trimagnesium citrate anhydrous (OTC)

Brand and Other Names:Magnitria
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

oral powder

  • 1504mg/powder sachet (elemental magnesium/sachet: 243mg [20mEq])

Magnesium Supplementation

Dietary supplement to treat or reduce the risk of magnesium deficiency

Dose based on elemental magnesium (Mg) 243-486 mg PO daily

If 486 mg/day administered, give as 2 doses 4-8 hr apart

Dosing Considerations

Indication: Recommended to treat or reduce the risk of hypomagnesemia in individuals diagnosed with a cardiovascular condition (eg, congestive heart failure, hypertension, tachyarrhythmia, atherosclerosis); gastrointestinal condition (eg, Crohn’s disease, ulcerative colitis, celiac disease); electrolyte abnormality (eg, hyponatremia, hypokalemia, hypocalcemia, hypophosphatemia, refractory potassium depletion); diabetes mellitus; nephrolithiasis; or osteoporosis

243 mg elemental Mg provides ~60% of recommended daily intake (RDI)

RDI for adults is 400 mg/day

Other ingredients: Xylitol, citric acid, natural and artificial orange flavor, dextrin, sucralose

Administration

Mix with 4-8 oz of water, stir well and drink

May take with or without food

Store in a dry location at 59-86°F (15-30°C)

Safety and efficacy not established

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Interactions

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              • baloxavir marboxil

                trimagnesium citrate anhydrous 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.

              Monitor Closely (31)

              • alendronate

                trimagnesium citrate anhydrous decreases levels of alendronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • amikacin

                amikacin, trimagnesium citrate anhydrous. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration of aminoglycosides with magnesium may increase risk of neuromuscular weakness and paralysis.

              • amlodipine

                trimagnesium citrate anhydrous, amlodipine. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Possible additive effect of magnesium and calcium channel blockers on reduction of ionic calcium may increase risk of hypotension or muscle weakness.

              • ciprofloxacin

                trimagnesium citrate anhydrous decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Multivalent cation-containing products may reduce bioavailability of quinolones; administer quinolone at least 2 hr before or 6 hr after magnesium; use alternatives if available.

              • demeclocycline

                trimagnesium citrate anhydrous decreases levels of demeclocycline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Multivalent cation-containing products may reduce bioavailability of tetracyclines; administer tetracycline at least 2 hr before or 6 hr after magnesium; use alternatives if available.

              • digoxin

                digoxin decreases effects of trimagnesium citrate anhydrous by increasing renal clearance. Use Caution/Monitor.

              • diltiazem

                trimagnesium citrate anhydrous, diltiazem. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Possible additive effect of magnesium and calcium channel blockers on reduction of ionic calcium may increase risk of hypotension or muscle weakness.

              • doxycycline

                trimagnesium citrate anhydrous decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Multivalent cation-containing products may reduce bioavailability of tetracyclines; administer tetracycline at least 2 hr before or 6 hr after magnesium; use alternatives if available.

              • felodipine

                trimagnesium citrate anhydrous, felodipine. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Possible additive effect of magnesium and calcium channel blockers on reduction of ionic calcium may increase risk of hypotension or muscle weakness.

              • gemifloxacin

                trimagnesium citrate anhydrous decreases levels of gemifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Multivalent cation-containing products may reduce bioavailability of quinolones; administer quinolone at least 2 hr before or 6 hr after magnesium; use alternatives if available.

              • gentamicin

                gentamicin, trimagnesium citrate anhydrous. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration of aminoglycosides with magnesium may increase risk of neuromuscular weakness and paralysis.

              • glimepiride

                trimagnesium citrate anhydrous increases levels of glimepiride by enhancing GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • glipizide

                trimagnesium citrate anhydrous increases levels of glipizide by enhancing GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • glyburide

                trimagnesium citrate anhydrous increases levels of glyburide by enhancing GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • isradipine

                trimagnesium citrate anhydrous, isradipine. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Possible additive effect of magnesium and calcium channel blockers on reduction of ionic calcium may increase risk of hypotension or muscle weakness.

              • levofloxacin

                trimagnesium citrate anhydrous decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Multivalent cation-containing products may reduce bioavailability of quinolones; administer quinolone at least 2 hr before or 6 hr after magnesium; use alternatives if available.

              • levothyroxine

                trimagnesium citrate anhydrous decreases levels of levothyroxine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • minocycline

                trimagnesium citrate anhydrous decreases levels of minocycline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Multivalent cation-containing products may reduce bioavailability of tetracyclines; administer tetracycline at least 2 hr before or 6 hr after magnesium; use alternatives if available.

              • moxifloxacin

                trimagnesium citrate anhydrous decreases levels of moxifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Multivalent cation-containing products may reduce bioavailability of quinolones; administer quinolone at least 2 hr before or 6 hr after magnesium; use alternatives if available.

              • nicardipine

                trimagnesium citrate anhydrous, nicardipine. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Possible additive effect of magnesium and calcium channel blockers on reduction of ionic calcium may increase risk of hypotension or muscle weakness.

              • nisoldipine

                trimagnesium citrate anhydrous, nisoldipine. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Possible additive effect of magnesium and calcium channel blockers on reduction of ionic calcium may increase risk of hypotension or muscle weakness.

              • nitrofurantoin

                trimagnesium citrate anhydrous decreases levels of nitrofurantoin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Multivalent cation-containing products may reduce bioavailability of nitrofurantoin; administer nitrofurantoin at least 2 hr before or 6 hr after magnesium; use alternatives if available.

              • ofloxacin

                trimagnesium citrate anhydrous decreases levels of ofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Multivalent cation-containing products may reduce bioavailability of quinolones; administer quinolone at least 2 hr before or 6 hr after magnesium; use alternatives if available.

              • omadacycline

                trimagnesium citrate anhydrous 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.

              • rilpivirine

                trimagnesium citrate anhydrous 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 given at least 2 hr before or at least 4 hr after rilpivirine.

              • sarecycline

                trimagnesium citrate anhydrous 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.

              • streptomycin

                streptomycin, trimagnesium citrate anhydrous. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration of aminoglycosides with magnesium may increase risk of neuromuscular weakness and paralysis.

              • tetracycline

                trimagnesium citrate anhydrous decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Multivalent cation-containing products may reduce bioavailability of tetracyclines; administer tetracycline at least 2 hr before or 6 hr after magnesium; use alternatives if available.

              • tiludronate

                trimagnesium citrate anhydrous decreases levels of tiludronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • tobramycin

                tobramycin, trimagnesium citrate anhydrous. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration of aminoglycosides with magnesium may increase risk of neuromuscular weakness and paralysis.

              • verapamil

                trimagnesium citrate anhydrous, verapamil. Either increases effects of the other by sedation. Use Caution/Monitor. Possible additive effect of magnesium and calcium channel blockers on reduction of ionic calcium may increase risk of hypotension or muscle weakness.

              Minor (0)

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                Adverse Effects

                Frequency Not Defined

                Asthenia

                Dizziness

                Hypotension

                Respiratory depression

                Diarrhea

                Abdominal cramping

                Electrolyte imbalance

                Hypermagnesemia

                Muscle weakness

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                Warnings

                Contraindications

                Known hypersensitivity to proton pump inhibitors

                GI obstructions

                Hypermagnesemia

                Cautions

                Kidney dysfunction

                Patients who experience a sudden change in bowel habits

                Coadministration with calcium channel blockers; magnesium may enhance the hypotensive effect of the calcium channel blockers

                May enhance neuromuscular-blocking effect of neuromuscular-blocking agents

                Avoid concomitant use of calcium polystyrene sulfonate

                High fat content of food decreases magnesium absorption

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                Pregnancy & Lactation

                Pregnancy Category: B; crosses placenta, physician should guide dosage for pregnant women

                Lactation: Excreted in human breast milk; concentrations remain constant during the first year of lactation; effects of prolonged increments in magnesium are not known

                Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs

                Pregnancy Categories

                A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                NA: Information not available.

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                Pharmacology

                Mechanism of Action

                Plays an important role in more than 300 biochemical reactions in the body, participating in neuromuscular activity, excitation-contraction coupling, temperature regulation, detoxification reactions, synthetic processes (including DNA and RNA synthesis), and energy production through carbohydrate metabolism

                Absorption

                At normal intake levels, ionic fractional absorption is 25-50%

                Distribution

                ~50% stored in bone; remaining 50% intracellular

                ~1% of total body magnesium is in plasma (55-70% ionized, 20-30% protein bound, 5-15% complexed with anions)

                Elimination

                Excretion: Principally in urine

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                A Patient Handout is not currently available for this monograph.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.