magnesium hydroxide (OTC)

Constipation

Magnesium hydroxide (400 mg/5 mL): 30-60 mL/day PO at bedtime or in divided doses

Magnesium hydroxide (800 mg/5 mL): 15-30 mL/day PO at bedtime or in divided doses

Chewable tablet: 8 tablets/day PO at bedtime or in divided doses

Acid Indigestion

Magnesium hydroxide (400 mg/5 mL): 5-15 mL PO q4hr; no more than 4 doses per 24-hour period

Chewable tablet: 2-4 tablets PO q4hr; no more than 4 doses per 24-hour period

Constipation

<2 years: Safety and efficacy not established

Suspension

• 2-6 years: 5-15 mL/day of regular-strength liquid PO at bedtime or in divided doses
• 6-12 years: 15-30 mL/day (400 mg/5 mL) or 7.5-15 mL/day (800 mg/5 mL) PO at bedtime or in divided doses
• ≥12 years: 30-60 mL/day (400 mg/5 mL) or 15-30 mL/day (800 mg/5 mL) PO at bedtime or in divided doses

Chewable tablet

• <3 years: Not recommended
• 3-6 years: 2 tablets PO once daily or in divided doses
• 6-12 years: 4 tablets PO once daily or in divided doses
• >12 years: 8 tablets PO once daily or in divided doses

Acid Indigestion

Liquid

• <12 years: Not recommended
• ≥12 years: 5-15 mL (400 mg/5 mL) PO q4hr; no more than 4 doses per 24-hour period

Chewable tablet

• <12 years: Not recommended
• ≥12 years: 2-4 tablets PO q4hr; no more than 4 doses per 24-hour period

Contraindicated (0)

Serious - Use Alternative (13)

• baloxavir marboxil

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

• doxycycline

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

• eltrombopag

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

• oxytetracycline

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

• pazopanib

  magnesium hydroxide will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; may use short-acting antacids in place of PPIs and H2 antagonists, but separate antacid and pazopanib dosing by several hours

• ponatinib

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

• potassium phosphates, IV

  magnesium hydroxide decreases effects of potassium phosphates, IV by cation binding in GI tract. Avoid or Use Alternate Drug. Magnesium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.

• raltegravir

  magnesium hydroxide will decrease the level or effect of raltegravir by cation binding in GI tract. Avoid or Use Alternate Drug. Magnesium containing antacids reduce raltegravir plasma levels when taken within 6 hr of raltegravir dose

• sotorasib

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

Monitor Closely (23)

• bictegravir

  magnesium hydroxide 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.

• cabotegravir

  magnesium hydroxide 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 hydroxide will decrease the level or effect of chloroquine by Mechanism: inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate doses by at least 4 hr

• ciprofloxacin

  magnesium hydroxide decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

• crizotinib

  magnesium hydroxide 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. .

• deferiprone

  magnesium hydroxide 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.

• deflazacort

  magnesium hydroxide and deflazacort both decrease serum potassium. Use Caution/Monitor.

• dolutegravir

  magnesium hydroxide will decrease the level or effect of dolutegravir by cation binding in GI tract. Use Caution/Monitor. Administer dolutegravir 2 hr before or 6 hr after taking medications containing polyvalent cations; use alternative therapy if available

• fleroxacin

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

• gemifloxacin

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

• lanthanum carbonate

  lanthanum carbonate, magnesium hydroxide. cation binding in GI tract. Use Caution/Monitor. Administer antacid at least 2 hours before or after lanthanum. .

• levofloxacin

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

• moxifloxacin

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

• ofloxacin

  magnesium hydroxide 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 hydroxide 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.

• pancrelipase

  magnesium hydroxide decreases effects of pancrelipase by pharmacodynamic antagonism. Use Caution/Monitor. Antacids may negate beneficial effects of enzymes.

• penicillamine

  magnesium hydroxide 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 hydroxide 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.

• riociguat

  magnesium hydroxide 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 hydroxide 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 phosphates, IV

  magnesium hydroxide decreases effects of sodium phosphates, IV by cation binding in GI tract. Modify Therapy/Monitor Closely. Magnesium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.

• vismodegib

  magnesium hydroxide 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

• vitamin D

  vitamin D increases levels of magnesium hydroxide by Other (see comment). Use Caution/Monitor. Comment: Vitamin D can increase serum magnesium concentrations, particularly in the presence of renal impairment. The combined use of vitamin D and magnesium-containing products should be avoided, if possible, in patients with chronic renal failure.

Minor (41)

• amikacin

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

• amiloride

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

• amphotericin B deoxycholate

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

• bazedoxifene/conjugated estrogens

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

• bendroflumethiazide

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

• bumetanide

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

• calcitonin salmon

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

• chlorothiazide

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

• chlorthalidone

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

• conjugated estrogens

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

• cyclopenthiazide

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

• dextrose

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

• dextrose (Antidote)

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

• digoxin

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

• doxercalciferol

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

• drospirenone

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

• estradiol

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

• estrogens esterified

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

• estropipate

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

• ethacrynic acid

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

• furosemide

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

• gentamicin

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

• glucagon intranasal

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

• hydrochlorothiazide

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

• ibandronate

  magnesium hydroxide 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 hydroxide by increasing renal clearance. Minor/Significance Unknown.

• mannitol

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

• mestranol

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

• methyclothiazide

  methyclothiazide decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

• metolazone

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

• neomycin PO

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

• nitrofurantoin

  magnesium hydroxide 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 hydroxide by increasing renal clearance. Minor/Significance Unknown.

• sodium polystyrene sulfonate

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

• spironolactone

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

• streptomycin

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

• tobramycin

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

• torsemide

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

• triamterene

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

• amikacin

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

• amiloride

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

• amphotericin B deoxycholate

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

• baloxavir marboxil

  Serious - Use Alternative (1)magnesium hydroxide 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 hydroxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

• bendroflumethiazide

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

• bictegravir

  Monitor Closely (1)magnesium hydroxide 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.

• bumetanide

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

• cabotegravir

  Monitor Closely (1)magnesium hydroxide 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 hydroxide by decreasing renal clearance. Minor/Significance Unknown.

• chloroquine

  Monitor Closely (1)magnesium hydroxide will decrease the level or effect of chloroquine by Mechanism: inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate doses by at least 4 hr

• chlorothiazide

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

• chlorthalidone

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

• ciprofloxacin

  Monitor Closely (1)magnesium hydroxide decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

• conjugated estrogens

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

• crizotinib

  Monitor Closely (1)magnesium hydroxide 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 hydroxide by increasing renal clearance. Minor/Significance Unknown.

• deferiprone

  Monitor Closely (1)magnesium hydroxide 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.

• deflazacort

  Monitor Closely (1)magnesium hydroxide and deflazacort both decrease serum potassium. Use Caution/Monitor.

• demeclocycline

  Serious - Use Alternative (1)magnesium hydroxide 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 hydroxide by increasing renal clearance. Minor/Significance Unknown.

• dextrose (Antidote)

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

• digoxin

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

• dolutegravir

  Monitor Closely (1)magnesium hydroxide will decrease the level or effect of dolutegravir by cation binding in GI tract. Use Caution/Monitor. Administer dolutegravir 2 hr before or 6 hr after taking medications containing polyvalent cations; use alternative therapy if available

• doxercalciferol

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

• doxycycline

  Serious - Use Alternative (1)magnesium hydroxide 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 hydroxide by decreasing renal clearance. Minor/Significance Unknown.

• eltrombopag

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

• estradiol

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

• estropipate

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

• fleroxacin

  Monitor Closely (1)magnesium hydroxide 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 hydroxide by increasing renal clearance. Minor/Significance Unknown.

• gemifloxacin

  Monitor Closely (1)magnesium hydroxide 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 hydroxide by increasing renal clearance. Minor/Significance Unknown.

• glucagon intranasal

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

• hydrochlorothiazide

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

• ibandronate

  Minor (1)magnesium hydroxide 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 hydroxide by increasing renal clearance. Minor/Significance Unknown.

• infigratinib

  Serious - Use Alternative (1)magnesium hydroxide 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.

• lanthanum carbonate

  Monitor Closely (1)lanthanum carbonate, magnesium hydroxide. cation binding in GI tract. Use Caution/Monitor. Administer antacid at least 2 hours before or after lanthanum. .

• levofloxacin

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

• mannitol

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

• mestranol

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

• methyclothiazide

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

• metolazone

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

• minocycline

  Serious - Use Alternative (1)magnesium hydroxide 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 hydroxide 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 hydroxide by increasing renal clearance. Minor/Significance Unknown.

• nitrofurantoin

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

• pancrelipase

  Monitor Closely (1)magnesium hydroxide decreases effects of pancrelipase by pharmacodynamic antagonism. Use Caution/Monitor. Antacids may negate beneficial effects of enzymes.

• paromomycin

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

• pazopanib

  Serious - Use Alternative (1)magnesium hydroxide will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; may use short-acting antacids in place of PPIs and H2 antagonists, but separate antacid and pazopanib dosing by several hours

• penicillamine

  Monitor Closely (1)magnesium hydroxide 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 hydroxide 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 hydroxide decreases levels of ponatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• potassium phosphates, IV

  Serious - Use Alternative (1)magnesium hydroxide decreases effects of potassium phosphates, IV by cation binding in GI tract. Avoid or Use Alternate Drug. Magnesium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.

• raltegravir

  Serious - Use Alternative (1)magnesium hydroxide will decrease the level or effect of raltegravir by cation binding in GI tract. Avoid or Use Alternate Drug. Magnesium containing antacids reduce raltegravir plasma levels when taken within 6 hr of raltegravir dose

• riociguat

  Monitor Closely (1)magnesium hydroxide 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 hydroxide 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 phosphates, IV

  Monitor Closely (1)magnesium hydroxide decreases effects of sodium phosphates, IV by cation binding in GI tract. Modify Therapy/Monitor Closely. Magnesium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.

• sodium polystyrene sulfonate

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

• sotorasib

  Serious - Use Alternative (1)magnesium hydroxide 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 hydroxide by decreasing renal clearance. Minor/Significance Unknown.

• streptomycin

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

• tetracycline

  Serious - Use Alternative (1)magnesium hydroxide 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 hydroxide by increasing renal clearance. Minor/Significance Unknown.

• torsemide

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

• triamterene

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

• vismodegib

  Monitor Closely (1)magnesium hydroxide 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

• vitamin D

  Monitor Closely (1)vitamin D increases levels of magnesium hydroxide by Other (see comment). Use Caution/Monitor. Comment: Vitamin D can increase serum magnesium concentrations, particularly in the presence of renal impairment. The combined use of vitamin D and magnesium-containing products should be avoided, if possible, in patients with chronic renal failure.