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magnesium sulfate (MgSO4)

Indications: 1) prevention & treatment of hypomagnesemia 2) pre-eclampsia, eclampsia 3) short-term treatment of postmyocardial infarction 4) torsades de pointes 5) pediatric acute nephritis 6) prevention of cerebral palsy in premature infants? [4] (perinatal administration to mother) Contraindications: 1) heart block 2) severe renal insufficiency Benefit/risk: - pre-eclampsia - reduces risk of progression from pre-eclampsia to eclampsia (50%) [5] - number needed to treat (NNT) = 90 for prevention of seizure [5] - may reduce risk of maternal mortality - no benefit for infant [5] - 25% of women report adverse events [5] - flushing is most common adverse effect - number needed to harm = 200 for respiratory depression - number needed to harm = 37 to necessitate C-section [5] - severe asthma attack [6] - NNT = 3 to prevent hospitalization - no benefit is asthma attack is less than severe - no adverse events noted [6] Dosage: 1) 1 g IV every 6 hours for 4 doses 2) 2 g in 50 mL D5W/NS IV over 20 min 3) severe cases may require 8-12 g/day in divided doses 4) maximum infusion rate 2 g/hr to avoid hypotension Adverse effects: 1) depressed CNS 2) blocked peripheral neuromuscular transmission 3) flushing 4) somnolence 5) respiratory paralysis 6) may accumulate in renally impaired patients 7) diarrhea 8) depressed deep tendon reflexes Drug interactions: 1) additive CNS depression when used with: a) barbiturates b) opiates c) general anesthetics d) other CNS depressants 2) increased neuromuscular blockage when used with neuromuscular blocking agent 3) use with caution with cardiac glycosides Mechanism of action: cofactor in enzymatic reactions

General

pharmaceutical magnesium

Properties

MISC-INFO: elimination route KIDNEY pregnancy-category A safety in lactation +

Database Correlations

PUBCHEM cid=24083

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  4. Rouse DJ et al. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008 Aug 28; 359:895. PMID: 18753646 - Stanley FJ and Crowther C. Antenatal magnesium sulfate for neuroprotection before preterm birth? N Engl J Med 2008 Aug 28; 359:962. PMID: 18753653
  5. The NNT: Magnesium Sulfate for Women with Preeclampsia http://www.thennt.com/nnt/magnesium-for-pre-eclampia/ - Duley L, Glmezoglu AM, Henderson-Smart DJ, Chou D Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev. 2010 Nov 10;(11):CD000025 PMID: 21069663
  6. The NNT: Intravenous Magnesium Sulfate Given During an Asthma Attack. http://www.thennt.com/nnt/magnesium-sulfate-for-asthma-attack/ - Rowe BH, Bretzlaff JA, Bourdon C, Bota GW, Camargo CA Jr Magnesium sulfate for treating exacerbations of acute asthma in the emergency department. Cochrane Database Syst Rev. 2000;(2):CD001490. PMID: 10796650

Component-of

ascorbate/biotin/cobalamin/copper sulfate/ferrous fumarate/folic acid/magnesium sulfate/manganese sulfate/nicotinic acid/pantothenate/polysaccharide iron complex/pyridoxine/riboflavin/thiamine/zinc sulfate ascorbate/cholecalciferol/cobalamin/copper sulfate/ferrous fumarate/folic acid/kelp/magnesium oxide/magnesium sulfate/nicotinamide/pyridoxine/riboflavin/vitamin a/zinc sulfate ascorbate/cobalamin/copper sulfate/ferrous fumarate/folic acid/magnesium sulfate/manganese sulfate/nicotinamide/pantothenate/polysaccharide iron complex/pyridoxine/riboflavin/thiamine/zinc sulfate ascorbate/cobalamin/copper sulfate/ferrous fumarate/folic acid/magnesium sulfate/manganese sulfate/nicotinamide/pantothenate/pyridoxine/riboflavin/thiamine/zinc sulfate ascorbate/cobalamin/copper/copper sulfate/ferrous fumarate/folic acid/magnesium sulfate/manganese/manganese sulfate/nicotinamide/pantothenate/pyridoxine/riboflavin/thiamine/zinc sulfate calcium chloride/glucose/magnesium sulfate/potassium chloride/sodium bicarbonate/sodium chloride/sodium phosphate cobalamin/magnesium sulfate/manganese sulfate/nicotinamide/panthenol/pyridoxine/riboflavin/thiamine/zinc sulfate cobalamin/magnesium sulfate/manganese/manganese sulfate/nicotinamide/panthenol/pyridoxine/riboflavin/thiamine/zinc sulfate Elliotts B Solution (buffered intrathecal electrolyte/dextrose injection) magnesium sulfate/polyethylene glycol/potassium chloride/sodium bicarbonate/sodium chloride magnesium sulfate/potassium chloride/potassium phosphate/sodium chloride/sodium phosphate magnesium sulfate/potassium chloride/sodium sulfate (Sutab) magnesium sulfate/potassium sulfate magnesium sulfate/potassium sulfate/prolyl endopeptidase magnesium sulfate/potassium sulfate/sodium sulfate (Suprep)