 hr after, antacids containing Al, Mg, or Ca is not recommended.

• bosutinib

  magnesium oxide decreases levels of bosutinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Bosutinib displays pH-dependent solubility; may use short-acting antacids with administration separated by 2 hr.

• budesonide

  magnesium oxide decreases effects of budesonide by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Enteric-coated budesonide dissolves at pH >5.5. Also, dissolution of extended-release budesonide tablets is pH dependent. Coadministration with drugs that increase gastric pH may cause these budesonide products to prematurely dissolve, and possibly affect release properties and absorption of the drug in the duodenum.

• cabotegravir

  magnesium oxide will decrease the level or effect of cabotegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Administer antacid products at least 2 hr before or 4 hr after taking oral cabotegravir.

• chloroquine

  magnesium oxide will decrease the level or effect of chloroquine by cation binding in GI tract. Use Caution/Monitor. Separate doses by at least 4 hr

• ciprofloxacin

  magnesium oxide decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• crizotinib

  magnesium oxide decreases levels of crizotinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that elevate the gastric pH may decrease the solubility of crizotinib and subsequently reduce its bioavailability. However, no formal studies have been conducted. .

• dabrafenib

  magnesium oxide will decrease the level or effect of dabrafenib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that alter upper GI tract pH (eg, PPIs, H2-blockers, antacids) may decrease dabrafenib solubility and reduce its bioavailability

• deferiprone

  magnesium oxide decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.

• delafloxacin

  magnesium oxide will decrease the level or effect of delafloxacin by cation binding in GI tract. Modify Therapy/Monitor Closely. Oral delafloxacin form chelates with alkaline earth and transition metal cations. Administer oral delafloxacin at least 2 hr before or 6 hr after these agents.

• elvitegravir

  magnesium oxide will decrease the level or effect of elvitegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Elvitegravir plasma concentrations are lower with antacids due to the formation of ionic complexes in the GI tract and not due to changes in gastric pH; separate dose from antacid by at least 2 hr

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  magnesium oxide decreases levels of elvitegravir/cobicistat/emtricitabine/tenofovir DF by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration from antacids by 2 hr.

• fleroxacin

  magnesium oxide decreases levels of fleroxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• gefitinib

  magnesium oxide decreases levels of gefitinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Separate gefitinib and antacid doses by at least 6 hr.

• gemifloxacin

  magnesium oxide decreases levels of gemifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• ledipasvir/sofosbuvir

  magnesium oxide decreases levels of ledipasvir/sofosbuvir by Other (see comment). Use Caution/Monitor. Comment: Ledipasvir solubility decreases as pH increases; drugs that increase gastric pH are expected to decrease levels of ledipasvir; separate antacid and ledipasivr/sofosbuvir administration by 4 hr.

• levofloxacin

  magnesium oxide decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• lisdexamfetamine

  magnesium oxide will increase the level or effect of lisdexamfetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

• methylphenidate

  magnesium oxide decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

• moxifloxacin

  magnesium oxide decreases levels of moxifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• neratinib

  magnesium oxide will decrease the level or effect of neratinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate antacid and neratinib dosing by 3 hr.

• nilotinib

  magnesium oxide decreases levels of nilotinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Avoid this interaction by administering antacids 2 hr after or 2 hr before nilotinib.

• ofloxacin

  magnesium oxide decreases levels of ofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• omadacycline

  magnesium oxide will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

• penicillamine

  magnesium oxide decreases levels of penicillamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• pexidartinib

  magnesium oxide will decrease the level or effect of pexidartinib by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate pexidartinib by 2 hr before or after taking a locally-acting antacid.

• rilpivirine

  magnesium oxide decreases levels of rilpivirine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Coadministration of antacids with rilpivirine may cause significant decreases in rilpivirine plasma concentrations because of increased gastric pH. If antacids must be administered, they should be given at least 2 hr before or at least 4 hr after rilpivirine. For the combination product dolutegravir/rilpivirine, antacids should be given at least 4 hr before or at least 6 hr afterwards.

• riociguat

  magnesium oxide decreases levels of riociguat by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration by at least 1 hour.

• sarecycline

  magnesium oxide will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of magnesium oxide by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sodium sulfate/potassium sulfate/magnesium sulfate

  sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of magnesium oxide by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sofosbuvir/velpatasvir

  magnesium oxide will decrease the level or effect of sofosbuvir/velpatasvir by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Velpatasvir solubility decreases as gastric pH increases (practically insoluble at pH >5). Separate administration of sofosbuvir/velpatasvir from antacids by at least 4 hr.

• vismodegib

  magnesium oxide will decrease the level or effect of vismodegib by Other (see comment). Use Caution/Monitor. Drugs that increase gastric pH alter vismodegib solubility and therefore reduce bioavailability; effect on efficacy unknown

Minor (40)

• amikacin

  amikacin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• amiloride

  amiloride increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown.

• amphotericin B deoxycholate

  amphotericin B deoxycholate decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• bazedoxifene/conjugated estrogens

  bazedoxifene/conjugated estrogens decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• bendroflumethiazide

  bendroflumethiazide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• bumetanide

  bumetanide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• calcitonin salmon

  calcitonin salmon increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown.

• chlorothiazide

  chlorothiazide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• chlorthalidone

  chlorthalidone decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• cisplatin

  cisplatin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• conjugated estrogens

  conjugated estrogens decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• conjugated estrogens, vaginal

  conjugated estrogens, vaginal decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• cyclopenthiazide

  cyclopenthiazide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• dextrose

  dextrose decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• digoxin

  digoxin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• doxercalciferol

  doxercalciferol increases levels of magnesium oxide by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• drospirenone

  drospirenone increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown.

• estradiol

  estradiol decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• estrogens conjugated synthetic

  estrogens conjugated synthetic decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• estrogens esterified

  estrogens esterified decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• estropipate

  estropipate decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• ethacrynic acid

  ethacrynic acid decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• furosemide

  furosemide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• gentamicin

  gentamicin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• glucagon intranasal

  glucagon intranasal increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown.

• hydrochlorothiazide

  hydrochlorothiazide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• ibandronate

  magnesium oxide decreases levels of ibandronate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• indapamide

  indapamide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• mannitol

  mannitol decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• mestranol

  mestranol decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• metolazone

  metolazone decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• neomycin PO

  neomycin PO decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• nitrofurantoin

  magnesium oxide decreases levels of nitrofurantoin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• paromomycin

  paromomycin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• sodium polystyrene sulfonate

  sodium polystyrene sulfonate increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

• spironolactone

  spironolactone increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown.

• streptomycin

  streptomycin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• tobramycin

  tobramycin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• torsemide

  torsemide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• triamterene

  triamterene increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown.

• acalabrutinib

  Monitor Closely (1)magnesium oxide decreases levels of acalabrutinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Acalabrutinib solubility decreases with increasing gastric pH. Separate dosing by at least 2 hr between administration of antacids and acalabrutinib.

• amikacin

  Minor (1)amikacin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• amiloride

  Minor (1)amiloride increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown.

• amphotericin B deoxycholate

  Minor (1)amphotericin B deoxycholate decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• atazanavir

  Serious - Use Alternative (1)magnesium oxide will decrease the level or effect of atazanavir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Atazanavir solubility decreases as pH increases. Reduced plasma concentrations of atazanavir are expected if antacids or buffered medications are coadministered. Administer atazanavir 2 hr before or 1 hr after these medications.

• baloxavir marboxil

  Serious - Use Alternative (1)magnesium oxide will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. Avoid or Use Alternate Drug. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Human studies not conducted.

• bazedoxifene/conjugated estrogens

  Minor (1)bazedoxifene/conjugated estrogens decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• bendroflumethiazide

  Minor (1)bendroflumethiazide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• bictegravir

  Monitor Closely (1)magnesium oxide will decrease the level or effect of bictegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Bictegravir can be taken under fasting conditions 2 hr before antacids containing Al, Mg, or Ca. Routine administration of bictegravir simultaneously with, or 2 hr after, antacids containing Al, Mg, or Ca is not recommended.

• bosutinib

  Monitor Closely (1)magnesium oxide decreases levels of bosutinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Bosutinib displays pH-dependent solubility; may use short-acting antacids with administration separated by 2 hr.

• budesonide

  Monitor Closely (1)magnesium oxide decreases effects of budesonide by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Enteric-coated budesonide dissolves at pH >5.5. Also, dissolution of extended-release budesonide tablets is pH dependent. Coadministration with drugs that increase gastric pH may cause these budesonide products to prematurely dissolve, and possibly affect release properties and absorption of the drug in the duodenum.

• bumetanide

  Minor (1)bumetanide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• cabotegravir

  Monitor Closely (1)magnesium oxide will decrease the level or effect of cabotegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Administer antacid products at least 2 hr before or 4 hr after taking oral cabotegravir.

• calcitonin salmon

  Minor (1)calcitonin salmon increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown.

• chloroquine

  Monitor Closely (1)magnesium oxide will decrease the level or effect of chloroquine by cation binding in GI tract. Use Caution/Monitor. Separate doses by at least 4 hr

• chlorothiazide

  Minor (1)chlorothiazide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• chlorthalidone

  Minor (1)chlorthalidone decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• ciprofloxacin

  Monitor Closely (1)magnesium oxide decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• cisplatin

  Minor (1)cisplatin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• conjugated estrogens

  Minor (1)conjugated estrogens decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• conjugated estrogens, vaginal

  Minor (1)conjugated estrogens, vaginal decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• crizotinib

  Monitor Closely (1)magnesium oxide decreases levels of crizotinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that elevate the gastric pH may decrease the solubility of crizotinib and subsequently reduce its bioavailability. However, no formal studies have been conducted. .

• cyclopenthiazide

  Minor (1)cyclopenthiazide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• dabrafenib

  Monitor Closely (1)magnesium oxide will decrease the level or effect of dabrafenib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that alter upper GI tract pH (eg, PPIs, H2-blockers, antacids) may decrease dabrafenib solubility and reduce its bioavailability

• deferiprone

  Monitor Closely (1)magnesium oxide decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.

• delafloxacin

  Monitor Closely (1)magnesium oxide will decrease the level or effect of delafloxacin by cation binding in GI tract. Modify Therapy/Monitor Closely. Oral delafloxacin form chelates with alkaline earth and transition metal cations. Administer oral delafloxacin at least 2 hr before or 6 hr after these agents.

• demeclocycline

  Serious - Use Alternative (1)magnesium oxide decreases levels of demeclocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• dextrose

  Minor (1)dextrose decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• digoxin

  Minor (1)digoxin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• dolutegravir

  Serious - Use Alternative (1)magnesium oxide will decrease the level or effect of dolutegravir by cation binding in GI tract. Avoid or Use Alternate Drug. Administer dolutegravir 2 hr before or 6 hr after taking medications containing polyvalent cations

• doxercalciferol

  Minor (1)doxercalciferol increases levels of magnesium oxide by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• doxycycline

  Serious - Use Alternative (1)magnesium oxide decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• drospirenone

  Minor (1)drospirenone increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown.

• eltrombopag

  Serious - Use Alternative (1)magnesium oxide decreases levels of eltrombopag by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Separate by at least 4 hours.

• elvitegravir

  Monitor Closely (1)magnesium oxide will decrease the level or effect of elvitegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Elvitegravir plasma concentrations are lower with antacids due to the formation of ionic complexes in the GI tract and not due to changes in gastric pH; separate dose from antacid by at least 2 hr

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (1)magnesium oxide decreases levels of elvitegravir/cobicistat/emtricitabine/tenofovir DF by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration from antacids by 2 hr.

• estradiol

  Minor (1)estradiol decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• estrogens conjugated synthetic

  Minor (1)estrogens conjugated synthetic decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• estrogens esterified

  Minor (1)estrogens esterified decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• estropipate

  Minor (1)estropipate decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• ethacrynic acid

  Minor (1)ethacrynic acid decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• fleroxacin

  Monitor Closely (1)magnesium oxide decreases levels of fleroxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• furosemide

  Minor (1)furosemide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• gefitinib

  Monitor Closely (1)magnesium oxide decreases levels of gefitinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Separate gefitinib and antacid doses by at least 6 hr.

• gemifloxacin

  Monitor Closely (1)magnesium oxide decreases levels of gemifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• gentamicin

  Minor (1)gentamicin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• glucagon intranasal

  Minor (1)glucagon intranasal increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown.

• hydrochlorothiazide

  Minor (1)hydrochlorothiazide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• ibandronate

  Minor (1)magnesium oxide decreases levels of ibandronate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• indapamide

  Minor (1)indapamide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• infigratinib

  Serious - Use Alternative (1)magnesium oxide will decrease the level or effect of infigratinib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer infigratinib 2 hr before and after administration of a locally-acting antacid.

• ledipasvir/sofosbuvir

  Monitor Closely (1)magnesium oxide decreases levels of ledipasvir/sofosbuvir by Other (see comment). Use Caution/Monitor. Comment: Ledipasvir solubility decreases as pH increases; drugs that increase gastric pH are expected to decrease levels of ledipasvir; separate antacid and ledipasivr/sofosbuvir administration by 4 hr.

• levofloxacin

  Monitor Closely (1)magnesium oxide decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• lisdexamfetamine

  Monitor Closely (1)magnesium oxide will increase the level or effect of lisdexamfetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

• mannitol

  Minor (1)mannitol decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• mestranol

  Minor (1)mestranol decreases levels of magnesium oxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• methylphenidate

  Monitor Closely (1)magnesium oxide decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

• metolazone

  Minor (1)metolazone decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• minocycline

  Serious - Use Alternative (1)magnesium oxide decreases levels of minocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• moxifloxacin

  Monitor Closely (1)magnesium oxide decreases levels of moxifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• neomycin PO

  Minor (1)neomycin PO decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• neratinib

  Monitor Closely (1)magnesium oxide will decrease the level or effect of neratinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate antacid and neratinib dosing by 3 hr.

• nilotinib

  Monitor Closely (1)magnesium oxide decreases levels of nilotinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Avoid this interaction by administering antacids 2 hr after or 2 hr before nilotinib.

• nitrofurantoin

  Minor (1)magnesium oxide decreases levels of nitrofurantoin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• ofloxacin

  Monitor Closely (1)magnesium oxide decreases levels of ofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• omadacycline

  Monitor Closely (1)magnesium oxide will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

• oxytetracycline

  Serious - Use Alternative (1)magnesium oxide decreases levels of oxytetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• paromomycin

  Minor (1)paromomycin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• penicillamine

  Monitor Closely (1)magnesium oxide decreases levels of penicillamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• pexidartinib

  Monitor Closely (1)magnesium oxide will decrease the level or effect of pexidartinib by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate pexidartinib by 2 hr before or after taking a locally-acting antacid.

• ponatinib

  Serious - Use Alternative (1)magnesium oxide decreases levels of ponatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• rilpivirine

  Monitor Closely (1)magnesium oxide decreases levels of rilpivirine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Coadministration of antacids with rilpivirine may cause significant decreases in rilpivirine plasma concentrations because of increased gastric pH. If antacids must be administered, they should be given at least 2 hr before or at least 4 hr after rilpivirine. For the combination product dolutegravir/rilpivirine, antacids should be given at least 4 hr before or at least 6 hr afterwards.

• riociguat

  Monitor Closely (1)magnesium oxide decreases levels of riociguat by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration by at least 1 hour.

• sarecycline

  Monitor Closely (1)magnesium oxide will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

• sodium polystyrene sulfonate

  Minor (1)sodium polystyrene sulfonate increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of magnesium oxide by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sodium sulfate/potassium sulfate/magnesium sulfate

  Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of magnesium oxide by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sofosbuvir/velpatasvir

  Monitor Closely (1)magnesium oxide will decrease the level or effect of sofosbuvir/velpatasvir by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Velpatasvir solubility decreases as gastric pH increases (practically insoluble at pH >5). Separate administration of sofosbuvir/velpatasvir from antacids by at least 4 hr.

• sotorasib

  Serious - Use Alternative (1)magnesium oxide will decrease the level or effect of sotorasib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer sotorasib 4 hr before or 10 hr after administration of a locally-acting antacid.

• spironolactone

  Minor (1)spironolactone increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown.

• streptomycin

  Minor (1)streptomycin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• tetracycline

  Serious - Use Alternative (1)magnesium oxide decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• tobramycin

  Minor (1)tobramycin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• torsemide

  Minor (1)torsemide decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• triamterene

  Minor (1)triamterene increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown.

• vismodegib

  Monitor Closely (1)magnesium oxide will decrease the level or effect of vismodegib by Other (see comment). Use Caution/Monitor. Drugs that increase gastric pH alter vismodegib solubility and therefore reduce bioavailability; effect on efficacy unknown