MINERALS

Potassium
Overview: Potassium is a very important mineral for the proper function of all cells, tissues, and organs in the human body. It is also an electrolyte, a substance that conducts electricity in the body, along with sodium, chloride, calcium, and magnesium. Potassium is crucial to heart function and plays a key role in skeletal and smooth muscle contraction, making it important for normal digestive and muscular function, too. Many foods contain potassium, including all meats, some types of fish (such as salmon, cod, and flounder), and many fruits, vegetables, and legumes. Dairy products are also good sources of potassium. Having too much potassium in the blood is called hyperkalemia; having too little is known as hypokalemia. Keeping the right potassium balance in the body depends on the amount of sodium and magnesium in the blood. Too much sodium -common in Western diets that use a lot of salt -- may increase the need for potassium. Diarrhea, vomiting, excessive sweating, malnutrition, malabsorption syndromes (such as Crohn's disease) can also cause potassium deficiency, as well as use of a kind of heart medicine called loop diuretics. Most people get all of the potassium they need from a healthy diet rich in vegetables and fruits. Older people have a greater risk of hyperkalemia because our kidneys are less efficient at eliminating potassium as we age. Older people should be careful when taking medication that may affect potassium levels, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and ACE inhibitors (see section on Interactions). Whatever your age, talk to your doctor before taking potassium supplements. Bone Health At least one study shows a positive link between a diet rich in potassium and bone health. More research is needed to determine whether a diet high in potassium can reduce bone turnover in people. Hypokalemia The most important use of potassium is to treat the symptoms of hypokalemia (low potassium), which include weakness, lack of energy, muscle cramps, stomach

disturbances, an irregular heartbeat, and an abnormal EKG (electrocardiogram, a test that measures heart function). Hypokalemia is usually caused by the body losing too much potassium in the urine or intestines; it's rarely caused by a lack of potassium in the diet. Hypokalemia can be life-threatening and should always be treated by a doctor. High Blood Pressure Some studies have linked low levels of potassium in the diet with high blood pressure. And there is some evidence that potassium supplements might cause a slight drop in blood pressure. But not all studies agree -- two large studies found no effect on blood pressure. It may be that taking potassium only helps lower blood pressure if you're not getting enough of this mineral to start with. Before taking potassium or any supplement for high blood pressure, talk to your doctor. Stroke People who get a lot of potassium in their diet have a lower risk of stroke. However, potassium supplements don't seem to have the same benefit. Inflammatory Bowel Disease (IBD) People with IBD (ulcerative colitis or Crohn's disease) often have trouble absorbing nutrients from their intestine, and may have low levels of potassium and other important nutrients. If you have IBD, your doctor may check your potassium levels and recommend a supplement. Dietary Sources: Good sources of potassium include bananas, citrus juices (such as orange juice), avocados, cantaloupes, tomatoes, potatoes, lima beans, flounder, salmon, cod, chicken, and other meats. Available Forms: Several potassium supplements are on the market, including potassium acetate, potassium bicarbonate, potassium citrate, potassium chloride, and potassium gluconate. It is available in tablets, capsules, effervescent tablets, powders, and liquids. Potassium can also be found in multivitamins. How to Take It:

Potassium supplements, other than the small amount included in a multivitamin, should be taken only under your doctor's supervision. Do not give potassium supplements to a child unless your doctor tells you to. The recommended daily intakes of dietary potassium are listed below: Pediatric

Infants birth - 6 months: 500 mg or 13 mEq Infants 7 months - 12 months: 700 mg or 18 mEq Children 1 year: 1,000 mg or 26 mEq Children 2 - 5 years: 1,400 mg or 36 mEq Children 6 - 9 years: 1,600 mg or 41 mEq Children over 10 years: 2,000 mg or 51 mEq

Adult

2,000 mg or 51 Meq, including for pregnant and nursing women

Precautions: Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a knowledgeable health care provider. Older adults should talk to their doctor before taking potassium supplements. Side effects can include diarrhea, stomach irritation, and nausea. At higher doses, muscle weakness, slowed heart rate, and abnormal heart rhythm may occur. Contact your health care provider if you develop severe stomach pain, irregular heartbeat, chest pain, or other symptoms. People with hyperkalemia or kidney disease should not take potassium supplements. People who take ACE inhibitors, potassium-sparing diuretics, or the antibiotic trimethoprim and sulfamethoxazole (Bactrim, Septra) should not take potassium. Possible Interactions: If you are being treated with any of the following medications, you should not use potassium without first talking to your health care provider.

The following medications may cause potassium levels to rise:

Nonsteroidal anti-inflammatory drugs (NSAIDs): People who have poor kidney function and take NSAIDs are at higher risk. ACE inhibitors: These drugs treat high blood pressure, heart disease, diabetes, some chronic kidney diseases, migraines, and scleroderma. People who take ACE inhibitors and also take NSAIDs, potassium-sparing diuretics, or salt substitutes may be particularly vulnerable to hyperkalemia (too much potassium). A rise in potassium from ACE inhibitors may also be more likely in people with poor kidney function and diabetes. ACE inhibitors include:
o o o o o o o o o

Benazepril (Lotensin) Captopril (Capoten) Enlapril (Vasotec) Fosinopril (Monopril) Lisinopril (Zestril) Moexipril (Univasc) Peridopril (Aceon) Ramipril (Altace) Trandolapril (Mavik)

Heparin (used for blood clots) Cyclosporine (used to suppress the immune system) Trimethoprimand sulfamethoxazole, called Bactrim or Septra (an antibiotic) Beta-blockers: Used to treat high blood pressure, glaucoma, migraines
o o o

Atenolol (Tenormin) Metoprolol (Lopressor, Toprol-XL) Propranolol (Inderal)

The following medications may cause potassium levels to decrease:

Thiazide diuretics
o o o o

Hydrochlorothiazide Chlorothiazide (Diuril) Indapamide (Lozol) Metolzaone (Zaroxolyn) Furosemide (Lasix) Bumetanide (Bumex) Torsemide (Demadex) Ethacrynic acid (Edecrin)

Loop diuretics
o o o o

Corticosteroids Amphotericin B (Fungizone) Antacids Insulin Fluconazole (Diflucan): Used to treat fungal infections Theophylline (TheoDur): Used for asthma Laxatives

If you are taking any of these medications, it is important for your doctor to test your potassium levels to see whether or not you need a supplement. Do not start taking a supplement on your own. Other potential interactions include: Digoxin -- Low blood levels of potassium increase the likelihood of toxic effects from digoxin, a medication used to treat abnormal heart rhythms and heart failure. Your doctor will test your potassium levels to make sure they stay normal.

Phosphorus
Overview: Next to calcium, phosphorus is the most abundant mineral in the body. These two important nutrients work closely together to build strong bones and teeth. About 85% of phosphorus in the body can be found in bones and teeth, but it is also present in cells and tissues throughout the body. Phosphorus helps filter out waste in the kidneys and plays an essential role in how the body stores and uses energy. It also helps reduce muscle pain after a hard workout. Phosphorus is needed for the growth, maintenance, and repair of all tissues and cells, and for the production of the genetic building blocks, DNA and RNA. Phosphorus is also needed to help balance and use other vitamins and minerals, including vitamin D, iodine, magnesium, and zinc. Most people get plenty of phosphorus in their diets. The mineral is found in milk, grains, and protein-rich foods. Some health conditions such as diabetes, starvation, and alcoholism can cause levels of phosphorus in the body to fall. The same is true of conditions that make it hard for people to absorb nutrients, such as Crohn's disease and celiac disease. Some medications can cause phosphorus levels to drop, including some antacids and diuretics (water pills). Symptoms of phosphorus deficiency include loss of appetite, anxiety, bone pain, fragile bones, stiff joints,

fatigue, irregular breathing, irritability, numbness, weakness, and weight change. In children, decreased growth and poor bone and tooth development may occur. Having too much phosphorus in the body is actually more common and more worrisome than having too little. Too much phosphorus is generally caused by kidney disease or by consuming too much dietary phosphorus and not enough dietary calcium. As the amount of phosphorus you eat rises, so does the need for calcium. The delicate balance between calcium and phosphorus is necessary for proper bone density and prevention of osteoporosis. Uses: Phosphates (phosphorus) are used clinically to treat the following:

Hypophosphatemia, low levels of phosphorus in the body Hypercalcemia, high blood calcium levels Calcium-based kidney stones

These conditions require a doctor's care. Phosphates are also used in enemas as laxatives. Most people get plenty of phosphorus in their diets. Sometimes athletes use phosphate supplements before competitions or heavy workouts to help reduce muscle pain and fatigue, although it's not clear how much it helps or if it improves performance. Dietary Sources: Protein-rich foods, such as meat, poultry, fish, eggs, dairy products, nuts, and legumes, are good sources of phosphorus. Other sources include whole grains, hard potatoes, dried fruit, garlic cloves, and carbonated beverages. Available Forms: Elemental phosphorus is a white or yellow waxy substance that burns on contact with air. It is highly toxic and is only used in medicine as a homeopathic treatment. Elemental phosphorus should be taken only under the guidance of a qualified professional. Instead, health care providers may use one or more of the following inorganic phosphates, which are not toxic:

Dibasic potassium phosphate Monobasic potassium phosphate

Dibasic sodium phosphate Monobasic sodium phosphate Tribasic sodium phosphate Phosphatidyl choline Phosphatidyl serine

How to Take It: Recommended dietary allowances (RDAs) for dietary phosphorous are listed below. Most people do not need to take phosphorus supplements. Pediatric

Infants 0 - 6 months: 100 mg daily Infants 7 - 12 months: 275 mg Children 1 - 3 years: 460 mg Children 4 - 8 years: 500 mg Children 9 - 18 years: 1,250 mg

Adult

Adults 19 years and older: 700 mg Pregnant and breastfeeding females under 18 years: 1,250 mg Pregnant and breastfeeding females 19 years and older: 700 mg

Precautions: Because of the potential for side effects and interactions with prescription and nonprescription medications, dietary supplements should be taken only under the supervision of a knowledgeable health care provider. Too much phosphate can be toxic. It can cause diarrhea and calcification (hardening) of organs and soft tissue, and can interfere with the body's ability to use iron, calcium, magnesium, and zinc. Athletes and others taking supplements that contain phosphate should only do so occasionally and with the guidance and direction of a health care provider. Nutritionists recommend a balance of calcium and phosphorus in the diet. The typical Western diet, however, contains roughly 2 - 4 times more phosphorus than calcium. Meat and poultry contain 10 - 20 times as much phosphorus as calcium, and carbonated beverages such as colas have as much as 500 mg of phosphorus in

one serving. When there is more phosphorus than calcium in the body, the body will use calcium stored in bones. This can cause osteoporosis (brittle bones) and lead to gum and teeth problems. A balance of dietary calcium and phosphorus can lower the risk of osteoporosis. Possible Interactions: If you are currently being treated with any of the following medications, you should not use phosphorus preparations without first talking with your health care provider. Alcohol -- Alcohol may leach phosphorus from the bones and cause low levels in the body. Antacids -- Antacids containing aluminum, calcium, or magnesium (such as Mylanta, Amphojel, Maalox, Riopan, and Alternagel) can bind phosphate in the gut and prevent the body from absorbing it. When these antacids are used long-term, this can lead to low phosphate levels (hypophosphatemia). Anticonvulsants -- Some anticonvulsants (including phenobarbital and carbamazepine or Tegretol) may lower phosphorus levels and increase levels of alkaline phosphatase, an enzyme that helps remove phosphate from the body. Bile acid sequestrants -- Bile acid sequestrants are drugs that lower cholesterol. They can decrease the oral absorption of phosphates from the diet or from supplements. Oral phosphate supplements should be taken at least 1 hour before or 4 hours after these drugs. Bile acid sequestrants include:

Cholestyramine (Questran) Colestipol (Colestid)

Corticosteroids -- Corticosteroids, including prednisone or methylprednisolone (Medrol), may increase phosphorus levels in the urine. Insulin -- High doses of insulin may lower blood levels of phosphorus in people with diabetic ketoacidosis (a condition caused by severe insulin insufficiency). Potassium supplements or potassium-sparing diuretics -- Using phosphorus supplements along with potassium supplements or potassium-sparing diuretics may result in too much potassium in the blood (hyperkalemia). Hyperkalemia can be a serious problem, resulting in life-threatening heart rhythm abnormalities (arrhythmias). Potassium-sparing diuretics include:

Spironolactone (Aldactone) Triamterene (Dyrenium)

ACE inhibitors (blood pressure medication) -- Drugs called angiotensinconverting enzyme (ACE) inhibitors, used to treat high blood pressure, may lower phosphorus levels. They include:

Benazepril (Lotensin) Captopril (Capoten) Enalapril (Vasotec) Fosinopril (Monopril) Lisinopril (Zestril, Prinivil) Quinapril (Accupril) Ramipril (Altace)

Other drugs -- Other drugs may lower phosphorus levels. They include cyclosporine (used to suppress the immune system), cardiac glycosides (digoxin or Lanoxin), heparins (blood-thinning drugs), and non-steroidal anti-inflammatory drugs (such as ibuprofen or Advil). Salt substitutes also contain high levels of potassium and may lower phosphorus levels if used long-term.

Magnesium
Overview: Every organ in the body -- especially the heart, muscles, and kidneys -- needs the mineral magnesium. It also contributes to the makeup of teeth and bones. Most important, it activates enzymes, contributes to energy production, and helps regulate calcium levels as well as copper, zinc, potassium, vitamin D, and other important nutrients in the body. You can get magnesium from many foods. However, most people in the United States probably do not get as much magnesium as they should from their diet. Foods rich in magnesium include whole grains, nuts, and green vegetables. Green leafy vegetables are particularly good sources of magnesium. Although you may not get enough magnesium from your diet, it' s rare to be truly deficient in magnesium. Certain medical conditions, however, can upset the body's magnesium balance. For example, an intestinal virus that causes vomiting or diarrhea can cause temporary magnesium deficiencies. Some gastrointestinal

diseases (such as irritable bowel syndrome or IBS and ulcerative colitis), diabetes, pancreatitis, hyperthyroidism (high thyroid hormone levels), kidney disease, and taking diuretics can lead to deficiencies. Too much coffee, soda, salt, or alcohol as well as heavy menstrual periods, excessive sweating, and prolonged stress can also lower magnesium levels. Symptoms of magnesium deficiency may include agitation and anxiety, restless leg syndrome (RLS), sleep disorders, irritability, nausea and vomiting, abnormal heart rhythms, low blood pressure, confusion, muscle spasm and weakness, hyperventilation, insomnia, poor nail growth, and even seizures. Uses: Getting enough magnesium may help conventional treatment for the following conditions work better: Asthma Several studies show that intravenous (IV) magnesium and magnesium inhaled through a nebulizer can help treat acute attacks of asthma in children aged 6 - 18 as well as adults. But there is no evidence that taking oral magnesium helps control asthma symptoms. Low levels of magnesium may increase risk of developing asthma. A population-based clinical study of more than 2,500 children aged 11 - 19 years found that low dietary magnesium intake may be associated with risk of asthma. The same was found in a group of more than 2,600 adults aged 18 - 70. Diabetes People who have type 2 diabetes often have low levels of magnesium in the blood. A large clinical study of over 2000 people found that getting more magnesium in the diet may help protect against developing type 2 diabetes. Some -- though not all -- studies suggest that taking magnesium supplements may help blood sugar control and insulin sensitivity in people with diabetes or prediabetes. Fibromyalgia A small preliminary clinical study of 24 people with fibromyalgia suggest that a proprietary tablet containing both malic acid and magnesium may improve pain and tenderness associated with fibromyalgia when taken for at least 2 months. Other studies suggest the combination of calcium and magnesium may be helpful for some people with fibromyalgia.

However, a review article evaluating a number of studies found that magnesium with malic acid offered no pain relief. More studies are needed. Noise-related hearing loss One study suggests that taking magnesium may prevent temporary or permanent hearing loss due to very loud noise. Arrhythmia and heart failure Magnesium is essential to heart health. It helps maintain a normal heart rhythm and is sometimes given intravenously (IV) in the hospital to reduce the chance of atrial fibrillation and cardiac arrhythmia (irregular heartbeat). People with congestive heart failure (CHF) are often at risk for developing cardiac arrhythmia. For this reason, your doctor may decide that magnesium should be a part of the treatment of CHF. One well-designed study found that taking magnesium orotate for a year reduced symptoms and improved survival rates compared to placebo in people with CHF. Magnesium and calcium need to work together at very precise ratios to ensure your heart functions properly. If you have a cardiac history, talk to your doctor before taking magnesium supplements. Results of studies using magnesium to treat heart attack survivors, however, have been mixed. Some have reported lower death rates as well as fewer arrhythmias and improved blood pressure when magnesium is used as part of the treatment following a heart attack. But one study found that magnesium slightly increased the risk of sudden death, chance of another heart attack, or need for bypass surgery in the year after a heart attack. If you have had a heart attack, your doctor will decide if magnesium supplementation, either IV or orally, is right for you. High blood pressure Eating low-fat dairy products along with lots of fruits and vegetables on a regular basis is associated with lower blood pressure. All of these foods are rich in magnesium as well as calcium and potassium. A large clinical study of more than 8,500 women found that a higher intake of dietary magnesium may decrease the risk of high blood pressure in women. A few studies also suggest that magnesium supplements may help lower blood pressure, although not all studies agree. Migraine headache A few studies suggest that taking magnesium supplements may help prevent migraine headaches. In addition, a few clinical studies suggest that magnesium

supplements may shorten the duration of a migraine and reduce the amount of medication needed. People who have migraine headaches tend to have lower levels of magnesium compared to those with tension headaches or no headaches at all. Some experts suggest combining magnesium with the herb feverfew along with vitamin B2 (riboflavin) may be helpful when you have a headache. However, some studies suggest that magnesium sulfate may be less effective than prescription medications for preventing migraines in those who have 3 or more headaches per month. The only exception to this may be women who get migraine headaches around the time of their period. Osteoporosis Not getting enough calcium, vitamin D, magnesium, and other micronutrients may play a role in the development of osteoporosis. To prevent osteoporosis, it is important to get enough calcium, magnesium, and vitamin D; to eat a wellbalanced diet; and to do weight-bearing exercises throughout life. Preeclampsia and eclampsia Preeclampsia is characterized by a sharp rise in blood pressure during the third trimester of pregnancy. Women with preeclampsia may develop seizures, which is then called eclampsia. Magnesium, given in the hospital intravenously (IV), is the treatment of choice to prevent or treat seizures associated with eclampsia or to prevent complications from preeclampsia. Premenstrual syndrome (PMS) Scientific studies suggest that magnesium supplements may help relieve symptoms associated with PMS, particularly bloating, insomnia, leg swelling, weight gain, and breast tenderness. One study suggests that a combination of magnesium and vitamin B6 may work better than either one alone. Restless legs syndrome A small clinical study including only 10 patients found that magnesium improved insomnia related to restless legs syndrome (a disorder characterized by uncomfortable sensations in the legs, which are worse during periods of inactivity or rest or while sitting or lying down). Dietary Sources:

Rich sources of magnesium include tofu, legumes, whole grains, green leafy vegetables, wheat bran, Brazil nuts, soybean flour, almonds, cashews, blackstrap molasses, pumpkin and squash seeds, pine nuts, and black walnuts. Other good dietary sources of this mineral include peanuts, whole wheat flour, oat flour, beet greens, spinach, pistachio nuts, shredded wheat, bran cereals, oatmeal, bananas, and baked potatoes (with skin), chocolate, and cocoa powder. Many herbs, spices, and seaweeds supply magnesium, such as agar seaweed, coriander, dill weed, celery seed, sage, dried mustard, basil, cocoa powder, fennel seed, savory, cumin seed, tarragon, marjoram, poppy seed. Available Forms: Magnesium is available in many forms. Recommended types include magnesium citrate, magnesium gluconate, and magnesium lactate, all of which are more easily absorbed into the body than other forms. Time-release preparations may improve absorption. Ask your health care provider. Other familiar sources are magnesium hydroxide (often used as a laxative or antacid) and magnesium sulfate (generally used orally as a laxative or in multivitamins, or added to a bath). Some magnesium can be absorbed through the skin. How to Take It: Be sure to check with your health care provider before taking magnesium supplements and before considering them for a child. Under certain circumstances, such as certain heart arrhythmias or preeclampsia, a doctor will give magnesium intravenously (IV) in the hospital. It is a good idea to take a B vitamin complex, or a multivitamin containing B vitamins, because the level of vitamin B6 in the body determines how much magnesium will be absorbed into the cells. Dosages are based on the dietary reference intakes (DRIs) issued from the Food and Nutrition Board of the United States Government's Office of Dietary Supplements, part of the National Institutes of Health. Pediatric Do not give magnesium supplements to a child without a doctor' s supervision.

Infants and children up to 3 years of age: 40 - 80 mg daily

Children 4 - 6 years of age: 120 mg daily Children 7 - 10 years of age: 170 mg daily

Adult

Adolescent and adult males: 270 - 400 mg daily Adolescent and adult females: 280 - 300 mg daily Pregnant females: 320 mg daily Breastfeeding females: 340 - 335 mg daily

A person' s need for magnesium increases during pregnancy, recovery from surgery and illnesses, and athletic training. Precautions: Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable health care provider. People with heart or kidney disease should not take magnesium supplements except under their doctor's supervision. It is very rare to overdose on magnesium from food. However, people who ingest large amounts of milk of magnesia (as a laxative or antacid) or epsom salts (as a laxative or tonic) may overdose, especially if they have kidney problems. Too much magnesium can cause serious health problems, including nausea, vomiting, severely lowered blood pressure, slowed heart rate, deficiencies of other minerals, confusion, coma, and even death. More common side effects from magnesium include upset stomach and diarrhea. Magnesium competes with calcium for absorption and can cause a calcium deficiency if calcium levels are already low. Some medications may lower magnesium levels in the body. These include chemotherapy drugs, diuretics, digoxin (Lanoxin), hormonal supplementation, steroids, and certain antibiotics. Possible Interactions: If you are currently being treated with any of the following medications, you should not use magnesium without first talking to your health care provider.

Antibiotics -- Taking magnesium supplements may reduce the absorption of quinolone antibiotics, tetracycline antibiotics, and nitrofurantoin (Macrodandin). Magnesium should be taken 1 hour before or 2 hours after taking these medications. Quinolone and tetracycline antibiotics include:

Ciprofloxacin (Cipro) Moxifloxacin (Avelox) Tetracycline (Sumycin) Doxycycline (Vibramycin) Minocycline (Minocin)

Blood Pressure Medications, Calcium Channel Blockers -- Magnesium may increase the risk of negative side effects (such as dizziness, nausea, and fluid retention) from calcium channel blockers (particularly nifedipine or Procardia) in pregnant women. Other calcium channel blockers include:

Aamlodipine (Norvasc) Diltiazem (Cardizem) Felodipine (Plendil) Verapamil (Calan)

Medications for diabetes -- Magnesium hydroxide, commonly found in antacids such as Alternagel, may increase the absorption of some medications used to control blood sugar levels (particularly glipizide or Glucatrol and glyburide or Micronase). If you take these medications to control blood sugar, your doctor may need to adjust your dose. Digoxin (Lanoxin) -- Low blood levels of magnesium can increase negative effects from digoxin, including heart palpitations and nausea. In addition, digoxin can cause more magnesium to be lost in the urine. A doctor will monitor magnesium levels in people taking digoxin to see whether they need a magnesium supplement. Diuretics -- Two types of diuretics known as loop (such as furosemide or Lasix) and thiazide (including hydrochlorothiazide) diuretics can lower magnesium levels. For this reason, doctors who prescribe diuretics may recommend magnesium supplements as well. Hormone Replacement Therapy -- Magnesium levels tend to decrease during menopause. Clinical studies suggest, however, that hormone replacement therapy may help prevent the loss of this mineral. Postmenopausal women or those taking

hormone replacement therapy should talk with a health care provider about the risks and benefits of magnesium supplementation. Levothyroxine -- There have been case reports of magnesium-containing antacids reducing the effectiveness of levothyroxine, a medication that treats underactive thyroid. Penicillamine -- Penicillamine, a medication used to treat Wilson's disease (a condition characterized by high levels of copper in the body) and rheumatoid arthritis, can inactivate magnesium, particularly when high doses of the drug are used over a long period of time. Supplementation with magnesium and other nutrients may reduce side effects associated with penicillamine. If you take penicillamine, a health care provider can determine whether magnesium supplements are right for you. Tiludronate (Skelid) and Alendronate (Fosamax) -- Magnesium may interfere with absorption of medications used in osteoporosis, including alendronate (Fosamax). Magnesium or antacids containing magnesium should be taken 1 hour before or 2 hours after taking these medications. Others -- Aminoglycoside antibiotics (such as gentamicin and tobramycin), thiazide diuretics (such as hydrochlorothiazide), loop diuretics (such as furosemide and bumetanide), amphotericin B, corticosteroids (prednisone or Deltasone), antacids, and insulin may lower magnesium levels. Please refer to the depletions monographs on some of these medications for more information.