What is Milk of Magnesia. How is it used for constipation and indigestion. What are the recommended dosages for adults and children. What are the potential drug interactions and side effects. How can Milk of Magnesia be used safely and effectively.

Understanding Milk of Magnesia: Composition and Forms

Milk of Magnesia, also known as magnesium hydroxide, is a popular over-the-counter medication used primarily for treating constipation and acid indigestion. Its active ingredient, magnesium hydroxide, works as both a laxative and an antacid, making it a versatile remedy for various gastrointestinal issues.

This medication comes in several forms and strengths:

• Chewable tablets: 311mg and 400mg
• Suspension: 7.75%, 400mg/5mL, 800mg/5mL, 1200mg/15mL, and 2400mg/10mL

The availability of different formulations allows for flexible dosing based on individual needs and preferences.

Dosage Guidelines for Adults: Constipation and Acid Indigestion

For adults, the dosage of Milk of Magnesia varies depending on the condition being treated and the strength of the formulation used.

Constipation Treatment for Adults

When using Milk of Magnesia for constipation relief, adults should follow these guidelines:

• Magnesium hydroxide (400 mg/5 mL): 30-60 mL/day orally at bedtime or in divided doses
• Magnesium hydroxide (800 mg/5 mL): 15-30 mL/day orally at bedtime or in divided doses
• Chewable tablet: 8 tablets/day orally at bedtime or in divided doses

Acid Indigestion Treatment for Adults

For treating acid indigestion, adults should adhere to these dosage recommendations:

• Magnesium hydroxide (400 mg/5 mL): 5-15 mL orally every 4 hours, with no more than 4 doses per 24-hour period
• Chewable tablet: 2-4 tablets orally every 4 hours, with no more than 4 doses per 24-hour period

Pediatric Dosing: Ensuring Safe Usage for Children

When administering Milk of Magnesia to children, it’s crucial to follow age-appropriate dosing guidelines to ensure safety and effectiveness.

Constipation Treatment for Children

For constipation relief in children, the following dosage recommendations apply:

• 2-6 years: 5-15 mL/day of regular-strength liquid orally 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) orally 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) orally at bedtime or in divided doses

For chewable tablets:

• 3-6 years: 2 tablets orally once daily or in divided doses
• 6-12 years: 4 tablets orally once daily or in divided doses
• >12 years: 8 tablets orally once daily or in divided doses

Acid Indigestion Treatment for Children

For acid indigestion in children 12 years and older:

• Liquid: 5-15 mL (400 mg/5 mL) orally every 4 hours; no more than 4 doses per 24-hour period
• Chewable tablet: 2-4 tablets orally every 4 hours; no more than 4 doses per 24-hour period

Drug Interactions: Potential Risks and Precautions

Milk of Magnesia can interact with various medications, potentially altering their effectiveness or causing adverse effects. It’s essential to be aware of these interactions to ensure safe use.

Serious Interactions Requiring Alternative Treatments

Several medications have serious interactions with Milk of Magnesia, necessitating the use of alternative treatments or careful management:

• Baloxavir marboxil: Milk of Magnesia may decrease its effectiveness by binding to it in the gastrointestinal tract.
• Tetracycline antibiotics (demeclocycline, doxycycline, minocycline, oxytetracycline, tetracycline): Milk of Magnesia can inhibit their absorption.
• Eltrombopag: Absorption may be reduced when taken with Milk of Magnesia.
• Infigratinib: Milk of Magnesia can interfere with its absorption.
• Pazopanib: The effectiveness may be reduced due to increased gastric pH caused by Milk of Magnesia.
• Ponatinib: Milk of Magnesia can decrease its levels by altering gastric pH.
• Raltegravir: Its plasma levels may be reduced when taken with Milk of Magnesia.
• Sotorasib: Milk of Magnesia can interfere with its absorption.

Timing Considerations for Medication Administration

In some cases, the timing of Milk of Magnesia administration relative to other medications is crucial:

• Infigratinib: If use with Milk of Magnesia cannot be avoided, administer infigratinib 2 hours before or after the antacid.
• Pazopanib: If antacids must be used, separate the dosing by several hours.
• Raltegravir: Avoid taking Milk of Magnesia within 6 hours of raltegravir doses.
• Sotorasib: If necessary, administer sotorasib 4 hours before or 10 hours after Milk of Magnesia.

Mechanism of Action: How Milk of Magnesia Works

Understanding how Milk of Magnesia functions in the body can provide insight into its effectiveness and potential side effects.

Laxative Action

As a laxative, Milk of Magnesia works through osmotic action. When magnesium hydroxide reaches the small intestine, it draws water into the intestinal lumen. This increased water content softens the stool and promotes bowel movements. Additionally, the increased intestinal volume stimulates peristalsis, further facilitating defecation.

Antacid Properties

In its role as an antacid, Milk of Magnesia neutralizes stomach acid. The magnesium hydroxide reacts with hydrochloric acid in the stomach to form magnesium chloride and water. This reaction raises the pH of the stomach contents, providing relief from heartburn and indigestion.

Side Effects and Precautions: Ensuring Safe Usage

While Milk of Magnesia is generally safe when used as directed, it can cause side effects and may not be suitable for everyone.

Common Side Effects

Users may experience:

• Diarrhea
• Stomach cramps
• Nausea
• Weakness
• Irregular heartbeat (rare)

Precautions and Contraindications

Certain individuals should exercise caution or avoid using Milk of Magnesia:

• People with kidney problems: Magnesium can accumulate in the body, leading to toxicity.
• Those on a magnesium-restricted diet
• Individuals with severe abdominal pain or symptoms of appendicitis
• Pregnant or breastfeeding women should consult a healthcare provider before use

Long-term Use Considerations: Balancing Benefits and Risks

While Milk of Magnesia can be effective for short-term relief, prolonged use may lead to complications.

Potential Risks of Chronic Use

• Electrolyte imbalances, particularly hypomagnesemia
• Dependence on laxatives for bowel movements
• Altered gut microbiome
• Interference with nutrient absorption

Alternatives for Long-term Constipation Management

For chronic constipation, consider these alternatives:

• Dietary changes: Increasing fiber and water intake
• Regular exercise
• Probiotics
• Bulk-forming laxatives
• Consultation with a healthcare provider for underlying causes

Special Populations: Tailoring Usage for Specific Groups

Certain populations may require special considerations when using Milk of Magnesia.

Elderly Patients

Older adults may be more susceptible to side effects and should start with lower doses. They should be monitored for signs of magnesium toxicity, especially if they have reduced kidney function.

Patients with Gastrointestinal Disorders

Individuals with inflammatory bowel disease, diverticulitis, or other gastrointestinal conditions should consult a healthcare provider before using Milk of Magnesia, as it may exacerbate symptoms or mask underlying issues.

Children

Pediatric dosing should be strictly followed to prevent overdose. Parents should be educated on proper administration and potential side effects.

Alternative Uses: Beyond Constipation and Indigestion

While primarily used for constipation and indigestion, Milk of Magnesia has found applications in other areas.

Dermatological Applications

Some people use Milk of Magnesia topically for:

• Acne treatment: As a facial mask or spot treatment
• Deodorant alternative: Applied to underarms to control odor
• Seborrheic dermatitis: To manage oily skin and flaking

However, these uses are not FDA-approved, and effectiveness may vary. Consult a dermatologist before using Milk of Magnesia for skin conditions.

Veterinary Use

In veterinary medicine, Milk of Magnesia is sometimes used for similar purposes as in humans, particularly for treating constipation in large animals. However, dosage and administration should always be under the guidance of a veterinarian.

Storage and Handling: Maintaining Product Efficacy

Proper storage and handling of Milk of Magnesia are crucial for maintaining its effectiveness and safety.

Storage Guidelines

• Store at room temperature, away from direct sunlight and heat
• Keep the container tightly closed when not in use
• Do not freeze liquid formulations
• Keep out of reach of children

Shelf Life and Expiration

Milk of Magnesia typically has a shelf life of 2-3 years. Always check the expiration date before use and discard any expired product. If the liquid becomes discolored or develops an unusual odor, it should not be used.

Comparing Milk of Magnesia to Other Laxatives and Antacids

Understanding how Milk of Magnesia compares to other over-the-counter options can help in choosing the most appropriate treatment.

Laxative Comparisons

• Osmotic laxatives (e.g., polyethylene glycol): Generally gentler, may be better for long-term use
• Stimulant laxatives (e.g., bisacodyl): Work faster but can cause cramping
• Bulk-forming laxatives (e.g., psyllium): More natural approach, good for long-term use

Antacid Comparisons

• Calcium carbonate antacids: Longer-lasting relief but may cause constipation
• Aluminum hydroxide antacids: Gentler on the stomach but may cause constipation
• H2 blockers and proton pump inhibitors: More effective for frequent heartburn but not for immediate relief

Milk of Magnesia offers a unique combination of laxative and antacid properties, making it versatile for treating both constipation and indigestion. However, its effectiveness and suitability can vary depending on individual needs and health conditions.

Milk of Magnesia (magnesium hydroxide) dosing, indications, interactions, adverse effects, and more

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

chewable tablet

• 311mg
• 400mg

suspension

• 7.75%
• 400mg/5mL
• 800mg/5mL
• 1200mg/15mL
• 2400mg/10mL

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

Dosage Forms & Strengths

chewable tablet

• 311mg
• 400mg

suspension

• 7.75%
• 400mg/5mL
• 800mg/5mL
• 1200mg/15mL
• 2400mg/10mL

Constipation

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

• 3-6 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: 5-15 mL (400 mg/5 mL) PO q4hr; no more than 4 doses per 24-hour period

Chewable tablet

• ≥12 years: 2-4 tablets PO q4hr; no more than 4 doses per 24-hour period

Interactions

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• 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 h3 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.

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Adverse Effects

Frequency Not Defined

Abdominal cramping

Diarrhea

Electrolyte imbalance

Hypotension

Muscle weakness

Respiratory depression

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Warnings

Contraindications

Renal failure

Existing electrolyte imbalance

Appendicitis symptoms or acute surgical abdomen

Myocardial damage or heart block

Fecal impaction or rectal fissures

Intestinal obstruction or perforation

Undiagnosed abdominal pain

Cautions

Use with caution in renal insufficiency

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Pregnancy & Lactation

Pregnancy category: A

Lactation: Use in nursing mothers appears to be safe

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

Laxative: Promotes osmotic retention of fluid, which distends the colon with increased peristaltic activity and stimulates bowel evacuation

Antacid: Reacts with hydrochloric acid in stomach to form magnesium chloride

Absorption

Bioavailability: 15-30%

Onset: 0. 5-6 hr (laxative)

Elimination

Excretion: Urine (up to 30% as absorbed magnesium), feces (as unabsorbed drug)

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Images

Dulcolax (magnesium hydroxide) oral –	400 mg/5 mL suspension
Dulcolax (magnesium hydroxide) oral –	1,200 mg chewable tablet
Phillips Milk of Magnesia oral –	400 mg/5 mL suspension
Phillips Milk of Magnesia oral –	400 mg/5 mL suspension
Phillips Milk of Magnesia oral –	400 mg/5 mL suspension
Phillips Milk of Magnesia oral –	400 mg/5 mL suspension
Phillips Milk of Magnesia oral –	400 mg/5 mL suspension
Phillips Milk of Magnesia oral –	311 mg chewable tablet
Phillips Milk of Magnesia oral –	400 mg/5 mL suspension
Phillips Milk of Magnesia oral –	400 mg/5 mL suspension
Phillips Milk of Magnesia oral –	400 mg/5 mL suspension
Milk of Magnesia oral –	400 mg/5 mL suspension
Milk of Magnesia oral –	400 mg/5 mL suspension
Milk of Magnesia oral –	400 mg/5 mL suspension
Milk of Magnesia oral –	400 mg/5 mL suspension
Milk of Magnesia oral –	400 mg/5 mL suspension
Milk of Magnesia oral –	400 mg/5 mL suspension
Milk of Magnesia oral –	400 mg/5 mL suspension
Milk of Magnesia oral –	400 mg/5 mL suspension
Milk of Magnesia oral –	400 mg/5 mL suspension
Milk of Magnesia oral –	400 mg/5 mL suspension
Milk of Magnesia oral –	400 mg/5 mL suspension
Pedia-Lax (mag hydroxide) oral –	400 mg (170 mg magnesium) chewable tablet

Copyright © 2010 First DataBank, Inc.

Magnesium Hydroxide Dosage Guide + Max Dose, Adjustments

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Medically reviewed by Drugs.com. Last updated on Nov 11, 2022.

Applies to the following strengths: 24%; 8%; 400 mg; 16%; 311 mg; 325 mg; 1200 mg/15 mL; 600 mg; 1200 mg

Usual Adult Dose for:

• Constipation
• Dyspepsia

Usual Pediatric Dose for:

• Constipation
• Dyspepsia

Additional dosage information:

• Renal Dose Adjustments
• Liver Dose Adjustments
• Precautions
• Dialysis
• Other Comments

Usual Adult Dose for Constipation

CONCENTRATED ORAL SUSPENSION (2400 mg/10 mL): 3600 to 7200 mg (as magnesium hydroxide) orally per day, given once a day in divided doses, or as directed

• Maximum dose: 7200 mg/day
• Duration of therapy: Up to 7 days

ORAL SUSPENSION (1200 mg/15 mL): 2400 mg to 4800 mg (as magnesium hydroxide) orally per day, given once a day, in divided doses, or as directed

• Maximum dose: 4800 mg/day
• Duration of therapy: Up to 7 days

ORAL LIQUID (400 mg/5 mL): 2400 to 4800 mg (as magnesium hydroxide) orally once a day

• Maximum dose: 4800 mg/day
• Duration of therapy: Up to 7 days

Comments:

• In most patients, effects are usually seen within 30 minutes to 6 hours of administration
• Single doses should be taken at bedtime.
• Each dose should be taken with 8 ounces of water.

Use: Relief of occasional constipation/irregularity

Usual Adult Dose for Dyspepsia

CONCENTRATED ORAL SUSPENSION (2400 mg/10 mL): 1200 mg (as magnesium hydroxide) orally up to 4 times a day as needed

• Maximum dose: 4800 mg/day
• Duration of therapy: 7 days

ORAL LIQUID (400 mg/5 mL): 400 to 1200 mg (as magnesium hydroxide) orally up to 4 times a day

• Maximum dose: 4800 mg/day
• Duration of therapy: Up to 7 days

Comments:

• Concentrated suspension doses may be taken with water.
• Dosage cups should not be used to measure oral liquid doses.

Uses:

• Treatment of acid indigestion
• Treatment of heartburn
• Treatment of upset/sour stomach

Usual Pediatric Dose for Constipation

CONCENTRATED ORAL SUSPENSION (2400 mg/10 mL):
Under 12 years: Data not available

12 years and older: 3600 to 7200 mg (as magnesium hydroxide) orally per day, given once a day or in divided doses

• Maximum dose: 7200 mg/day
• Duration of therapy: 7 days

ORAL SUSPENSION (1200 mg/15 mL):
Under 6 years: Data not available

6 to 11 years: 1200 mg to 2400 mg (as magnesium hydroxide) orally per day, given once a day, in divided doses, or as directed

• Maximum dose: 2400 mg/day
• Duration of therapy: Up to 7 days

12 years and older: 2400 mg to 4800 mg (as magnesium hydroxide) orally per day, given once a day, in divided doses, or as directed

• Maximum dose: 4800 mg/day
• Duration of therapy: Up to 7 days

ORAL LIQUID (400 mg/5 mL):
Under 2 years: Data not available

2 to 5 years: 400 mg to 1200 mg (as magnesium hydroxide) orally once a day

• Maximum dose: 1200 mg/day
• Duration of therapy: Up to 7 days

6 to 11 years: 1200 mg to 2400 mg (as magnesium hydroxide) orally once a day

• Maximum dose: 2400 mg/day
• Duration of therapy: Up to 7 days

12 years and older: 2400 mg to 4800 mg (as magnesium hydroxide) orally once a day

• Maximum dose: 4800 mg/day
• Duration of therapy: Up to 7 days

TABLETS:
Under 2 years: Data not available

2 to under 6 years:

• Initial dose: 400 mg to 1200 mg (as magnesium hydroxide) orally once a day or in divided doses
• Maximum dose: 1200 mg/day
• Duration of therapy: Up to 7 days

6 to under 12 years:

• Initial dose: 1200 mg to 2400 mg (as magnesium hydroxide) orally once a day or in divided doses
• Maximum dose: 2400 mg/day
• Duration of therapy: Up to 7 days

Comments:

• In most patients, effects are usually seen within 30 minutes to 6 hours of administration.
• Some experts recommend: Caregivers of children who fail to have a bowel movement within 6 hours of administration should contact the child’s healthcare provider.
• Single doses should be taken at bedtime.
• Each dose should be taken with 8 ounces of water.

Use: Relief of occasional constipation/irregularity

Usual Pediatric Dose for Dyspepsia

CONCENTRATED ORAL SUSPENSION (2400 mg/10 mL):
Under 12 years: Data not available

12 years and older: 1200 mg (as magnesium hydroxide) orally up to 4 times a day or as needed

• Maximum dose: 4800 mg/day
• Duration of therapy: 7 days

ORAL LIQUID (400 mg/5 mL):
Under 12 years: Data not available

12 years and older: 400 to 1200 mg (as magnesium hydroxide) orally up to 4 times a day

• Maximum dose: 4800 mg/day
• Duration of therapy: Up to 7 days

Comments:

• Concentrated suspension doses may be taken with water.
• Dosage cups should not be used to measure oral liquid doses.

Uses:

• Treatment of acid indigestion
• Treatment of heartburn
• Treatment of upset/sour stomach
• Relieves acid indigestion, heartburn, and sour stomach

Renal Dose Adjustments

Dose adjustment(s) may be required; however, no specific guidelines have been suggested. Caution recommended.

Liver Dose Adjustments

Data not available

Precautions

CONTRAINDICATIONS:

• Patients with an allergic reaction to the active component or any of the ingredients

Safety and efficacy of concentrated oral suspensions have not been established in patients younger than 12 years.

Safety and efficacy of some oral liquids, oral suspensions, and tablets have not been established in patients younger than 6 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Oral liquid/suspension: Shake well prior to measuring dose; measure with the included measuring device.
• Antacid: May be taken with water.
• Laxative: Take with a full glass of water.

Storage requirements:

• Oral liquid/suspension: Close tightly when not in use; avoid freezing

Patient advice:

• Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
• Patients should be instructed to avoid using products if the tamper evident feature(s) are torn, broken, and/or missing.

More about magnesium hydroxide

• Check interactions
• Compare alternatives
• Reviews (247)
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• Latest FDA alerts (2)
• Side effects
• During pregnancy
• Drug class: antacids
• Breastfeeding
• En español

Patient resources

• Drug Information
• Magnesium Hydroxide Chewable Tablets
• Magnesium Hydroxide Suspension

Other brands

Milk of Magnesia, Phillips’ Milk of Magnesia, Dulcolax Milk of Magnesia, Ex-Lax Milk of Magnesia, Pedia-Lax Chewable Tablets

Related treatment guides

• Acne
• Constipation
• Indigestion

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Dosing complexes | ETATRON D.S.

Dosing technologies › Stations for dosing and preparation of reagents › Dosing complexes

This section presents automatic complexes for proportional dosing of antiscalants, biocides, solutions of chemical reagents to adjust pH and reduce the corrosive activity of water

The kits include: dosing pump, agitator, sensors, water meter with pulse output, reagent tank.

ATTENTION!!! Here are the types of zagalnyh stations. Each station is assembled according to the needs of the customer.

The ETATRON dosing complex is designed to introduce reagents into water that prevent the processes of oxygen and carbon dioxide corrosion of equipment, scale formation in hot water and steam boilers, corrosion in the steam-condensate path, heat and water supply systems, as well as biological fouling in cooling systems. Thanks to dosing complexes and a wide range of reagents for water treatment, water-chemical regimes are maintained.

A dosing pump installed on or near the dosing tank receives an external signal to operate from a water meter or a pH sensor, etc. and begins to supply the previously prepared solution from the tank to the pipeline at certain intervals. In addition to operation from an external signal, the operation of the dosing pump can be programmed for continuous dosing. The level sensor included in the scope of supply prevents dry running.

Dosing kits. Dosing of chemicals into water.

Dosing set includes:

• Dosing pump
• Water meter (flow meter)
• Dosing bottle
• Level sensor
• pH probe (optional)
• Free chlorine cell (optional)

We offer reagent dosing systems with the following options:

• One or more containers.
• Tank capacity up to 1000 l.
• Possibility to install several dosing pumps
• Agitator
• Possibility to install level sensors

Standard versions of reagent dosing systems

Model	Pump head [l/h]	Pump pressure [bar]	Container [l]	Agitator [kW]
ET-60	1 ~ 8	15 ~ 2	60	0. 18
ET-100	1 ~ 8	15 ~ 2	108	0.18
ET-200	1 ~ 8	15 ~ 2	230	0.25
ET-300	5 ~ 80	20 ~ 1	315	0.25
ET-500	5 ~ 80	20 ~ 1	530	0.37
ET-1000	5 ~ 80	20 ~ 1	1040	0.55

ETATRON station

Metering pumps

Mixers, agitators, hand mixers

Tanks, containers, protective trays, supports (plates)

Pulse meters / meters

Example:

Dosing of acid into water

At the Beloretsk Metallurgical Plant, the volume of industrial wastewater has been reduced and a new treatment plant has been put into operation

April 26, 2018

At the Beloretsk Iron and Steel Works, the volume of industrial effluents has been reduced and a new treatment plant has been put into operation

Water Magazine, April 2018

At the Beloretsk Metallurgical Plant, a new technology for cleaning billets (wire rod) from scale has been introduced, which made it possible to reduce the amount of industrial waste generated by eight times. In parallel with this, the wastewater treatment plant was reconstructed. As a result of the implementation of these projects, the negative environmental impact on the main water artery of Bashkortostan, the Belaya River, has been completely excluded.

Igor Tatarkin, Chief Ecologist of Beloretsk Iron and Steel Works, tells Voda Magazine about this.

JSC Beloretsk Iron and Steel Works (JSC BMK is part of the Mechel Group) is the largest hardware company in Russia, it occupies a leading position in the production and sale of metal products among domestic hardware companies. The plant produces rolled wire, steel wire from high-quality steel grades, steel ropes, strip of various sizes and sections, nails.

BMK high-strength wire workshop (TsVP No. 16) was put into operation in 1962. The workshop produces high-strength wire for reinforced concrete structures and sleepers, spring wire for machine builders and ordinary quality wire for the construction industry. The workshop provides 25% of the production of hardware from the total production of BMK.

The construction of wastewater treatment facilities at TsVP No. 16 was carried out in the 1950s and 1960s. At that time, the effluents discharged into the reservoir after treatment met the established requirements. At the time of the tightening of state requirements for the quality of wastewater discharged into a fishery reservoir, the treatment facilities of CVP No. 16 were outdated in terms of new environmental standards.

Before modernization, waste pickling solutions and washing waters were generated in the shop. The main mass of pollutants in wastewater was formed due to the process of etching the surface of steel rod with sulfuric acid, as a result of which the highest concentration excess in treated wastewater was observed for sulfate anion. About 100 tons of acid were passed through the pickling baths monthly.

In addition, in CVP No. 16, rinsing wastewater from technological units, equipment cooling, and storm sewage were generated. The total discharge from the industrial site of CVP No. 16 averaged 2400 m3/day.

Rinsing wastewater and spent pickling solutions flowed by gravity into the receiving chamber of acidic wastewater at the treatment plant, from which they were pumped to the ruff-mixer. Lime milk was also dosed there for neutralization. From the mixer, the neutralized water flowed through a gravity tray into the reaction chambers, where air was supplied and where the process of coagulation of pollutants in the waste water took place.

Further, water was supplied to the clarifier through a system of gravity flumes. From the clarifier, clean water was drained into a clarified water tank, from where it was pumped to the workshop for reuse. The sludge from the conical part of the clarifier was fed into the cards, from where it was periodically pumped out to the sludge trap by a pump. The clarified water from the sludge trap was discharged by gravity into the r. White.

Given today’s increased requirements for the quality of discharged effluents, there is a question of modernizing both the main process equipment of the shop and the wastewater treatment plant using the best available technologies. It was decided to develop a project for TsVP No. 16 to abandon acid pickling of scale from steel rod and switch to a new environmentally friendly technology that excludes a number of sources of wastewater pollution from the production process, which are formed during pickling and subsequent washing of wire rod with water. This, in turn, makes it possible to reduce the volume of industrial and storm sewage from the workshop from 2400 to 300 m3/day, and bring their qualitative composition in line with the requirements of environmental standards.

In addition, the introduction of acid-free technology (line for mechanical descaling) made it possible to eliminate harmful and dangerous production factors associated with acids, improve the working conditions of shop workers, and also eliminate the rejection of the workpiece (wire rod) during pickling.

From 2015 to March 2018 BMK implemented the project “Modernization of high-strength wire shop No. 16” in order to abandon the acid pickling of wire rod and switch to the best available production technologies.

The BMK Design and Engineering Department (PKO) completed a project that included the installation of new pumping stations to collect and pump all the company’s wastewater, including storm water, to a treatment station, as well as a new water intake station equipped with a modern fish protection device, as required by law today.

The site storm sewer has not been updated for many years and is no longer up to modern standards.

For a more efficient and organized collection of storm and industrial waters, the project developers proposed to strengthen the old system of “industrial drainage”, divided into three independent sections, with new modern equipment, and to reconstruct the existing catchment wells.

JSC “BMK” decided to reconstruct the treatment facilities as part of the environmental policy pursued by the enterprise. To solve a complex problem – cleaning wastewater from a metallurgical enterprise, a tender was organized among companies involved in the construction of treatment facilities. As an independent expert in evaluating the proposed technologies for wastewater treatment, the branch of the “TsLATI for the Republic of Belarus” of the Federal State Budgetary Institution “TsLATI for the Volga Federal District” was involved.

The most effective proposal for solving the task was provided by Enviro-Chemie GmbH, a German company that has been operating in the global wastewater treatment market for more than 40 years. In Russia, Enviro-Chemie GmbH has been implementing projects for 20 years, has a solid list of commissioned facilities for the treatment of wastewater of various degrees of pollution in all areas of industry.

BMK planned to send five streams of water to the treatment plant. The water of each of the flows from the production had a different degree of pollution and the total volume of wastewater entering the treatment was 300 m3/day. The presence of its own accredited laboratory is a competitive advantage of Enviro-Chemie GmbH, so the specialists had the opportunity to analyze wastewater in each of the streams. The main pollutants are metals: copper, zinc, nickel, iron. In order to achieve the water quality required for discharge into the fishery reservoir, it was decided to use a physico-chemical method of purification, since it is the most effective in removing this kind of pollution.

It was decided to place a new cleaning station measuring 12x8x6 m in the existing building of the neutralization station, having carried out the necessary reconstruction of the building itself for this. All construction and installation works related to the implementation of the project were carried out both by the services of the enterprise itself and by contractors, in the main part – Beloretsky Trading House OJSC. Installation supervision and commissioning were carried out directly by specialists from the German Enviro-Chemie GmbH.

The cleaning process is as follows. Initially, wastewater enters the equalizer, where it is mixed, and then fed into the oxidation reactor, into which sodium hypochlorite NaOCl is dosed to oxidize nitrites and ferrous iron. For an efficient oxidation process and maintaining the pH of the medium in the range from 4 to 5, h3SO4 is dosed into the reactor. The oxidation reaction is carried out automatically, dosing adjustment is carried out by measuring the Redox potential. Further, wastewater is sent to the second reactor, where the formation of insoluble metal hydroxides occurs. A reagent is added to the same reactor to improve the coagulation process. Then the water flows by gravity into the third reactor, where, in the process of dosing the flocculant, small flakes of sediment are collected into macroflocculi. A metal precipitator is also dosed into the same reactor to remove residual metal concentrations in order to achieve the required SSS. Solutions of coagulant, flocculant and metal precipitator are prepared and dosed on the Enviro Chemie Dosomat® unit operating in automatic mode. Waste water is fed to a shelf clarifier in order to effectively remove the resulting sludge. The sludge from the bottom of the shelf sump is fed into the sludge thickener, and from there it enters for dehydration in a chamber filter press.