Can I take Esomeprazole and Magnesium together?

Why this happens

Esomeprazole reduces stomach acid. The body needs a certain level of acidity to absorb magnesium from food and supplements efficiently. Over time, this reduced absorption can deplete the body's magnesium stores. Furthermore, magnesium-containing antacids can physically bind to or change the environment for esomeprazole, potentially reducing its effectiveness if taken at the exact same time.

What you should do

If you are taking esomeprazole long-term, your doctor may want to check your magnesium levels with a blood test. If you are taking a magnesium supplement or antacid, try to leave a gap of at least 2 hours between taking it and your esomeprazole dose. Seek medical advice if you experience muscle twitches, tremors, or a racing heart.

Important precautions

Severe diarrhoea

Esomeprazole can increase your risk of serious bowel infections, such as C. difficile. If you develop severe or persistent watery diarrhoea, fever, or stomach pain, contact your doctor immediately.

Low magnesium levels (hypomagnesaemia)

Taking esomeprazole for more than 3 months can cause your blood magnesium levels to drop. This is particularly dangerous if you are already taking magnesium supplements or medicines like digoxin, as it can lead to severe fatigue, muscle spasms, or an irregular heartbeat. Your doctor may need to monitor your levels via blood tests.

Long-term use (over 1 year)

Taking esomeprazole for a long time can lead to weakened bones (osteoporosis) and increased risk of fractures, as well as low magnesium levels in your blood. Your doctor may need to monitor your mineral levels.

Severe kidney or liver disease

Your doctor may need to prescribe a lower dose, as your body will take longer to clear esomeprazole.

Kidney disease

If you have kidney problems, you must not take magnesium supplements without medical supervision, as your kidneys may not be able to clear excess magnesium from your blood, leading to toxic levels.

Masking stomach cancer symptoms

Esomeprazole can hide the symptoms of stomach cancer. You must tell your doctor if you have unexplained weight loss, persistent vomiting, or difficulty swallowing before starting this medicine.

Food and drink warnings

Alcohol

While alcohol does not directly interact with esomeprazole, it can increase stomach acid production and irritate the stomach lining, which may worsen the symptoms you are taking esomeprazole to treat.

It is best to avoid or strictly limit alcohol when taking magnesium. Alcohol acts as a diuretic, which can increase the amount of magnesium your body loses through urine, potentially making the supplement less effective. Additionally, chronic alcohol use can lead to magnesium deficiency.

Dairy products and high-calcium foods

Large amounts of calcium (found in milk, cheese, and yoghurt) can interfere with how your body absorbs magnesium. If you are taking a magnesium supplement, try to avoid taking it at the same time as a high-calcium meal or calcium supplement.

Caffeine

Caffeine (found in coffee, tea, and some fizzy drinks) can trigger or worsen acid reflux and heartburn. This may make esomeprazole less effective at managing your symptoms. It is best to limit caffeine intake around the time you take magnesium. Like alcohol, caffeine has a mild diuretic effect and can increase the excretion of magnesium through the kidneys.

High-fibre foods (Bran, whole grains)

Foods very high in fibre or phytates (found in whole grains and beans) can bind to magnesium in the gut and reduce the amount your body absorbs. It is best to take magnesium supplements on an empty stomach or away from very high-fibre meals.

Using other medicines

Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Disclaimer

This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.