magnesium sulfate (MgSO4)

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^[1]^[2]^[3]^[4]^[5]^[6]

Indications

prevention & treatment of hypomagnesemia
pre-eclampsia, eclampsia
short-term treatment of postmyocardial infarction
torsades de pointes
pediatric acute nephritis
prevention of cerebral palsy in premature infants?^[4] (perinatal administration to mother)

Contraindications

heart block
severe renal insufficiency

pregnancy category = a

safety in lactation = +

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 g IV every 6 hours for 4 doses
2 g in 50 mL D5W/NS IV over 20 min
severe cases may require 8-12 g/day in divided doses
maximum infusion rate 2 g/hr to avoid hypotension

Adverse effects

depressed CNS
blocked peripheral neuromuscular transmission
flushing
somnolence
respiratory paralysis
may accumulate in renally impaired patients
diarrhea
depressed deep tendon reflexes

Drug interactions

additive CNS depression when used with:
- barbiturates
- opiates
- general anesthetics
- other CNS depressants
increased neuromuscular blockage when used with neuromuscular blocking agent
use with caution with cardiac glycosides

Mechanism of action

cofactor in enzymatic reactions

More general terms

pharmaceutical magnesium

Component of

References

↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
↑ ^4.0 ^4.1 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: https://www.ncbi.nlm.nih.gov/pubmed/18753646
Stanley FJ and Crowther C. Antenatal magnesium sulfate for neuroprotection before preterm birth? N Engl J Med 2008 Aug 28; 359:962. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18753653
↑ ^5.0 ^5.1 ^5.2 ^5.3 ^5.4 ^5.5 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: https://www.ncbi.nlm.nih.gov/pubmed/21069663
↑ ^6.0 ^6.1 ^6.2 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: https://www.ncbi.nlm.nih.gov/pubmed/10796650

Database

PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=24083

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