Magnezijum sulfat (Magnesii sulfas heptahydricum solutio)
MINERALNI PREPARATI MAGNEZIJUMA – MAGNEZIJUM SULFAT:
RASTVORI MAGNEZIJUM SULFATA 10% – 40% (100 – 400 mg/ g),
MAGNEZIJUM SULFAT 100% monokomponentni prašak.
Magnesii sulfas solutio 10% – 40% (Magnesium sulfas heptahydricum),
Magnesii sulfas pulvis.
– namenjeni za prevenciju infarkta miokarda i hipomagnezijemije, kod hipomagneziemije (E83.4) različite etiologije, kao izvori elektrolita, laksativi. Preparat u kom je magnezijum (Mg2+) potpuno jonizovan, sa konstantom stabilnosti 0.
MINERALNI PREPARATI MAGNEZIJUMA – MAGNEZIJUM SULFAT:
RASTVORI MAGNEZIJUM SULFATA 10% – 40% (100 – 400 mg/ g),
MAGNEZIJUM SULFAT 100% monokomponentni prašak.
Magnesii sulfas solutio 10% – 40% (Magnesium sulfas heptahydricum),
Magnesii sulfas pulvis.
A06AD04 – droge za konstipaciju, osmotski aktivni laksativi, magnezijum sulfat,
A12CC02 – mineralni suplementi, magnezijum sulfat,
B05XA05 – rastvori elektrolita,
D11AX05 – dermatologici,
V04CC02 – dijagnostici, test prolaznosti žučnih kanala,
V60AB – monokomponentni homeopatik,
V60B – antropozofik.
U skladu sa:
Eu. Ph. 8, 01.07.2015. monografijom:01/2008:0044 corrected 6.0: 0044 Magnesium sulfate heptahydrate (Magnesii sulfas heptahydricus)
Pharmacopée française 2002 ANSM: MAGNÉSIUM (SULFATE DE) HEPTAHYDRATÉ POUR PRÉPARATIONS HOMÉOPATHIQUES
MAGNESIA SULFURICA POUR PRÉPARATIONS HOMÉOPATHIQUES
Magnesii sulfas heptahydricus ad praeparationes homoeopathicas
HAB: Magnesium sulfuricum Urtinktur D1 Dilution Ph. Eur. Method 3.1.1 (HAB 5a) Class A or Class B,
USP 29: Magnesium sulfate
Mineralni preparati u tečnom obliku (nerazblaženi ili razblaženi) za oralnu i lokalnu (topikalnu) upotrebu.
a) Magnesii sulfas solutio 10%, 20%, 33%, 40% (Magnesium sulfate heptahydrate dilution 10%, 20%, 33%, 40%),
sadrži magnezijum sulfat p.a. (pro analysi – analitičke čistoće 99,9%)
Molecular formula: MgSO4 x 7H2O Molecular weight ; 246.47456 (heptahydrate) H14MgO11S
a) Magnesii sulfas solutio 10% – 40% 100 – 400 mg magnezijum sulfata/ grama rastvora (100 – 400 g u 100g rastvora),
b) Magnesii sulfas pulvis 100% magnezijum sulfat.
Magnezijum sulfat ispoljava mnogobrojna istražena dejstva.
sadrži magnezijum sulfat p.a. (pro analysi – analitičke čistoće 99,9%)
Molecular formula: MgSO4 x 7H2O Molecular weight 95.21 (anhydrous); 246.47456 (heptahydrate) H14MgO11S
a) Magnesii sulfas solutio 10% – 40% 100 – 400 mg magnezijum sulfata/ grama rastvora (xx mmol – xxx mmol 100g rastvora),
b) sterilna voda (aqua sterilisata).
Magnezijum se označava jedinicom miliekvivalent na litar (mEq/L) ili milimol po litru (mmol/L). 1 gram MgSO4 x7H2O sadrži 4 mola elementarnog Mg.
Normalne vrednosti su :
odrasli: 0.66 – 1.07 mmol/L (1.6 – 2.6 mg/dL)
0.7-1 mmol/L (1,5 – 2 mEq/ L ; 1.7 – 2.4 mg/ dL)
Kritična vrednost : < 1,0 ; > 4,9 mg/ dL.
Magnezijum je jedan od glavnih intracelularnih katjona. Za normalnu neuromuskularnu aktivnost potrebna je normalna koncentracija ekstracelularnog kalcijuma i magnezijuma.
Intracelularni magnezijum je važan kofaktor za razne enzime, transportere i nukleinske kiseline koje su neophodne za normalnu celularnu funkciju, replikaciju i energetski metabolizam.
Niska vrednost magnezijuma (< 0,65 mmol/L) u krvi može biti izazvana:
– gubitkom magnezijuma zbog dijareje, znojenja, povraćanja ili
– zbog nedovoljnog unosa magnezijuma hranom,
– gubitka magnezijuma zbog teških opekotina ili odvodnjavanja rane
– bolestima kao što su cistična fibroza, ciroza jetre, akutni pankreatitis, hipo i hipertiroidizam, hipoparatiroidizam,
– upotrebom lekova kao što su diuretici ili antibiotici,
– dobijanjem tečnosti IV putem bez dovoljno magnezijuma,
– alkoholizmom, hiperaldosteronizmom, dijabetičkom acidozom.
– velikim fizičkim naporima (planinari, biciklisti, drvoseče, …),
Visoka vrednosti magnezijuma u krvi može biti izazvana:
– insuficijencijom bubrega,
– traumama kao što su opekotine, udesi ili operacije,
– nekontrolisanim dijabetesom,
Indikacije: Mineralni preparati su namenjeni poboljšanju opšteg stanja organizma kroz razna naučno dokazana dejstva.
Upotreba kod profilakse hipomagnezijemije i hipomagnezijemije, kod infarkta miokarda.
– neuromuskularna preosetljivost (tremor, trzanje mišića, tetanije, grčevi),
– kardiološki problemi (tahikardija, aritmija, fibrilacija komore, u EKG-u produženje KT),
– gastrointestinalni problemi (ulcerozni kolitis, morbus Chron, celijakija, sindrom kratkog creva),
– kontinuirana upotreba diuretika ili nefrotoksičnih lekova,
– opstipacija (konstipacija).
Ima jako dejstvo kod: hipomagnezijemije.
Upotrebljava se kao: izvor elektrolita, kod infarkta miokarda, poremećaja u radu jetre, probavnih smetnji, konstipacije, inkontinencije urina, poremećaja mokrenja, kod problema sa prostatom, menstrualnih bolova, krvarenja, obilne vaginalne sekrecije, nervnih tegoba, osmotski laksans, kod prevencije i tretmana eklampsije, …
Doziranje i način primene:
individualno u zavisnosti od godina starosti i stanja organizma
Magnesii sulfas solutio 10% – 40%:
(10% = 100 mg/ g; 20% = 200 mg/ g; 33,3% = 333 mg/ g; 40% = 400 mg/ g Mg2+ u obliku magnezijum sulfata).
2 g (55 kapi) podeljeno u 2 do 4 doze.
Mineralni preparati MAGNEZIJUM SULFAT HSS i TM:
pojedinačna doza: 0,5-1 g, preporučena dnevna doza (PDD): 2 g.
Oralna (sat vremena pre obroka) i lokalna primena.
Upotreba na koži: aplicirati na obolelo mesto u tankom sloju ili obliku impregniranog zavoja.
Napraviti pauzu posle 4 nedelje neprekidne upotrebe.
Po preporukama, preparat postiže najbolje efekte pri upotrebi od 8 do 12 nedelja, duža upotreba je bezbedna uz pauze.
Toksičnost: akutna toksičnost: kvantitativni podaci o toksičnosti nisu dostupni, toksični uticaji očekuju se samo kod velikih doza, nakon gutanja većih količina: mučnina, povraćanje, proliv.
Kontraindikacije: preosetljivost na aktivne supstance, preosetljivost na jedinjenja magnezijuma, bubrežna insuficijencija, anurija, dehidracija, poremećaj u srčanoj provodljivosti, intestinalna opstrukcija, inflamatorna bolest creva, abdominalni bol nepoznatog porekla, bubrežna insuficijencija, elektrolitička neravnoteža (poremećaj elektrolita) i hipermagnesemia.
U većim koncentracijama nadražuje GIT, izaziva proliv, slabost, hiporefleksiju, respiratornu depresiju i komu, smetnje u kardiovaskularnom sistemu (hipotenzija).
Interakcije: magnezijumove soli utiču na apsorpciju lekova (tetraciklina, Chinolone, …) i ne treba ih uzimati zajedno već u razmaku od 2 do 4 sata.
Čuvanje: na tamnom, suvom i hladnom mestu do 20˚C, van domašaja dece i izlaganja EM zračenju, u dobro zatvorenoj originalnoj ambalaži.
Rok upotrebe: 1 godina, posle prvog otvaranja 6 meseci.
Pakovanje: 50 g i 100 g, farmaceutske braon bočice standarno, 250 g, 500 g, 1000 g i 5000 g na zahtev.
MAGNEZIJUM SULFAT HSS i TM:
energetska vrednost u 100 mL: 0 kJ/ 0 kcal,
u preporučenoj dnevnoj dozi (PDD) 2 g: 0kJ/ 0 kcal,
suve materije (DR) više od
Magnesii sulfas solutio 10% – 40%.
10,0% – 40,0% (Fr. Ph.).
Bez konzervanasa, proteina, masti i ugljenih hidrata.
MAGNEZIJUM SULFAT HSS i TM su rukom rađeni proizvodi.
Analizu na teške metale broj 146-353/06-15 od juna 2015. godine i analizu broj 147/05/16 od 16. maja 2016. godine izvršila CH analitička laboratorija. ANALIZA MgSO4 p.a.
Cena zavisi od količine magnezijum sulfata; obrazac za izračunavanje: 2 + (MgCl2 g% x 0,04) x 100 RSD
40% RSD – 280,00/ 50 g, 360,00/ 100 g, sadrži 40 grama MgSO4 x7H2O u 100 grama rastvora,
33% RSD – 280,00/ 60 g, 330,00/ 100 g, sadrži 33 grama MgSO4 x7H2O u 100 u grama rastvora,
20% RSD – 240,00/ 50 g, 280,00/ 100 g,sadrži 20 grama MgSO4 x7H2O u 100 grama rastvora,
10% RSD – 220,00/ 50 g, 240,00/ 100 g, sadrži 10 grama MgSO4 x7H2O u 100 grama rastvora,
100% 33 grama MgSO4 x7H2O – RSD 132,00 monokomponentni prah (kristal), p.a. (analitičke) čistoće,
100% 100 grama MgSO4 x7H2O – RSD 400,00 monokomponentni prah (kristal), p.a. (analitičke) čistoće.
Podaci ažurirani oktobra 2016.
X X X X X
Epsom Salts BP
Last Updated on eMC 03-Mar-2016 Thornton & Ross Ltd
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- 1. Name of the medicinal product
- 2. Qualitative and quantitative composition
- 3. Pharmaceutical form
- 4. Clinical particulars
- 4.1 Therapeutic indications
- 4.2 Posology and method of administration
- 4.3 Contraindications
- 4.4 Special warnings and precautions for use
- 4.5 Interaction with other medicinal products and other forms of interaction
- 4.6 Pregnancy and lactation
- 4.7 Effects on ability to drive and use machines
- 4.8 Undesirable effects
- 4.9 Overdose
- 5. Pharmacological properties
- 5.1 Pharmacodynamic properties
- 5.2 Pharmacokinetic properties
- 5.3 Preclinical safety data
- 6. Pharmaceutical particulars
- 6.1 List of excipients
- 6.2 Incompatibilities
- 6.3 Shelf life
- 6.4 Special precautions for storage
- 6.5 Nature and contents of container
- 6.6 Special precautions for disposal and other handling
- 7. Marketing authorisation holder
- 8. Marketing authorisation number(s)
- 9. Date of first authorisation/renewal of the authorisation
- 10. Date of revision of the text
- Name of the medicinal product
Epsom Salts BP
- Qualitative and quantitative composition
Magnesium Sulfate Heptahydrate BP 100% W/W.
- Pharmaceutical form
Crystals or Crystalline Powder.
Brilliant colourless crystals or a white crystalline powder.
- Clinical particulars
4.1 Therapeutic indications
- For the relief of occasional constipation.
- For the relief of pain from sprains, bruises and boils.
4.2 Posology and method of administration
- Oral. As a dilute solution.
- Cutaneous. As a concentrated solution or paste.
Recommended doses and dosage schedules
|Adults and children over 12 years:||5-15g (1 – 3 teaspoons) to be taken as required in 250 ml of water, which may be flavoured with citrus juices.|
|The elderly:||To be used with caution, not exceeding the adult dose.|
|As a wet dressing suitable for all ages:||Dissolve one tablespoonful in a small cupful of warm water and apply with lint or cotton wool as required.|
Internal use is contraindicated in all cases of acute gastro-intestinal conditions (except constipation), renal impairment, and in children with intestinal parasitic diseases.
Do not give internally to children under 12 years old.
Hypersensitivity to magnesium sulfate.
4.4 Special warnings and precautions for use
Keep out of the sight and reach of children.
Avoid prolonged use.
If symptoms persist for longer than 7 days consult your doctor.
Laxatives should not be taken where there is severe abdominal pain.
Osmotic laxatives may produce dehydration so sufficient water should always be taken.
Use with caution in elderly or debilitated patients.
4.5 Interaction with other medicinal products and other forms of interaction
Oral magnesium salts have the properties of antacids therefore it is recommended that this product is not taken within two to four hours of any other medicinal products to minimise interactions.
There is a risk of metabolic alkalosis when oral magnesium salts are given with polystyrene sulphonate resins. Magnesium salts, taken internally, potentiate the effects of competitive neuromuscular blocking drugs such as tubocurarine.
Magnesium salts may interfere with the absorption of many drugs including (but not limited to) ACE inhibitors (captopril, enalapril, fosinopril); antibacterials and antifungals (azithromycin, cefaclor, cefpodoxime, isoniazid, itraconazole, ketoconazole, methenamine, tetracyclines, rifampicin and quinolone antibacterials); antivirals (atazanavir and tipranavir); antihistamines (fexofenadine); bisphosphonates; corticosteroids (deflazacort); dipyridamole; antiepileptics (gabapentin and phenytoin); ulcer healing drugs (lansoprazole); levothyroxine; mycophenolate; rosuvastatin; antipsychotics (sulpiride and phenothiazines); chloroquine and hydroxychloroquine; penicillamine, and digoxin if given concomitantly.
Alkaline urine may result, increasing excretion of aspirin. Magnesium salts possibly reduce absorption of bile acids and may reduce absorption of eltrombopag (give at least 4 hours apart). The plasma concentration of ulipristal may be reduced. Magnesium salts possibly reduce the plasma concentration of erlotinib (give at least 4 hours before or 2 hours after erlotinib).
4.6 Pregnancy and lactation
Do not use in pregnancy or while breastfeeding.
4.7 Effects on ability to drive and use machines
No or negligible influence.
4.8 Undesirable effects
Hypermagnesaemia may occur after prolonged usage of magnesium sulfate as a purgative. May cause colic. Ingestion of magnesium salts may cause gastrointestinal irritation and watery diarrhoea. Rarely paralytic ileus has been reported.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
Though magnesium is poorly absorbed following oral administration there may be sufficient accumulation to produce toxic effects if given to a patient with impaired renal function.
Symptoms of hypermagnesaemia may include extreme thirst, a feeling of heat, hypotension due to vasodilation, drowsiness, nausea, vomiting, gastrointestinal irritation and watery diarrhoea, flushing, confusion, slurred speech, double vision and muscle weakness, loss of tendon reflexes due to neuromuscular blockade, CNS and respiratory depression, cardiac arrhythmias (including bradycardia), coma and cardiac arrest.
Treatment of mild hypermagnesaemia is usually limited to restricting magnesium intake. In severe hypermagnesaemia, ventilatory and circulatory support may be required. Slow intravenous injection of calcium gluconate (10 to 20ml of 10% calcium gluconate) is recommended to reverse the effects on cardiovascular and respiratory systems. If renal function is normal, adequate fluids should be given to promote renal magnesium clearance. This may be increased by the use of furosemide. Haemodialysis using a magnesium-free dialysis solution effectively removes magnesium, and this may be necessary in patients with renal impairment, or for whom other methods prove ineffective.
- Pharmacological properties
5.1 Pharmacodynamic properties
A06A D04 Osmotically acting laxatives
Magnesium sulfate is a saline purgative.
It can be employed locally in various inflammatory conditions, due to its osmotic action.
5.2 Pharmacokinetic properties
When a dilute solution of magnesium sulfate is taken by mouth, the absorption of water from the intestine is reduced, and the bulky fluid contents distend the bowel. Active peristalsis is excited and evacuation of the contents of the intestine results.
Magnesium salts cause the secretion of cholecystokinin from the duodenal mucosa, it has been suggested that cholecystokinin – mediated pancreatic secretion and increased secretion and motility of the small intestine and colon may contribute to the cathartic effect
Magnesium sulfate causes bowel evacuation normally within 2-4 hours.
5.3 Preclinical safety data
No data of relevance which is additional to that already included in other sections of the SPC.
- Pharmaceutical particulars
6.1 List of excipients
Magnesium sulfate is incompatible with polymyxin B sulfate, with sodium and potassium tartrates, with soluble phosphates and arsenates and with alkali carbonates and bicarbonates in concentrated solution
6.3 Shelf life
36 months unopened
6.4 Special precautions for storage
Do not store above 25°C. Store in the original package.
6.5 Nature and contents of container
300gm: Polypropylene securitainer with LDPE/HDPE white cap
6.6 Special precautions for disposal and other handling
- Marketing authorisation holder
- C. M. Ltd.
- Marketing authorisation number(s)
- Date of first authorisation/renewal of the authorisation
- Date of revision of the text
X X X X X
Dosage ADI=400-800 mg
(Davies, S., and Stewart, A. 1990. Nutritional Medicine. Avon Books, New York. 509pp.)
Total Plants: 538 Total Activities: 65
antiaggregant 400 mg/day, antialcoholic, antianginal 400 mg/day, antianorectic, antianxiety 400 mg/day, antiarrhythmic 400 mg/day, antiarthritic, antiasthmatic, antiatherosclerotic 400 mg/day, anticephalagic, antiCFS, anticlimacteric 500-750 mg/day, anticonvulsant, anticoronary 400 mg/day, antidepressant, antidiabetic 400-800 mg/man/day, antidysmenorrheic 100 mg 4 x/day, antiendometriotic 500 mg/day, antienterotic, antiepileptic 450 mg/day, antifatigue, antifibromyalgic 200-300, mg, 3x/day, antigastrotic, antiglaucomic, antihyperkinetic, antihypertensive, antihypoglycemic, antiinflammatory 100 mg 4 x/day, antiinsomniac, antilithic, antiLyme 400-1,000 mg, antimastalgic, antimenopausal 500-750 mg/day, antimigraine 200 mg/day/man, antimitral-valve-prolapse, antiMS, antinephrolytic, antineurotic, antiosteoporotic 500-1,000 mg/day/wmn/orl, antiplaque 500-1,000 mg/day, AntiPMS 400-800 mg/day/wmn/orl, antiPMS 400-800 mg/day/wmn orl, antiRaynaud’s 280-350 mg/day, antiretinopathic 400 mg/day, antispasmodic, antispasmophilic 500 mg/day, antistress 500-750 mg/day, antistroke 400 mg/day, Antisyndrome-X 400 mg/man/day, anxiolytic 500-750 mg/day, Calcium-Antagonist, Cardioprotective, CNS-Depressant, diuretic, hypocholesterolemic 400 mg/day, hypotensive 260-500 mg/day, immunomodulator, insulinogenic 400 mg/day, laxative 300-500 mg/day, litholytic, myorelaxant 100 mg 4 x/day, neurotransmitter, tranquilizer 500-750 mg/day, uterorelaxant 100 mg 4 x/day, vasodilator
Challem, J., Berkson, Burt, and Smith, Melissa Dianne. 2000. Syndrome X – The complete nutritional program to prevent and reservse insulin resistance. John Wiley & Sons, New York. 272 pp. $24.95
Davies, S., and Stewart, A. 1990. Nutritional Medicine. Avon Books, New York. 509pp.
Facciola, S. 1998. Cornucopia – A Source Book of Edible Plants. Kampong Publications, Vista CA. 713 pp.
Pizzorno, J.E. and Murray, M.T. 1985. A Textbook of Natural Medicine. John Bastyr College Publications, Seattle, Washington (Looseleaf).
Werbach, M. 1993. Healing with Food. Harper Collins, New York, 443 pp.
For Healthcare Professionals
The following is a list of the primary uses of magnesium.
Asthma and Chronic Obstructive Pulmonary Disease (COPD): Magnesium helps to promote relaxation of the bronchial smooth muscles, thus opening the airways and easing breathing.
Cardiovascular Disease (CVD): Magnesium is essential for proper functioning of the entire cardiovascular system.
Acute myocardial infarction: People dying of heart attacks have lower magnesium levels than people of the same age dying of other causes. IV magnesium is a valued treatment for acute myocardial infarction.
The benefits of using magnesium are it:
– improves production within the heart;
– dilates the coronary arteries, which results in improved delivery of oxygen to the heart;
– reduces peripheral vascular resistance, which creates reduced demand on the heart;
– inhibits platelets from aggregating and forming blood clots;
– reduces the size of the infarct (blockage);
– improves heart rate andarrhythmias.
Angina: angina is caused be a spasming of a coronary artery and usually responds to magnesium supplementation. IV magnesium supplementation can also help with angina due to atherosclerosis by the same mechanisms as described above for myocardial infarctions.
Cardiac arrhythmia: The current understanding of why magnesium helps to treat arrhythmia is due to magnesium’s role in properpotassium levels. When these two electrolytes are out of balance or deficient, proper nerve and muscle firing cannot occur.
Cardiomyopathy: Several studies have shown that magnesium supplementation produces improvements in heart functioning for individuals with a variety of cardiomyopathies.
Congestive Heart Failure: is characterized by an energy depleted state and many CHF patients are deficient in both magnesium and Co Q10. Magnesium supplementation is also beneficial because many conventional treatments for CHF cause magnesium depletion.
High Blood Pressure: Population studies have shown a correlation between higher magnesium intake and lower blood pressure. Studies which have used magnesium as an intervention to treat high blood pressure show mixed results. Cases in which magnesium supplementation has been shown to be helpful is, first, when a patient is taking a diuretic which depletes magnesium. Second, when high blood pressure is associated with high renin output. Finally, magnesium may be helpful when a patient has elevated intracellular sodium or decreased intracellular potassium (measured by red blood cells studies). A 4 week trial of magnesium supplementation is often recommended to see if magnesium supplementation is beneficial.
Intermittent Claudication: is a peripheral vascular disease. Atherosclerosis causes this condition, and like coronary artery disease, peripheral vascular disease is also associated with a magnesium deficiency.
Low HDL Cholesterol Levels: Magnesium deficiency is associated with an increase in both LDL (bad) cholesterol and triglycerides and a decrease in HDL. *Mitral Valve Prolapse: Research has shown that 85% of patients with mitral valve prolapse have magnesium deficiency.
Prevention of Strokes and Transient Ischemic Attacks (TIAs): Blood vessels supplying the brain are particularly sensitive to magnesium status. Vascular spasming can result from magnesium deficiency and this spasming can sometimes cause strokes orTIAs. Supplementation with magnesium can cause relaxation in the vessels and improve blood flow to the brain. Magnesium can also protect against strokes just as it may reduce risk of heart attack.
Diabetes and Hypoglycemia: Magnesium plays a key role in the secretion and action of insulin. Without adequate magnesium levels, it is impossible for the body to properly control blood sugar levels. Magnesium may also helps to prevent diabetic sequelae such as retinopathy and heart disease. Diabetics may actually require more than the RDA for magnesium. Vitamin B6 is also critical for the transport of magnesium into cells and therefore must also be considered in a comprehensive treatment.
Eosinophilia-Myalgia Syndrome: This syndrome was first recognized in 1989 and in most cases is caused by contaminated L-tryptophan. It is characterized by early peripheral eosinophilia, severe muscle pain, inflammation, and in some cases neural and visceral involvement. It has been found that individuals with EMS have a selective decrease in skeletal muscle ATP concentration, possibly due to a magnesium deficiency (recall that magnesium plays a key role in ATP manufacturing). In preliminary studies, it appears that magnesium injections may be helpful in treating this disease.
Fatigue: Magnesium deficiency, even if subclinical, can lead to chronic fatigue syndrome. Studies have shown improvement of symptoms for individuals suffering from CFS with intramuscular injection of magnesium sulfate and also with oral magnesium andpotassium aspartate.
Fibromyalgia: Intracellular magnesium deficiency may be a contributing factor to fibromyalgia. One study shows that magnesium malate supplementation helps to improve the number and severity of tender points. Others suggest using magnesium chelated to the entire family of Kreb cycle intermediates.
Glaucoma: Magnesium supplementation has been shown to improve peripheral circulation and has benefited those suffering fromglaucoma in terms of improvements in visual fields.
Hearing Loss: There is an association between low magnesium and noise-induced hearing loss.
Kidney Stones: Magnesium increases the solubility of calcium in the urine, thereby preventing stone formation and also prevents recurrent stone formation. Concomitant use of vitamin B6 actually increases magnesium’s effectiveness even more. Magnesium citrate is the most effective form for this purpose.
Migraine and Tension Headaches: Due to magnesium’s role in blood vessel tone, magnesium deficiency is linked to tension andmigraine headaches. In fact, low levels of magnesium are found in the serum, saliva, and red blood cells of migraine sufferers. In addition, migraines are also linked to mitral valve prolapse. Changes in blood platelets which result from mitral valve prolapse cause the platelets to release substances that cause expansion in blood vessels in the head leading to migraines.
Osteoporosis: Calcium and magnesium go hand-in-hand in terms of their importance in treating and preventing osteoporosis. Women with osteoporosis have indicators of magnesium deficiency including low bone magnesium. In addition, the conversion of vitamin D to its more active form relies on adequate magnesium levels.
Pregnancy: One’s need for magnesium increases during pregnancy. Adequate magnesium during pregnancy is critical for the prevention of pre-eclampsia, pre-term delivery, and fetal growth retardation and supplementation decreases one’s risk of developing these conditions.
Premenstrual Syndrome and Dysmenorrhea: Red blood cell magnesium levels in those suffering from PMS symptoms are significantly lower than those who do not have PMS. Magnesium supplementation has shown beneficial effects in treating PMSsymptoms such as emotional instability, generalized aches and pains and lower premenstrual pain threshold. Effects are even greater when vitamin B6 and other nutrients are added to treatment.
Attention Deficit or Hyperactivity Disorder (ADD/ADHD): Symptoms of ADHD look a lot like symptoms of magnesium deficiency such as excessive fidgeting, anxious restlessness, psychomotor instability, and learning disabilities. In one study, 95% of the ADHD patients had magnesium deficiency when levels were measure in their serum, red blood cells, and hair. In another study, individuals who were supplemented with magnesium showed improvement in terms of hyperactivity compared to the control group.
Cancer: Magnesium is important in controlling growth of cells and may be helpful in treating cancer.
Magnesium deficiency is common in the geriatric population as well as in women during the premenstrual period. Deficiency is often secondary to conditions that reduce absorption or increase secretion such as: high calcium intake, alcohol, surgery, diuretics, liver and kidney disease, and oral contraceptive pill use. Signs and symptoms of deficiency include:
-problems in nerve conduction and muscle contraction
-loss of appetite
-predisposition to stress
Magnesium excess is rare and is typically iatrogenic from IV magnesium, from laxatives or antacids containing magnesium, or intramuscular injections. Signs and symptoms of excess or toxicity may include:
-diarrhea (most common, does not occur with parenteral administration)
-nausea and vomiting
-depressed mental status
-electrocardiographic (ECG) abnormalities
Low serum magnesium reflects end-stage deficiency as most of the body’s magnesium concentrates in the cells and not in the serum. The best test to detect deficiency is the level of magnesium in the red blood cells.
The different types of magnesium include magnesium oxide, gluconate, sulfate, chloride, and carbonate.
-Taking magnesium supplements with food is less likely to cause diarrhea.
-The recommended dosages varies based on age and health status. To determine what your specific requirements are talk to your naturopathic doctor or other trained medical professional.
-Infant: 40mg (under 6 months); 60mg (6-12 months)
-Child: 80mg (1-3 years); 120mg (4-6 years); 170mg (7-10 years)
-Adolescent: 270mg/ 280mg (Males/ Females 11-14 years);
400mg/ 300mg (Males/ Females 15-18 years)
-Adult: 350mg/ 280mg (Males/ Females 19+ years)
Children: No problems have been reported with normal intake in infants and children.
Pregnancy and Breastfeeding: No problems have been reported with normal intake during pregnancy and nursing.
Contraindications: individuals with impaired kidney function can accumulate magnesium (some medications such as aminoglycosides and amphotericin-B cause both renal tubular damage and magnesium depletion patterns); individuals with high-grade atrioventricular blocks or bifascicular blocks must avoid magnesium supplementation because it can slow cardiac conduction.
Precautions: Due to magnesium’s effect on blood sugar, for individuals with diabetes or hypoglycemia, it should be introduced slowly to prevent complications.
Nutrient Interactions include:
Alcohol – Hypomagnesemia is common in alcoholics due to increased renal excretion.
Calcium – High intake may decrease magnesium absorption.
Manganese – Concomitant magnesium use may be necessary during manganese supplementation.
Phosphate – High intake may decrease magnesium absorption. Separate intake by 2 hours.
Potassium – and magnesium deficiency often occur together and need to be treated concomitantly.
Vitamin B1 – One case report indicates that a patient developed cardiac beriberi with polyneuritis after protracted use of large amounts of magnesium trisilicate.
Vitamin B6 – is necessary for magnesium to enter cells. Using these two nutrients together may increase the therapeutic efficacy of magnesium supplementation.
Vitamin D – enhances the bioavailability of magnesium.
Zinc – supplementation may increase magnesium intake needs.
-Murray Michael T (2005) Encyclopedia of Nutritional Supplements, The Essential Guide for Improving Your Health Naturally, Prima Publishing.
-Hoffer Abram, Prousky Jonathan (2006) Naturopathic Nutrition, A Guide to Nutrient-Rich Food & Nutritional Supplements for Optimum Health, CCNM Press
– Bralley J Alexander and Lord Richard S (2005) Laboratory Evaluations in Molecular Medicine, Nutrients, Toxicants, and Cell Regulators Institute for Advances in Molecular Medince, GA
-Stargrove Mitchell Bebell, Treasure Jonathan, McKee Dwight L (2008) Herb, Nutrient, and Drug Interactions, Clinical Implications and Therapeutic Strategies. Mosby
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In the US, Magnesium Sulfate (magnesium sulfate systemic) is a member of the following drug classes: laxatives, minerals and electrolytes, miscellaneous anticonvulsants and is used to treat Hypomagnesemia, Seizure Prevention and Ventricular Arrhythmia.
Magnesium sulfate granules
Magnesium Sulfate-Sodium Chloride injection
Magnesium sulfate injection
Magnesium sulfate Oral, Topical application, Route Not Applicable
Magnesium Sulfate in Dextrose Injection
ATC (Anatomical Therapeutic Chemical Classification)
Laxative, osmotically acting
Used in electrolyte solutions
Diagnostic agent, test for bilde duct patency
Sulfuric acid magnesium salt (1:1), x hydrate (USP)
Magnesii sulfas heptahydricus (PH: Ph. Eur. 8)
Magnesium Sulfate (PH: USP 37)
Magnesium sulfate heptahydrate (PH: Ph. Eur. 8)
Magnesium Sulfate Heptahydrate (PH: BP 2015
Magnesium sulfuricum Bundesanzeiger Nr. 190 a vom 10.10.1985
Monographie BGA/BfArM (Kommission D)
ZDRAVLJE u 3 minute – Opasnost deficijencije magnezija
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MAGNEZILUM HLORID I MAGNEZIJUM SULFAT
Excessive parenteral doses of magnesium salts lead to the development of hypermagnesaemia, important signs of which are respiratory depression and loss of deep tendon reflexes, both due to neuromuscular blockade. Other symptoms of hypermagnesaemia may include nausea, vomiting, flushing of the skin, thirst, hypotension due to peripheral vasodilatation, drowsiness, confusion, slurred speech, double vision, muscle weakness, bradycardia, coma, and cardiac arrest.
Hypermagnesaemia is uncommon after oral magnesium salts except in the presence of renal impairment. Ingestion of magnesium salts may cause gastrointestinal irritation and watery diarrhoea.
Effects on the gastrointestinal tract.
There are isolated reports of paralytic ileus in patients receiving magnesium salts.1,2 Delayed intestinal transit has also been reported in a neonate who received an intramuscular overdose of magnesium.3 See also Pregnancy, under Precautions, Go to Pregnancy..
- Hill WC, et al. Maternal paralytic ileus as a complication of magnesium sulfate tocolysis. Am J Perinatol 1985; 2 47–8. PubMed
- Golzarian J, et al. Hypermagnesemia-induced paralytic ileus. Dig Dis Sci 1994; 39 1138–42. PubMed
- Narchi H. Neonatal hypermagnesemia more causes and more symptoms. Arch Pediatr Adolesc Med 2001; 155 1074. PubMed
Hypersensitivity reactions characterised by urticaria were described in 2 women after receiving magnesium sulfate intravenously.1
- Thorp JM, et al. Hypersensitivity to magnesium sulfate. Am J Obstet Gynecol 1989; 161 889–90. PubMed
Treatment of Adverse Effects
The management of hypermagnesaemia is reviewed on Go to Hypermagnesaemia..
A patient with hypermagnesaemia of a degree that is normally fatal was successfully treated using assisted ventilation, calcium chloride administered intravenously, and forced diuresis with mannitol infusions.1 In another report, a 7-year-old boy given an Epsom salt (magnesium sulfate) enema for abdominal cramping, developed asystole and died, despite aggressive attempts at resuscitation. Such enemas should be avoided because of the risk of significant, unpredictable rectal absorption, leading to toxic hypermagnesaemia.2
- Bohman VR, Cotton DB. Supralethal magnesemia with patient survival. Obstet Gynecol 1990; 76 984–6. PubMed
- Tofil NM, et al. Fatal hypermagnesaemia caused by an Epsom salt enema a case illustration. South Med J 2005; 98 253–6. PubMed
Parenteral magnesium salts should generally be avoided in patients with heart block or severe renal impairment. They should be used with caution in less severe degrees of renal impairment and in patients with myasthenia gravis. Patients should be monitored for clinical signs of excess magnesium (see Adverse Effects, Go to Adverse Effects), particularly when being treated for conditions not associated with hypomagnesaemia such as eclampsia. An intravenous preparation of a calcium salt should be available in case of toxicity. When used for hypomagnesaemia, serum-magnesium concentrations should be monitored.
Magnesium crosses the placenta. When used in pregnant women, fetal heart rate should be monitored and use within 2 hours of delivery should be avoided (see also Pregnancy, Go to Pregnancy.).
Oral magnesium salts should be used cautiously in patients with renal impairment. Taking with food may decrease the incidence of diarrhoea. Chronic diarrhoea from long-term use may result in electrolyte imbalance.
In breast milk samples from 10 pre-eclamptic women given magnesium sulfate, mean magnesium concentrations 24 hours after delivery were about 6.4 mg per 100 mL, and significantly higher than those in control subjects. However, by 48 and 72 hours after delivery, values were not significantly different. In both treated and control subjects, milk-magnesium concentrations were about twice those of maternal plasma concentrations. Although total doses of magnesium given to mothers may differ, the authors considered any increased magnesium load to a breast-fed infant to be quite small, about 1.5 mg of additional magnesium daily, and unlikely to significantly alter magnesium clearance from the neonate.1 Based on this, the American Academy of Pediatrics considers that use of magnesium sulfate is therefore usually compatible with breast feeding.2
- Cruikshank DP, et al. Breast milk magnesium and calcium concentrations following magnesium sulfate treatment. Am J Obstet Gynecol 1982; 143 685–8. PubMed
- American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 2001; 108 776–89. PubMed Correction. ibid.; 1029. Also available at online (accessed 180504)
Severe hypermagnesaemia and hypercalcaemia developed in 2 patients with hepatic encephalopathy given magnesium sulfate enemas; both patients died, one during and one after asystole. It was recommended that patients with liver disease who might develop renal impairment, or in whom renal failure is established, should not be prescribed enemas containing magnesium for treatment of hepatic encephalopathy as serious magnesium toxicity can occur, which may contribute to death.1
- Collinson PO, Burroughs AK. Severe hypermagnesaemia due to magnesium sulphate enemas in patients with hepatic coma. BMJ 1986; 293 1013–14. PubMed Correction. ibid.; 1222.
The meconium-plug syndrome (abdominal distention and failure to pass meconium) has been described in 2 neonates who were hypermagnesaemic after their mothers had received magnesium sulfate for eclampsia.1 It was believed that the hypermagnesaemia may have depressed the function of intestinal smooth muscle. See also Effects on the Gastrointestinal Tract, Go to Effects on the gastrointestinal tract.. In 36 hypermagnesaemic infants born to pre-eclamptic mothers treated with magnesium sulfate, significant neurobehavioural impairment persisted for over 24 hours after birth. Impairment was manifest by prolonged weakness in activities such as head lag, ventral suspension, suck reflex, and cry response; improvement corresponded to the decrease in plasma-magnesium concentrations.2
In studies in women with3 and without4 pre-eclampsia there were decreases in short-term fetal heart rate variability when women were given intravenous magnesium sulfate; however, although variability is considered a sign of fetal well-being the decrease was considered clinically insignificant.
- Sokal MM, et al. Neonatal hypermagnesemia and the meconium-plug syndrome. N Engl J Med 1972; 286 823–5. PubMed
- Rasch DK, et al. Neurobehavioral effects of neonatal hypermagnesemia. J Pediatr 1982; 100 272–6. PubMed
- Atkinson MW, et al. The relation between magnesium sulfate therapy and fetal heart rate variability. Obstet Gynecol 1994; 83 967–70. PubMed
- Hallak M, et al. The effect of magnesium sulfate on fetal heart rate parameters a randomized, placebo-controlled trial. Am J Obstet Gynecol 1999; 181 1122–7. PubMed
Parenteral magnesium sulfate potentiates the effects of competitive and depolarising neuromuscular blockers (Go to Magnesium salts.). The neuromuscular blocking effects of parenteral magnesium and aminoglycoside antibacterials may be additive. Similarly, parenteral magnesium sulfate and nifedipine have been reported to have additive effects (Go to Magnesium salts.).
Oral magnesium salts decrease the absorption of tetracyclines and bisphosphonates, and doses should be separated by a number of hours.
About one-third of magnesium is absorbed from the small intestine after oral doses and even soluble magnesium salts are generally very slowly absorbed. The fraction of magnesium absorbed increases if magnesium intake decreases. In plasma, about 25 to 30% of magnesium is protein bound. Parenteral magnesium salts are excreted mainly in the urine, and oral doses are eliminated in the urine (absorbed fraction) and the faeces (unabsorbed fraction). Small amounts are distributed into breast milk. Magnesium crosses the placenta.
Magnesium is the second most abundant cation in intracellular fluid and is an essential body electrolyte which is a cofactor in numerous enzyme systems.
The body is very efficient at maintaining magnesium concentrations by regulating absorption and renal excretion, and symptoms of deficiency are rare. It is therefore difficult to establish a daily requirement.
Foods rich in magnesium include nuts, unmilled grains, and green vegetables.
UK and US recommended dietary intake.
In the United Kingdom dietary reference values (DRV—see Go to Human requirements.)1 and in the United States recommended daily allowances (RDA)2 have been published for magnesium. In the UK the estimated average requirement (EAR) is 200 mg (or 8.2 mmol) daily for adult females and 250 mg (or 10.3 mmol) daily for adult males; the reference nutrient intake (RNI) is 270 mg (or 10.9 mmol) daily for adult females and 300 mg (or 12.3 mmol) daily for adult males; no increment is recommended during pregnancy but an increment of 50 mg (or 2.1 mmol) daily in the RNI is advised during lactation. In the USA under the new dietary reference intakes an EAR of 330 to 350 mg daily has been set in adult males and 255 to 265 mg daily in adult females; the corresponding RDAs are 400 to 420 mg and 310 to 320 mg daily.2 An increase in RDA to 350 to 360 mg is recommended during pregnancy but the standard RDA is considered adequate during lactation. A tolerable upper intake level of 350 mg daily has been set for adults.2
- DoH. Dietary reference values for food energy and nutrients for the United Kingdom report of the panel on dietary reference values of the committee on medical aspects of food policy. Report on health and social subjects 41. London HMSO, 1991. PubMed
- Standing Committee on the Scientific Evaluation of Dietary Reference Intakes of the Food and Nutrition Board. Dietary Reference Intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington, DC National Academy Press, 1999. Also available at online (accessed 180406)
Uses and Administration
Some magnesium salts are given as a source of magnesium ions in the treatment of magnesium deficiency and hypomagnesaemia (Go to Hypomagnesaemia.). Doses may be expressed in terms of mmol or mEq of magnesium, mass (mg) of magnesium, or mass of magnesium salt. In acute or severe hypomagnesaemia, magnesium may be given parenterally, usually as the chloride or sulfate. One suggested regimen is 20 mmol of magnesium in 1 litre of infusion solution (glucose 5% or sodium chloride 0.9%) given intravenously over 3 hours. Alternatively, 35 to 50 mmol of magnesium in 1 litre of infusion solution may be given over a period of 12 to 24 hours. Up to a total of 160 mmol may be required over 5 days. In those receiving parenteral nutrition, doses of about 12 mmol magnesium daily may be given to prevent recurrence of the deficit. Magnesium sulfate can also be given intramuscularly for severe magnesium deficiency. A recommended dose is 1 mmolkg of magnesium, given over a period of 4 hours; this route is stated to be painful. Careful monitoring of plasma-magnesium and other electrolyte concentrations is essential. Doses should be reduced in renal impairment. Other salts which are, or have been, used parenterally include magnesium ascorbate, magnesium aspartate hydrochloride, and magnesium pidolate.
In simple deficiency states magnesium salts may be given by mouth in doses adjusted according to individual requirements. For preventing recurrence of hypomagnesaemia, doses of 24 mmol daily in divided doses have been recommended. Salts that are, or have been, used orally include magnesium aspartate, magnesium chloride, magnesium citrate, magnesium gluceptate, magnesium gluconate, magnesium glycerophosphate, magnesium lactate, magnesium levulinate, magnesium orotate, and magnesium pidolate.
Magnesium salts such as the carbonate, hydroxide, oxide, and trisilicate are widely used for their antacid properties (Go to Antacids). Magnesium salts also act as osmotic laxatives (see Constipation, Go to Constipation); the salts generally used for this purpose are magnesium sulfate (an oral dose of 5 to 10 g in 250 mL of water being given for rapid bowel evacuation) and magnesium hydroxide (Go to Magnesium Hydroxide).
Parenteral magnesium sulfate has some specific uses. It is used for the emergency treatment of some arrhythmias such as torsade de pointes (see Go to Arrhythmias.) and those associated with hypokalaemia (Go to Hypokalaemia.). The usual dose is 2 g of magnesium sulfate (8 mmol of magnesium) given intravenously over 10 to 15 minutes and repeated once if necessary.
Parenteral magnesium sulfate is also used for the prevention of recurrent seizures in pregnant women with eclampsia (see Go to Eclampsia and pre-eclampsia.). Debate continues as to which dosage regimen is most appropriate. Typically an intravenous loading dose of 4 g of magnesium sulfate (16 mmol of magnesium) is given over 10 to 15 minutes. This is then followed by either an infusion of 1 g (4 mmol magnesium) per hour (for at least 24 hours after the last seizure) or by deep intramuscular injection of 5 g (20 mmol magnesium) into each buttock then 5 g intramuscularly every 4 hours (for at least 24 hours after the last seizure). Should seizures recur under either regimen, then an additional intravenous dose of 2 to 4 g can be given. It is essential to monitor for signs of hypermagnesaemia, and to stop magnesium dosage should this occur. Doses should be reduced in renal impairment.
The use of magnesium sulfate in acute myocardial infarction and premature labour is discussed below (see Go to Myocardial infarction. and Go to Premature labour., respectively).
Dried magnesium sulfate has been used in the form of Magnesium Sulphate Paste (BP 2005) as an application to inflammatory skin conditions such as boils and carbuncles, but prolonged or repeated use may damage the surrounding skin.
- McLean RM. Magnesium and its therapeutic uses a review. Am J Med 1994; 96 63–76. PubMed
- Fawcett WJ, et al. Magnesium physiology and pharmacology. Br J Anaesth 1999; 83 302–20. PubMed
- Fox C, et al. Magnesium its proven and potential clinical significance. South Med J 2001; 94 1195–1201. PubMed
- Gums JG. Magnesium in cardiovascular and other disorders. Am J Health-Syst Pharm 2004; 61 1569–76. PubMed
Magnesium sulfate has been used to prevent the undesirable haemodynamic response sometimes associated with intubation (Go to Anaesthesia). It has also been tried in the treatment of postanaesthetic shivering (Go to Shivering and its treatment.).
Parenteral magnesium is used for the treatment of some arrhythmias such as torsade de pointes (Go to Cardiac arrhythmias). However, for the suggestion that it did not have an antiarrhythmic effect in patients with myocardial infarction see Myocardial Infarction, Go to Myocardial infarction..
- Frick M, et al. The effect of oral magnesium, alone or as an adjuvant to sotalol, after cardioversion in patients with persistent atrial fibrillation. Eur Heart J 2000; 21 1177–85. PubMed
- Stuhlinger HG, et al. Der Stellenwert von Magnesium bei Herzrhythmusstorungen. Wien Med Wochenschr 2000; 150 330–4. PubMed
- Piotrowski AA, Kalus JS. Magnesium for the treatment and prevention of atrial tachyarrhythmias. Pharmacotherapy 2004; 24 879–95. PubMed
- Shiga T, et al. Magnesium prophylaxis for arrhythmias after cardiac surgery a meta-analysis of randomized controlled trials. Am J Med 2004; 117 325–33. PubMed
- Alghamdi AA, et al. Intravenous magnesium for prevention of atrial fibrillation after coronary artery bypass surgery a systematic review and meta-analysis. J Card Surg 2005; 20 293–9. PubMed
- Miller S, et al. Effects of magnesium on atrial fibrillation after cardiac surgery a meta-analysis. Heart 2005; 91 618–23. PubMed
Eclampsia and pre-eclampsia.
Magnesium sulfate has become the preferred treatment for seizures associated with eclampsia (Go to Eclampsia and pre-eclampsia.). Studies and systematic reviews have shown it to be more effective than phenytoin,1,2 diazepam,1,3 or lytic cocktail,4 as well as causing fewer adverse effects. Its advantages included a rapid effect and lack of sedation in the mother or the infant.5 It was also considered to have a wide safety margin with the added security of calcium gluconate being an easily available antidote should overdose occur. Subsequent meta-analysis6 and systematic review2-4 reinforced this favourable view.
Magnesium sulfate may also be used to prevent eclampsia in pre-eclamptic patients; trials have shown it to be more effective than phenytoin,7 or nimodipine.8 A randomised placebo-controlled trial9 involving over 10 000 women in 33 countries found that treatment with magnesium sulfate approximately halved the risk of developing eclampsia; the number of maternal deaths was also less in the treatment group although the differences in risk between this group and the placebo group were not significant.
Despite some concerns about the effects of early use of magnesium sulfate on the fetus (see Premature Labour, Go to Premature labour.), many,10,11 including WHO, consider magnesium sulfate the drug of choice for both treatment and prevention of eclampsia.
- The Eclampsia Trial Collaborative Group. Which anticonvulsant for women with eclampsia evidence from the Collaborative Eclampsia Trial. Lancet 1995; 345 1455–63. PubMed Correction. ibid.; 346 258.
- Duley L, Henderson-Smart D. Magnesium sulphate versus phenytoin for eclampsia. Available in The Cochrane Database of Systematic Reviews; Issue 3. Chichester John Wiley; 2003 (accessed 210605). PubMed
- Duley L, Henderson-Smart D. Magnesium sulphate versus diazepam for eclampsia. Available in The Cochrane Database of Systematic Reviews; Issue 3. Chichester John Wiley; 2003 (accessed 210605). PubMed
- Duley L, Gulmezoglu AM. Magnesium sulphate versus lytic cocktail for eclampsia. Available in The Cochrane Database of Systematic Reviews; Issue 3. Chichester John Wiley; 2000 (accessed 210605). PubMed
- Saunders N, Hammersley B. Magnesium for eclampsia. Lancet 1995; 346 788–9. PubMed
- Chien PFW, et al. Magnesium sulphate in the treatment of eclampsia and pre-eclampsia an overview of the evidence from randomised trials. Br J Obstet Gynaecol 1996; 103 1085–91. PubMed
- Lucas MJ, et al. A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia. N Engl J Med 1995; 333 201–5. PubMed
- Belfort MA, et al. A comparison of magnesium sulfate and nimodipine for the prevention of eclampsia. N Engl J Med 2003; 348 304–11. PubMed
- The Magpie Trial Collaborative Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate The Magpie Trial a randomised placebo-controlled trial. Lancet 2002; 359 1877–90. PubMed
- Roberts JM, et al. Preventing and treating eclamptic seizures. BMJ 2002; 325 609–10. PubMed
- WHO. Managing complications in pregnancy and childbirth a guide for midwives and doctors headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure. Available at online (accessed 180504)
Potassium and magnesium homoeostasis are linked, and hypokalaemia with increased urine potassium excretion may occur in patients with hypomagnesaemia. In this situation, correction of potassium deficit usually requires magnesium to be given as well. Magnesium sulfate at doses greater than those required to correct hypomagnesaemia has been associated with greater improvements in potassium balance than doses just sufficient to correct hypomagnesaemia.1
- Hamill-Ruth RJ, McGory R. Magnesium repletion and its effect on potassium homeostasis in critically ill adults results of a double-blind, randomized, controlled trial. Crit Care Med 1996; 24 38–45. PubMed
Low magnesium concentrations are thought to be important in the pathogenesis of migraine (Go to Migraine), but the precise role of magnesium supplementation in the disorder remains to be determined.1 In a double-blind study,2 24 mmol magnesium daily (in the form of magnesium citrate) reduced the incidence of migraine headache by 42% compared with a reduction of 16% with placebo. However, in another similar study,3 20 mmol magnesium daily (in the form of magnesium aspartate hydrochloride) was no more effective than placebo in producing a 50% reduction in migraine frequency or intensity. Intravenous magnesium sulfate has shown benefit in the treatment of migraine attacks,4 especially in those with aura,5,6 or in patients with low serum-magnesium levels.7
- Mauskop A, Altura BM. Role of magnesium in the pathogenesis and treatment of migraines. Clin Neurosci 1998; 5 24–7. PubMed
- Peikert A, et al. Prophylaxis of migraine with oral magnesium results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia 1996; 16 257–63. PubMed
- Pfaffenrath V, et al. Magnesium in the prophylaxis of migraine a double-blind placebo-controlled study. Cephalalgia 1996; 16 436–40. PubMed
- Demirkaya Ş, et al. Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Headache 2001; 41 171–7. PubMed
- Bigal ME, et al. Intravenous magnesium sulphate in the acute treatment of migraine without aura and migraine with aura a randomized, double-blind, placebo-controlled study. Cephalalgia 2002; 22 345–53. PubMed
- Bigal ME, et al. Eficácia de três drogas sobre a aura migranosa um estudo randomizado placebo controlado. Arq Neuropsiquiatr 2002; 60 406–9. PubMed
- Mauskop A, et al. Intravenous magnesium sulphate relieves migraine attacks in patients with low serum ionized magnesium levels a pilot study. Clin Sci 1995; 89 633–6. PubMed
Magnesium has an important physiological role in maintaining the ion balance in muscle including the myocardium. Magnesium might have an antiarrhythmic effect (see also Arrhythmias, Go to Arrhythmias.) and protect the myocardium against reperfusion injury including myocardial stunning (delayed recovery of myocardial contractility function). Intravenous magnesium salts have been used for cardiac arrhythmias and in an overview of studies in patients with suspected myocardial infarction their use, generally within 12 hours of the onset of chest pain, reduced mortality.1 The beneficial effect on mortality appeared to be confirmed by the LIMIT-2 study2 in which 8 mmol of magnesium was given by intravenous injection before thrombolysis and followed by a maintenance infusion of 65 mmol over the next 24 hours. Benefit was confirmed at follow-up an average of 2.7 years later;3 however, there was no evidence of an antiarrhythmic effect. These beneficial effects were not borne out by the larger ISIS-4 study,4 although there were slight differences in the magnesium regimen and its timing which might have played a part in these contradictory results. In an attempt to resolve the controversy, the MAGIC trial5 was designed to test the hypothesis that early use of magnesium in a similar dose to that used in the LIMIT-2 study would reduce short-term mortality in patients with ST elevation myocardial infarction. No benefit or harm of magnesium was observed, and at present the routine use of magnesium in myocardial infarction (Go to Myocardial infarction) cannot be recommended.
Patients with acute myocardial infarction may have magnesium deficiency and long-term treatment with oral magnesium has been tried, but in one study was associated with an increased risk of adverse cardiac events and could not be recommended for secondary prevention.6
- Teo KK, et al. Effects of intravenous magnesium in suspected acute myocardial infarction overview of randomised trials. BMJ 1991; 303 1499–1503. PubMed
- Woods KL, et al. Intravenous magnesium sulphate in suspected acute myocardial infarction results of the second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2). Lancet 1992; 339 1553–8. PubMed
- Woods KL, Fletcher S. Long-term outcome after intravenous magnesium sulphate in suspected acute myocardial infarction the second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2). Lancet 1994; 343 816–19. PubMed
- Fourth International Study of Infarct Survival Collaborative Group. ISIS–4 a randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58 050 patients with suspected acute myocardial infarction. Lancet 1995; 345 669–85. PubMed
- The Magnesium in Coronaries (MAGIC) Trial Investigators. Early administration of intravenous magnesium to high-risk patients with acute myocardial infarction in the Magnesium in Coronaries (MAGIC) trial a randomised controlled trial. Lancet 2002; 360 1189–96. PubMed
- Galløe AM, et al. Influence of oral magnesium supplementation on cardiac events among survivors of an acute myocardial infarction. BMJ 1993; 307 585–7. PubMed
Magnesium sulfate is one of the drugs that has been used for seizure prophylaxis in patients with porphyria (Go to Porphyria.) who continue to experience convulsions while in remission.
Pulmonary hypertension of the newborn.
Preliminary studies have suggested that intravenous magnesium sulfate may be effective in treating persistent pulmonary hypertension of the newborn, as mentioned on Go to Pulmonary hypertension.
Magnesium sulfate, given intravenously over 20 minutes in doses of 1.2 g to patients with acute exacerbations of chronic obstructive pulmonary disease (Go to Chronic obstructive pulmonary disease) who had received inhaled salbutamol, appeared to have moderate efficacy.1
Infusion of magnesium has been reported to be of benefit in some patients with acute asthma (Go to Asthma), but results have been conflicting;2-5 meta-analyses of these and other studies concluded that its routine use was not justified, but that it may benefit some patients with severe exacerbations.6,7 A meta-analysis of 5 trials in children concluded that intravenous magnesium sulfate is likely to be an effective adjunct to standard therapy in the symptomatic treatment of moderate to severe acute childhood asthma.8 Inhalation of magnesium has also been investigated, either alone or with salbutamol; another meta-analysis considered that it improved pulmonary function, particularly in combination with a beta2 agonist, with the best results seen in more severe cases.9
- Skorodin MS, et al. Magnesium sulfate in exacerbations of chronic obstructive pulmonary disease. Arch Intern Med 1995; 155 496–500. PubMed
- Skobeloff EM, et al. Intravenous magnesium sulfate for the treatment of acute asthma in the emergency department. JAMA 1989; 262 1210–13. PubMed
- Green SM, Rothrack SG. Intravenous magnesium for acute asthma failure to decrease emergency treatment duration or need for hospitalization. Ann Emerg Med 1992; 21 260–5. PubMed
- Ciarallo L, et al. Intravenous magnesium therapy for moderate to severe pediatric asthma results of a randomized, placebo-controlled trial. J Pediatr 1996; 129 809–14. PubMed
- Silverman RA, et al. IV magnesium sulfate in the treatment of acute severe asthma a multicenter randomized controlled trial. Chest 2002; 122 489–97. PubMed
- Rowe BH, et al. Magnesium sulfate for treating exacerbations of acute asthma in the emergency department. Available in The Cochrane Database of Systematic Reviews; Issue 1. Chichester John Wiley; 2000 (accessed 210605). PubMed
- Alter HJ, et al. Intravenous magnesium as an adjuvant in acute bronchospasm a meta-analysis. Ann Emerg Med 2000; 36 191–7. PubMed
- Cheuk DKL, et al. A meta-analysis on intravenous magnesium sulphate for treating acute asthma. Arch Dis Child 2005; 90 74–7. PubMed
- Blitz M, et al. Inhaled magnesium sulfate in the treatment of acute asthma. Available in The Cochrane Database of Systematic Reviews; Issue 3. Chichester John Wiley; 2005 (accessed 051005). PubMed
Intravenous magnesium sulfate has been investigated for a neuroprotective effect in stroke (Go to Stroke), but results have been largely disappointing.1
- Intravenous Magnesium Efficacy in Stroke (IMAGES) Study Investigators. Magnesium for acute stroke (Intravenous Magnesium efficacy in Stroke trial) randomised controlled trial. Lancet 2004; 363 439–45. PubMed
Magnesium sulfate has been found to minimise autonomic disturbance in ventilated patients and control spasms in non-ventilated patients when used in the treatment of tetanus (Go to Tetanus).
- Attygalle D, Rodrigo N. Magnesium as first line therapy in the management of tetanus a prospective study of 40 patients. Anaesthesia 2002; 57 811–17. PubMed
- William S. Use of magnesium to treat tetanus. Br J Anaesth 2002; 88 152–3. PubMed
The symbol ¤ denotes a preparation which is discontinued or no longer actively marketed.
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Arzneimittel-Patienteninformation (CH, USA)
Burger A., Wachter H. (Hrsg.) Hunnius. Pharmazeutisches Wörterbuch. Berlin, New York: de Gruyter, 1998
Europäisches Arzneibuch PhEur
Hagers Handbuch der Pharmazeutischen Praxis
Pharmacopoea Helvetica V
Reynolds J. (Hrsg.) Martindale. The Extra Pharmacopoeia. London: The Pharmaceutical Press, 1989
Tofil N.M., Benner K.W., Winkler M.K. Fatal hypermagnesemia caused by an Epsom salt enema: a case illustration. South Med J, 2005, 98(2), 253-6 Pubmed Externer Link