Milk of Magnesia Does Not Cause Liver Injury
Milk of Magnesia (magnesium hydroxide) is not associated with hepatotoxicity and does not cause liver injury. This medication is safe to use from a hepatic standpoint, even in patients with existing liver disease.
Safety Profile in Liver Disease
- Magnesium deficiency is commonly associated with liver diseases such as cirrhosis, alcoholic liver disease, and viral hepatitis, rather than magnesium causing liver damage 1
- Magnesium supplementation can actually improve liver function in certain liver diseases and may have protective effects against ischemia-reperfusion injury during liver transplantation 1, 2
- In patients with alcoholic liver disease, magnesium deficiency (along with zinc and vitamin E deficiencies) may actually accelerate liver disease progression 3
Mechanism of Action and Systemic Absorption
- Milk of Magnesia works through an osmotic mechanism in the intestinal lumen, drawing water into the bowel to produce a laxative effect 4, 5
- The poorly absorbable magnesium ions exert their effect locally in the gastrointestinal tract with minimal systemic absorption under normal circumstances 5
- The primary safety concern with magnesium-containing laxatives is hypermagnesemia in patients with significant renal impairment, not hepatotoxicity 4, 6
Critical Safety Considerations (Renal, Not Hepatic)
- Magnesium citrate and magnesium hydroxide are contraindicated in patients with significant renal impairment due to risk of life-threatening hypermagnesemia 4, 6
- Severe hypermagnesemia can manifest with bradycardia, asystole, shock, hypothermia, and respiratory failure in patients with end-stage renal disease 6
- Ensure adequate hydration during treatment to minimize any risk of magnesium accumulation 4
Clinical Context for Drug-Induced Liver Injury
When evaluating medications for hepatotoxicity, the focus should be on:
- Drugs other than acetaminophen rarely cause dose-related hepatotoxicity, with most idiosyncratic reactions occurring within the first 6 months of use 3
- Certain herbal preparations and nutritional supplements have been found to cause liver injury and should be included in medication history 3
- Methotrexate, pyrazinamide, and various other prescription medications are recognized hepatotoxins requiring monitoring 3
Milk of Magnesia is not among the medications that require hepatic monitoring or dose adjustment in liver disease.