What is happening. Magnesium-containing supplements and antacids can reduce cefpodoxime absorption. Magnesium hydroxide antacids in particular raise gastric pH, and because cefpodoxime proxetil requires gastric acidity for dissolution, co-administration can lower antibiotic bioavailability. Magnesium glycinate is a milder, well-buffered form but the timing principle still applies during an antibiotic course.
Mechanism. Antacid magnesium salts increase intragastric pH, reducing dissolution and absorption of acid-dependent cefpodoxime proxetil; divalent magnesium may also chelate beta-lactam drug in the gut lumen.
Recommendation. Separate dosing by at least 2 hours, taking cefpodoxime first. Avoid magnesium hydroxide antacids near the time of the antibiotic dose. Magnesium glycinate taken at bedtime, away from the antibiotic, is unlikely to interfere.