Taking common prescription drugs — like antibiotics, PPIs, and diuretics — can deplete magnesium by increasing magnesium loss or interfering with absorption. Discover the medications that cause magnesium depletion and what you can do about it.
With more than half the US population running dangerously low on this mineral, causes of magnesium depletion range from refining whole grains, low magnesium in soil, and depletion due to medications taken for years on end.
Mostly, prescription drugs cause your kidneys to excrete magnesium faster than you can consume it, called magnesium wasting. This can happen quickly after starting a medication.
What medications deplete magnesium?
| Medication Class | Example Medications | How it Depletes Magnesium |
|---|---|---|
| Acid Blockers/PPIs | Esomeprazole Famotidine Omeprazole Pantoprazole Ranitidine Cimetidine Nizatidine |
Unknown |
| Antibiotics | Tetracycline Aminoglycosides Pentamadine Doxycycline Neomycin Amoxicillin Azithromycin Cephalexin |
Increased excretion Reduced absorption |
| Antivirals | Foscarnet | May imbalance electrolytes |
| Anti-rheumetics | Penicillamine | Deactivate magnesium |
| Blood pressure drugs | Loop diuretics Thiazide diuretics ACE inhibitors |
Increased excretion |
| Corticosteroids | Hydrocortisone Dexamethasone Methylprednisolone Mometasone Prednisone Triamcinolone Flunisolide |
Increased excretion |
| Cardiac glycoside | Digoxin | Increased excretion |
| Immunosuppressants | Cyclosporine Tacrolimus |
Increased excretion |
| Oral contraceptives and Hormone replacement therapy | Estradiols (also in combination) Estrogen (conjugated, synthetic, in combination) Levonorgestrel Norethindrone Diethylstilbestrol Estropipate |
Changes to magnesium distribution |
Acid Blockers
Proton pump inhibitors’ relationship to magnesium depletion is well-documented and, as of yet, unexplained. In 2017, the FDA warned that “prescription proton pump inhibitor (PPI) drugs may cause low serum magnesium levels (hypomagnesemia) if taken for prolonged periods of time (in most cases, longer than one year).” This depletion is so serious that in some cases, supplementation did not fix the deficiency and the patient had to discontinue the use of the medication.
Antibiotics
While antibiotics — including Tetracycline, Aminoglycosides, Pentamadine, Doxycycline, Neomycin — have been linked to magnesium depletion, supplementing with magnesium can also diminish the effects of certain antibiotics, including Ciprofloxacin, Moxifloxacin, Tetracycline, Doxycycline, and Minocycline. Luckily, experts recommend supplementing 1–2 hours before taking the antibiotics to avoid compromising the medication’s potency. Gentamicin, from the antibiotic class aminoglycides, has been the subject of numerous studies regarding its ability to deplete magnesium.
Blood Pressure Medications
The kidneys filter magnesium. If everything is as it should be, most magnesium in the blood is reabsorbed. Loop diuretics inhibit magnesium reabsorption in the kidneys, which can cause magnesium depletion both in the short and long term.1 Thiazides induce magnesium excretion, and are implicated in depletion when taken in the long term. Magnesium supplementation often corrects these deficiencies.
Corticosteroids
According to pharmacist Suzy Cohen, author of the book Drug Muggers: Which Medications Are Robbing Your Body of Essential Nutrients and Natural Ways to Restore Them, “There is also evidence to suggest that corticosteroids may reduce serum magnesium levels.” These common medications include Hydrocortisone, Dexamethasone, Methylprednisolone, Mometasone, Prednisone, Triamcinolone, and Flunisolide.
Mineralocorticoids increase magnesium excretion, which can lead to deficiency. One study correlated magnesium depletion with length of time undergoing oral steroid therapy3.
Immunosuppressants
Numerous studies show that cyclosporine leads to magnesium deficiency in a clinical setting, possibly by increasing magnesium excretion. Another study found that patients administered tacrolimus had more severe magnesium depletion than those taking cyclosporine.
Oral Contraceptives and Hormone Replacement Therapy
Clinical studies documenting nutrient deficiencies (and their symptoms) associated with using the pill date all the way back to the 1960s. Even with all that research, scientists still haven't identified why estrogen medications cause magnesium depletion. Oral contraceptive use has been correlated with low serum magnesium levels. And it’s not just prescription estrogens to prevent pregnancy, hormone replacement therapy for postmenopausal women results in similar magnesium depletion.2 Read more about oral contraceptives and nutrient depletion here.
Signs of low magnesium caused by medications
Magnesium contributes to more than 300 reactions in the body, so depletion symptoms are wide ranging and felt in just about every part of the body. The following is just a sampling of magnesium deficiency signs:
- Irritability
- Sleep problems
- Fatigue
- Poor memory
- Neck pain
- Muscle cramps and spasms
- Shakiness
- Nausea
- Irregular heartbeat
- Problems concentrating
- Constipation
- Numbness and tingling
What do do about magnesium depletion
Get tested for magnesium deficiency
A blood serum test won’t do. In order to get an accurate assessment of your magnesium status, you’ll need to get a red blood cell test. That’s because magnesium is mostly found in the cells, not between the cells.
Take a magnesium supplement that absorbs
With so many almost unavoidable factors contributing to today’s rampant deficiency, supplementing this water-soluble nutrient is pretty low risk. There are several types of magnesium sold as supplements, each of which vary in their ability to absorb in the cells and actively contribute to the 300+ functions.
Magnesium is water-soluble, so your body can't store any excess, which makes absorption even more important. Lypo-Spheric® Magnesium provides elite nutrient absorption through liposome encapsulation. These fatty spheres take the mineral through a different system in the body to avoid the one that may face magnesium absorption challenges due to medication use.
What we learned
Several common medications — both prescribed and over the counter — can lower magnesium levels, including PPIs, HRT and hormonal birth control, antibiotics, and blood pressure drugs. You can feel magnesium deficiency in the brain and muscles. Magnesium supplements that absorb in the cells — made with liposome encapsulation — can help restore magnesium levels.
Frequently Asked Questions
What are signs of magnesium deficiency?
Tingling in the hands, muscle spasms, difficulty focusing, nausea, and irregular heartbeat can indicate magnesium deficiency.
What prescription drugs deplete magnesium?
Acid blockers/PPIs are some of the most aggressive, but oral contraceptives, HRT, antibiotics, and blood pressure drugs also change how the body absorbs magnesium and are associated with lower levels.
References
1 Mohn, E.S., Kern, H.J., Saltzman, E., Mitmesser, S.H., McKay, D.L. Evidence of Drug–Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update. Pharmaceutics, 2018, 10, 36; doi:10.3390/pharmaceutics10010036.
2 Palmery, M., Saraceno, A., Vaiarelli, A., Carlomagno, G. Oral contraceptives and changes in nutritional requirements. European Review for Medical and Pharmacological Sciences, 2013; 17; 1804-1813.
3 Rolla G, Bucca C, Bugiani M, Oliva A, Branciforte L. Hypomagnesemia in chronic obstructive lung disease: effect of therapy. Magnes Trace Elem. 1990;9(3):132-6. PMID: 1979000.
