Constipation, occasional: Note: Use of magnesium citrate has generally been replaced with other laxatives (eg, PEG solutions, lactulose) less likely to cause adverse effects (eg, electrolyte disturbances) (Tabbers 2014): Oral solution: Oral:
Children 2 to <6 years: 60 to 90 mL administered as a single dose or in divided doses
Children 6 to <12 years: 100 to 150 mL administered as a single dose or in divided doses
Children ≥12 years and Adolescents: 150 to 300 mL administered as a single dose or in divided doses
Bowel preparation: Limited data available: Oral: Oral Solution: Children >6 years and Adolescents: 4 to 6 mL/kg/day, may administer as a single dose or in divided doses the day before the procedure; maximum daily dose: 300 mL/day (NASPGHAN [Pall 2014])
There are no dosage adjustments provided in the manufacturer’s labeling; however, magnesium is renally excreted. Patients in severe renal failure should not receive magnesium due to toxicity from accumulation. Patients with a CrCl <25 mL/minute receiving magnesium should have serum magnesium levels monitored.
There are no dosage adjustments provided in the manufacturer’s labeling.
(For additional information see "Magnesium citrate: Drug information")
Bowel preparation before colonoscopy (off-label use): Note: This preparation should be avoided in patients with renal impairment, heart failure, decompensated cirrhosis, or baseline electrolyte abnormalities (A-Rahim 2021). There is no standard dosing for administration; the following recommendations are suggested by some experts.
Single agent:
Single-dose, same-day (for afternoon procedures): Oral: 1.5 bottles (450 mL or 15 oz) taken 8 hours prior to procedure, followed by clear liquids (at least three 240 mL glasses) over 2 hours. Four hours prior to the procedure, administer a second 1.5 bottle dose followed by clear liquids (three 240 mL glasses) over 1 hour (A-Rahim 2021).
Split-dose (evening before procedure): Oral: 1 to 1.5 bottles (300 to 450 mL or 10 to 15 oz) in the early evening (ie, between 6 and 8 PM) followed by clear liquids (at least three 240 mL glasses) over 2 hours. Patient should also be given a clear liquid diet the day prior to the procedure. Six hours prior to the colonoscopy, administer a second 1 to 1.5 bottle dose followed by clear liquids (three 240 mL glasses) over 1 hour (A-Rahim 2021; ASGE [Saltzman 2015]).
Adjunctive therapy: Oral: 1 bottle (300 mL or 10 oz) in the afternoon (4 PM) the day before the procedure, followed 1 hour later by low-volume polyethylene glycol electrolyte lavage solution (Sharma 1998; Sharma 2001).
Constipation, occasional: Oral: Solution: 195 to 300 mL as a single dose or in divided doses per 24 hours.
Magnesium is renally excreted; accumulation of magnesium in renal impairment may lead to magnesium toxicity. Use with extreme caution in patients with renal insufficiency; do not use in patients with renal failure (A-Rahim 2021; ASGE [Saltzman 2015]; Mounsey 2015).
There are no dosage adjustments provided in the manufacturer’s labeling; however, magnesium is renally excreted.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Oral:
Citroma: 1.745 g/30 mL (296 mL [DSC]) [contains polyethylene glycol, saccharin sodium]
Citroma: 1.745 g/30 mL (296 mL) [low sodium; contains alcohol, usp, benzoic acid, disodium edta]
Citroma: 1.745 g/30 mL (296 mL) [low sodium; contains fd&c red #40, saccharin sodium; cherry flavor]
Citroma: 1.745 g/30 mL (296 mL) [low sodium; contains saccharin sodium; lemon flavor]
GoodSense Magnesium Citrate: 1.745 g/30 mL (296 mL) [contains polyethylene glycol, saccharin sodium]
GoodSense Magnesium Citrate: 1.745 g/30 mL (296 mL) [low sodium; contains alcohol, usp, fd&c red #40, saccharin sodium]
GoodSense Magnesium Citrate: 1.745 g/30 mL (296 mL [DSC]) [low sodium; contains saccharin sodium]
GoodSense Magnesium Citrate: 1.745 g/30 mL (296 mL) [saccharin free; contains benzoic acid, disodium edta]
Generic: 1.745 g/30 mL (296 mL)
Tablet, Oral:
Generic: 100 mg
Yes
1 g magnesium citrate ≈ elemental magnesium 160 mg = magnesium 13.17 mEq = magnesium 6.59 mmol
Oral: Administer with full glass of water; to increase palatability of the oral solution, chill the solution prior to administration.
Oral: To increase palatability, chill the solution prior to administration. When used for occasional constipation, administer each dose with 8 oz (240 mL) of liquid.
Store at 15°C to 30°C (59°F to 86°F).
Oral solution: Discard remaining medication within 24 hours of opening.
Treatment of occasional constipation (OTC product: FDA approved in ages ≥2 years and adults); has also been used for preprocedure bowel preparation. Note: Approved ages for generic products may vary; consult labeling for specific information.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined: Gastrointestinal: Abdominal pain, diarrhea, flatulence, nausea, vomiting
OTC labeling: When used for self-medication, do not use if on low salt diet
Disease-related concerns:
• Constipation (self-medication, OTC use): Appropriate use: For occasional use only; serious side effects may occur with prolonged use. For use only under the supervision of a physician in patients with kidney dysfunction, sodium- or magnesium-restricted diets, abdominal pain/nausea/vomiting, with a sudden change in bowel habits which has persisted for >2 weeks, or use of a laxative for >1 week. If rectal bleeding develops or a bowel movement does not occur after use, discontinue use and consult a health care provider.
• Neuromuscular disease: Use with extreme caution in patients with myasthenia gravis or other neuromuscular disease.
• Renal impairment: Use with caution in patients with renal impairment; accumulation of magnesium may lead to magnesium intoxication.
None known.
Alfacalcidol: May increase the serum concentration of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving alfacalcidol. If magnesium-containing products must be used with alfacalcidol, serum magnesium concentrations should be monitored closely. Risk D: Consider therapy modification
Alpha-Lipoic Acid: Magnesium Salts may decrease the absorption of Alpha-Lipoic Acid. Alpha-Lipoic Acid may decrease the absorption of Magnesium Salts. Management: Separate administration of alpha-lipoic acid from that of any magnesium-containing compounds by several hours. If alpha-lipoic acid is given 30 minutes before breakfast, then administer oral magnesium-containing products at lunch or dinner. Risk D: Consider therapy modification
Aluminum Hydroxide: Citric Acid Derivatives may increase the absorption of Aluminum Hydroxide. Risk C: Monitor therapy
Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Risk X: Avoid combination
Bictegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Bictegravir. Management: Administer bictegravir under fasting conditions at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Risk D: Consider therapy modification
Cabotegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Cabotegravir. Management: Administer polyvalent cation containing products at least 2 hours before or 4 hours after oral cabotegravir. Risk D: Consider therapy modification
Calcitriol (Systemic): May increase the serum concentration of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving calcitriol. If magnesium-containing products must be used with calcitriol, serum magnesium concentrations should be monitored closely. Risk D: Consider therapy modification
Calcium Polystyrene Sulfonate: Laxatives (Magnesium Containing) may enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. More specifically, concomitant use of calcium polystyrene sulfonate with magnesium-containing laxatives may result in metabolic alkalosis or with sorbitol may result in intestinal necrosis. Management: Avoid concomitant use of calcium polystyrene sulfonate (rectal or oral) and magnesium-containing laxatives. Risk X: Avoid combination
Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Risk D: Consider therapy modification
Dolutegravir: Magnesium Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral magnesium salts. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral magnesium salts. Risk D: Consider therapy modification
Doxercalciferol: May enhance the hypermagnesemic effect of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving doxercalciferol. If magnesium-containing products must be used with doxercalciferol, serum magnesium concentrations should be monitored closely. Risk D: Consider therapy modification
Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Risk D: Consider therapy modification
Elvitegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Elvitegravir. Management: Administer elvitegravir 2 hours before or 6 hours after the administration of polyvalent cation containing products. Risk D: Consider therapy modification
Gabapentin: Magnesium Salts may enhance the CNS depressant effect of Gabapentin. Specifically, high dose intravenous/epidural magnesium sulfate may enhance the CNS depressant effects of gabapentin. Magnesium Salts may decrease the serum concentration of Gabapentin. Management: Administer gabapentin at least 2 hours after use of a magnesium-containing antacid. Monitor patients closely for evidence of reduced response to gabapentin therapy. Monitor for CNS depression if high dose IV/epidural magnesium sulfate is used. Risk D: Consider therapy modification
Levothyroxine: Magnesium Salts may decrease the serum concentration of Levothyroxine. Management: Separate administration of oral levothyroxine and oral magnesium salts by at least 4 hours. Risk D: Consider therapy modification
Multivitamins/Fluoride (with ADE): Magnesium Salts may decrease the serum concentration of Multivitamins/Fluoride (with ADE). Specifically, magnesium salts may decrease fluoride absorption. Management: To avoid this potential interaction separate the administration of magnesium salts from administration of a fluoride-containing product by at least 1 hour. Risk D: Consider therapy modification
Neuromuscular-Blocking Agents: Magnesium Salts may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy
PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Risk D: Consider therapy modification
Phosphate Supplements: Magnesium Salts may decrease the serum concentration of Phosphate Supplements. Management: Administer oral phosphate supplements as far apart from the administration of an oral magnesium salt as possible to minimize the significance of this interaction. Risk D: Consider therapy modification
Quinolones: Magnesium Salts may decrease the serum concentration of Quinolones. Management: Administer oral quinolones several hours before (4 h for moxi/pe/spar/enox-, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome/pe/enox-, 3 h for gemi-, and 2 h for levo-, nor-, or ofloxacin or nalidixic acid) oral magnesium salts. Risk D: Consider therapy modification
Raltegravir: Magnesium Salts may decrease the serum concentration of Raltegravir. Management: Avoid the use of oral / enteral magnesium salts with raltegravir. No dose separation schedule has been established that adequately reduces the magnitude of interaction. Risk X: Avoid combination
Sodium Polystyrene Sulfonate: Laxatives (Magnesium Containing) may enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. More specifically, concomitant use of sodium polystyrene sulfonate with magnesium-containing laxatives may result in metabolic alkalosis or with sorbitol may result in intestinal necrosis. Management: Avoid concomitant use of sodium polystyrene sulfonate (rectal or oral) and magnesium-containing laxatives. Risk X: Avoid combination
Tetracyclines: Magnesium Salts may decrease the absorption of Tetracyclines. Only applicable to oral preparations of each agent. Management: Avoid coadministration of oral magnesium salts and oral tetracyclines. If coadministration cannot be avoided, administer oral magnesium at least 2 hours before, or 4 hours after, oral tetracyclines. Monitor for decreased tetracycline therapeutic effects. Risk D: Consider therapy modification
Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant administration of trientine and oral products that contain polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. If other oral polyvalent cations are needed, separate administration by 1 hour. Risk D: Consider therapy modification
Some products may contain potassium and/or sodium.
Magnesium crosses the placenta; serum concentrations in the fetus are similar to those in the mother (Idama 1998; Osada 2002).
When dietary changes and lifestyle modifications are insufficient, agents other than magnesium citrate are recommended for the treatment of constipation in pregnant women (Gomes 2018; Shin 2015).
Stool output, electrolytes
Promotes bowel evacuation by causing osmotic retention of fluid which distends the colon with increased peristaltic activity
Onset of laxative effect: Oral solution: 0.5 to 6 hours
Absorption: Oral: Up to 30%
Excretion: Urine (IOM 1997); feces (as unabsorbed drug)
Solution (Citroma Oral)
1.745 g/30 mL (per mL): $0.00
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