Magnesium sulfate is used to treat pre-eclampsia, eclampsia and preterm labor.

Pre-eclampsia (also known as toxemia and Pregnancy-Induced High Blood

Pressure) consists of high blood pressure, protein in the urine and edema (swelling).
It can rapidly become severe pre-eclampsia, with very high blood pressure, visual
disturbances, failing kidneys and elevated liver enzymes. In rare cases, pre-eclampsia
develops into eclampsia, where potentially fatal convulsions occur. It also can become
HELLP Syndrome (hemolysis (H), which is the breaking down of red blood cells,
elevated liver enzymes (EL), and low platelet count (LP)), which is potentially fatal to
both the woman and her baby or babies.

Treating Pre-Eclampsia and Eclampsia

Questions to Discuss with Your Doctor

Preterm labor is defined as contractions and cervical effacement and/or dilation

before term.

Treating Preterm Labor

Table and Study Citations for Use in Preterm Labor
Questions to Discuss with Your Doctor

Treating Pre-Eclampsia and Eclampsia

1. Why is magnesium sulfate used for pre-eclampsia and eclampsia?

This drug typically is used in obstetrics to prevent severe pre-eclampsia from

becoming eclampsia (life-threatening convulsions). It also is used to stop the
convulsions of eclampsia. In the United States, it has been used to treat severe pre-
eclampsia for 60 years (Lancet, 1997, Vol. 350, p. 1491) and is FDA-approved for
this purpose.

2. How is it administered?

It usually is given to patients through an IV in the hospital, and sometimes it is

administered in shots.

A woman experiencing pre-eclampsia may receive a loading (big) dose through an IV

of 4 to 6 grams and a continuous dose of 1-2 grams per hour. She may receive these
doses before giving birth and sometimes for at least 24 hours after giving birth. If a
woman is having convulsions from eclampsia, she may receive a single dose of 4 to 6
grams to try to stop the convulsions.
3. How long do patients take magnesium sulfate?

In severe pre-eclampsia, magnesium sulfate is used for short periods of time (24 to 48
hours) until the baby or babies can be delivered, which is the only "cure" for pre-
eclampsia. If the baby or babies will be premature, it can buy enough time to
administer drugs to the woman to strengthen the baby's lungs (corticosteroids like
betamethasone).

4. a. What are some of the most common side effects of magnesium sulfate?

 Flushing
 Nausea
 Vomiting
 Palpitations
 Headache
 General muscle weakness
 Lethargy
 Constipation

4. b. What are some of the complications of magnesium sulfate(sometimes

occurring with magnesium overdose)?
Note: Your doctor can ensure your safety by monitoring you carefully and by
making sure your kidneys are fully functioning. This can be done with a blood test.
Severe pre-eclampsia sometimes can cause a woman's kidneys to fail, and that can
intensify the risk of a magnesium sulfate overdose. A blood test can check the level
of magnesium in your body.

 Cardiac arrest
 Pulmonary edema (lungs fill with fluid; can be fatal) 
 Chest pain
 Cardiac conduction defects
 Low blood pressure
 Low calcium
 Increased urinary calcium
 Visual disturbances
 Decreased bone density
 Respiratory depression (difficulty breathing) 
 Muscular hyperexcitability
Rare, Severe Complications

 Profound muscular paralysis

 Paralytic ileus (intestinal obstruction) 

Adapted from: Hill, Washington Clark, "Risks and Complications of Tocolysis,"

Clinical Obstetrics and Gynecology, 1995, Vol. 38, p. 733.

5. Does magnesium sulfate affect my baby or babies?

Yes, it crosses the placenta. After your baby or babies are born, they may have some
of it in their blood. Magnesium levels usually return to normal within a few days.

Click here for a list of neonatal side effects.

In the past, magnesium sulfate has been thought to be safe for babies whose mothers
take it. However, doctors are debating the significance of one 1997 study that
challenges this view. More studies are needed before definite conclusions can be
made. In addition, because of the significant risk of developing eclampsia, the benefits
of a woman being on magnesium sulfate may outweigh the risks to her and to her
baby.

This 1997 study was conducted at the University of Chicago and found an increased
number of neonatal deaths in women who took it for preterm labor in comparison to
those women who took another preterm labor drug (ritodrine, terbutaline,
indomethacin or nifedipine). A second group of women in this study with advanced
cervical dilation but not eligible for preterm labor drugs received either a 4 g dose of
magnesium sulfate or a placebo (saline). The women who received the magnesium
sulfate dose or doses had a higher rate of neonatal deaths (8 deaths out of 75
pregnancies) than the control group (1 death out of 75 pregnancies). The difference
was statistically significant. (Mittendorf, Robert et. al, Lancet, Vol. 350, pp. 1517-
1518.)

6. Will I be confined to my bed while on magnesium sulfate?

Yes, most women are. Your diet probably will be restricted to fluids because of the
risk of vomiting. You may need to use a bedpan or a catheter.

7. Can magnesium sulfate be combined with other drugs?

Magnesium sulfate, when combined with nifedipine, can cause neuromuscular

blockade (muscular paralysis). When combined with ritodrine or terbutaline,
magnesium sulfate can greatly increase the risk of severe complications - including
pulmonary edema and cardiovascular complications. A study of asthmatics found that
combining magnesium sulfate and terbutaline increased terbutaline's cardiovascular
side effects (Chest, 1994, Vol. 105, pp. 701-705).

8. Does magnesium sulfate work?

A 1998 review concluded that it is effective in preventing convulsions in women who

have severe pre-eclampsia and in stopping convulsions in eclamptic women. The
review consisted of 19 randomized, controlled trials, five retrospective studies and
eight observational reports published in English between 1966 and February 1998.
The review also concluded that more research is needed on whether magnesium
sulfate is effective for women with mild pre-eclampsia and gestational high blood
pressure (Obstetrics and Gynecology, Vol. 92, pp. 883-889).

9. Are there alternatives to magnesium sulfate in treating pre-eclampsia?

Magnesium sulfate is widely used in the United States to prevent convulsions from
severe pre-eclampsia. In Europe and Australia, the most popular choices are:
diazepam, phenytoin, chlormethiazole and barbituates.

Return to index

Treating Preterm Labor

1. Why is magnesium sulfate used in treating preterm labor?

When a woman experiences preterm labor (defined as contractions and cervical

effacement or dilation before term), sometimes she is given magnesium sulfate, which
is thought to relax the muscles of the uterus.

2. How is it administered?

It usually is given to patients through an IV in the hospital, and sometimes it is

administered in shots. Some studies have used a pill form of magnesium sulfate to
treat preterm labor, but the pill form appears to be experimental.

Dosages of magnesium sulfate vary quite a bit, depending on the doctor. In general,
women experiencing preterm labor may receive higher doses for longer periods of
time than women experiencing pre-eclampsia/eclampsia. Typically, a woman
experiencing preterm labor will receive a loading (big) dose of about 4 to 6 grams
through an IV. She then will receive a continuous dose through an IV of between 1
and 3 grams per hour. In some studies, the continuous dose was as high as 4 to 5
grams an hour.

3. How long do patients take magnesium sulfate?

In preterm labor, magnesium sulfate is given over 24 or 48 hours to try to halt labor.
Sometimes, a woman will then be put on a different preterm labor drug like
terbutaline or nifedipine and can be sent home. (For more information on
terbutaline, click here.) Some women who are very far from term and whose condition
is precarious may be kept on magnesium sulfate for longer periods of time -
sometimes weeks and months.

4. What are the side effects of magnesium sulfate?

The line between a "therapeutic" and "toxic" dose of magnesium sulfate is very thin.
In general, the larger the dose, the greater the chance of severe side effects. Doctors
can test your blood to see how much magnesium is in it. This will indicate when a
"safe" dose has been exceeded. They also can do reflex checks and monitor urine
output, which also may indicate when a "safe" dose has been exceeded.

More common side effects

 Flushing
 Nausea
 Vomiting
 Palpitations
 Headache
 General muscle weakness
 Lethargy
 Constipation

Complications (sometimes occurring with magnesium overdose)

 Cardiac arrest
 Pulmonary edema (lungs fill with fluid; can be fatal) 
 Chest pain
 Cardiac conduction defects
 Low blood pressure
 Low calcium
 Increased urinary calcium
 Visual disturbances
  Decreased bone density
 Respiratory depression (difficulty breathing) 
 Muscular hyperexcitability

Rare, Severe Complications

 Profound muscular paralysis

 Paralytic ileus (intestinal obstruction) 

Adapted from: Hill, Washington Clark, "Risks and Complications of Tocolysis,"

Clinical Obstetrics and Gynecology, 1995, Vol. 38, No. 4, p. 732.

5. Does magnesium sulfate affect my baby or babies?

Yes, it crosses the placenta. After your baby or babies are born, they may have some
of it in their blood.

Click here for a list of neonatal side effects.

In the past, magnesium sulfate has been thought to be safe for babies whose mothers
take it. However, doctors are debating the significance of one 1997 study that
challenges this view. More studies are needed before definite conclusions can be
made.

This 1997 study was conducted at the University of Chicago and found an increased
number of neonatal deaths in women who took it for preterm labor in comparison to
those women who took another preterm labor drug (ritodrine, terbutaline,
indemethacin or nifedipine). A second group of women in this study with advanced
cervical dilation but not eligible for preterm labor drugs received either a 4 g dose of
magnesium sulfate or a placebo (saline). The women who received the magnesium
sulfate dose had a higher rate (8 deaths out of 75 pregnancies) of neonatal deaths than
the control group (1 death out of 75 pregnancies). The differences were statistically
significant. The preterm labor dosages of magnesium sulfate involved in this study
were modest (4 gram loading dose and 2-3 grams per hour).(Mittendorf, Robert et. al,
Lancet, Vol. 350, pp. 1517-1518.)

6. Will I be confined to my bed while on magnesium sulfate?

Yes, most women are. Your diet probably will be restricted to fluids because of the
risk of vomiting. You may need to use a bedpan or a catheter.
7. Can magnesium sulfate be combined with other preterm labor drugs?

Yes, but there have been some complications. Magnesium sulfate, when combined
with nifedipine, can cause neuromuscular blockade (muscular paralysis). When
combined with ritodrine or terbutaline, it can greatly increase the risk of severe
complications - including pulmonary edema and cardiovascular complications. A
study of asthmatics found that combining magnesium sulfate and terbutaline increased
terbutaline's cardiovascular side effects.