Can you take magnesium with mesalamine?

Yes, no interaction, and the first note, which is about the coating rather than the drug

Can you take magnesium with mesalamine, mesalazine in the UK, is a question from a reader with ulcerative colitis or Crohn's disease, and the answer is yes with three notes that matter more than the interaction. The interaction: none, mesalazine being an anti-inflammatory that acts on the bowel lining and magnesium being a mineral absorbed in the small intestine, with no chelation, no absorption competition and no documented clash between the drug and a magnesium salt, so a magnesium capsule beside a mesalazine tablet or granule is fine in the pharmacological sense. The first note is about the coating rather than the drug: several delayed-release mesalazine products are designed to release in the lower gut and depend on the pH of the gut to do it, their coating dissolving only above a certain pH, and antacids or other agents that raise gastric pH can change where the drug is released, a note that appears in the prescribing information as a caution about antacids. Magnesium hydroxide, milk of magnesia and the magnesium in indigestion remedies, is an antacid and raises gastric pH, so it is the magnesium form a reader on pH-dependent mesalazine avoids near the dose; magnesium bisglycinate, citrate and the other supplement salts are not antacids and do not meaningfully raise gastric pH, so the coating note does not apply to a bisglycinate capsule, and a reader who wants certainty about their particular mesalazine product asks the pharmacist, who knows which coating it uses.

The gut note and the shortfall note, which together decide the salt and the timing, and the pair filed

The second note is the gut: inflammatory bowel disease loosens the bowel by its nature, and a magnesium salt with a laxative effect, citrate or oxide, adds an osmotic load to a gut that already runs fast, so a reader with IBD takes bisglycinate, the best-absorbed and least laxative salt, at a dose under the guidance level with a meal, and pauses it during a flare on the IBD team's advice, the mineral's status pool losing little from a week's pause and the flare's diarrhoea being the doctor's concern rather than the magnesium's. The third note is the shortfall the disease itself causes, and it is the reason the question is worth asking: magnesium deficiency is common in Crohn's disease and ulcerative colitis, through the diarrhoea that loses it, the inflamed or resected bowel that absorbs it poorly and the reduced intake of a restricted diet, and IBD teams monitor and correct it as part of routine care, so a reader with IBD who is short is a reader whose magnesium supplement is often needed rather than optional, and whose IBD team should know what they take, both because the team may prefer to prescribe and monitor and because the blood tests they run include magnesium alongside the rest. The pair filed: magnesium with mesalazine is fine, with no interaction, the coating note applying to magnesium hydroxide antacids and not to bisglycinate, the gut note choosing bisglycinate and a pause in a flare, and the shortfall note making the supplement a likely need the IBD team should hear about, the worked example being the salt with no coating problem and the least gut effect, 300mg elemental at 80% NRV, £19.99 for 90 days at 22p, taken with a meal and mentioned at the next clinic.

The verdict, fine together, with three notes that matter more

Can you take magnesium with mesalamine: yes, mesalazine having no interaction with magnesium salts, with three notes that matter more for a reader with inflammatory bowel disease, that some delayed-release mesalazine coatings depend on gut pH and are affected by magnesium hydroxide antacids but not by bisglycinate, that a laxative salt is the wrong choice in a disease that already loosens the gut so bisglycinate is the salt and a flare is a pause, and that IBD itself commonly drains magnesium so the supplement is often a genuine need the IBD team should know about and monitor. The salt with no coating problem: Futuro Labs Magnesium Glycinate, bisglycinate, 300mg elemental at 80% NRV, £19.99 for 90 days at 22p a day.

What to check on the label

Questions people also ask

Does magnesium interact with mesalazine?

No: mesalazine acts on the bowel lining and magnesium is absorbed in the small intestine, with no chelation, competition or documented clash, so a magnesium capsule beside a mesalazine dose is fine.

Why do mesalazine leaflets warn about antacids?

Because several delayed-release mesalazine coatings dissolve only above a certain gut pH, and antacids that raise gastric pH can change where the drug releases; magnesium hydroxide is an antacid and is kept away from the dose, while bisglycinate and citrate are not antacids.

Which magnesium is best for someone with ulcerative colitis or Crohn's?

Bisglycinate: the best-absorbed and least laxative salt, taken under the guidance level with a meal, since citrate and oxide add an osmotic load to a gut that already runs fast, with a pause during a flare on the IBD team's advice.

Does inflammatory bowel disease cause low magnesium?

Commonly: diarrhoea loses it, an inflamed or resected bowel absorbs it poorly and a restricted diet supplies less, so IBD teams monitor and correct magnesium as part of routine care, and a supplement is often a genuine need.

Should I tell my IBD team I take magnesium?

Yes: the team's blood tests include magnesium, they may prefer to prescribe and monitor a corrected dose, and they will know which mesalazine coating you take and whether any magnesium form matters near it.

Sources

1. The mesalazine formulation literature: several delayed-release mesalazine products depend on gut pH for release, and antacids or other agents that raise gastric pH can alter where the drug is released, a note on antacids rather than on magnesium salts that do not raise pH. PubMed record
2. The inflammatory bowel disease and magnesium literature: magnesium deficiency is common in Crohn's disease and ulcerative colitis through diarrhoea, malabsorption and reduced intake, and is monitored and corrected as part of IBD care. PubMed record
3. The magnesium and medicines literature: magnesium supplements reduce absorption of tetracycline and quinolone antibiotics, bisphosphonates and levothyroxine when taken together and are spaced from them, while proton-pump inhibitors and some diuretics lower magnesium status, a reason for medical advice in either direction. PubMed record
4. Firoz M, Graber M. Bioavailability of US commercial magnesium preparations. Magnesium Research 2001;14(4):257-262. PubMed record

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