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Generic Name

Excreted solely by the kidneys at a rate proportional to the
serum concentration and glomerular filtration.

Magnesium Sulfate

Onset

Trade Names
Epsom Salt
- Granules, oral
Magnesium Sulfate
- Injection, solution 4% (elemental magnesium 0.325 mEq/mL)
- Injection, solution, concentrate 8% (elemental magnesium
0.65 mEq/mL)
- Injection, solution, concentrate 50% (elemental magnesium 4
mEq/mL)

Immediate (IV, when used as an anticonvulsant); 1 h (IM).

Duration
30 min (IV, when used as an anticonvulsant); 3 to 4 h (IM).

Special Populations
Renal Function Impairment

Magnesium Sulfate in Dextrose 5%
- Injection, solution 1% (elemental magnesium 0.081 mEq/mL)
- Injection, solution 2% (elemental magnesium 0.162 mEq/mL)

No data available.

Pharmacology

No data available.

Magnesium is an important activator of many enzyme systems,
and deficits are accompanied by a variety of functional
disturbances. Magnesium has CNS depressant effects; it
prevents/controls seizures by blocking neuromuscular
transmission and decreasing the amount of acetylcholine
liberated at end plate by motor nerve impulse. Orally, it
attracts/retains water in intestinal lumen, thereby increasing
intraluminal pressure and inducing the urge to defecate.

Pharmacokinetics
Absorption
Immediately absorbed (IV).

Distribution
Approximately 1% to 2% of total body magnesium is in the
extracellular fluid space; 30% bound to albumin.

Metabolism
Magnesium is not metabolized.

Elimination

Hepatic Function Impairment

Indications and Usage
Parenteral
Seizure prevention and control in severe preeclampsia or
eclampsia; replacement therapy in magnesium deficiency,
especially in acute hypomagnesemia accompanied by signs of
tetany similar to those observed in hypocalcemia; corrects or
prevents hypomagnesemia by addition to TPN admixture;
control hypertension, encephalopathy, and convulsions in
children with acute nephritis.
Oral
Laxative.

Unlabeled Uses
Treatment of acute exacerbation of severe asthma; treatment of
torsades de pointes; paroxysmal atrial tachycardia; cerebral
edema; barium poisoning.

Contraindications
Toxemia of pregnancy during 2 h preceding delivery.

Dosage and Administration

give 2 g IV over 10 min.5 g (25 mL of a 10% solution). Use only if simpler measures have failed and there is no evidence of myocardial damage. Paroxysmal Atrial Tachycardia Adults PO 10 to 15 g. Children IV 25 to 75 mg/kg (max dose. dilute 1 to 2 g in 50 to 100 mL of dextrose 5% injection and administer over 5 to 60 min. Renal impairment The dose should be lower and frequent serum magnesium levels must be obtained.6 mEq/kg/day. the recommended dosage is 1 to 2 g IV over 5 to 60 min.1 to 0. 1 to 2 g/h by constant IV infusion or IM doses of 4 to 5 g of undiluted 50% solution every 4 h injected into alternate buttocks as needed (max. Consider reducing the dose by 50% (max adults. 5 g (10 mL) can be added to 1 L of dextrose 5% injection or sodium chloride 0. Hypomagnesemia Adults Mild hypomagnesemia IM 1 g (2 mL of undiluted 50% solution) injected every 6 h for 4 doses. According to American Heart Association (AHA) guidelines. Children TPN 0.2 mL/kg of a 20% solution) as needed to control seizures. IM 20 to 40 mg/kg (0.2 to 2 g over 20 min according to AHA/American College of Cardiology (ACC) guidelines. Barium Poisoning Adults IV 1 to 2 g. should continue until paroxysms cease. Typical daily intakes range from 10 to 24 mEq/day. Hypomagnesemia Children IV / intraosseous 25 to 50 mg/kg (max dose. 1 to 2 g (diluted in 10 mL of dextrose 5% injection) administered IV/intraosseous over 5 to 20 min. the initial dosage is 4 to 6 g (diluted in 100 mL) given IV over 15 to 20 min. 2 g) over 10 to 20 min every 4 to 6 h for 3 or 4 doses. Therapy IV According to AHA/ACC guidelines. repeat as needed. Off-Label Uses Asthma (life-threatening) Adults IV 1. Seizures in Eclampsia/Preeclampsia Children Adults Nephritic Seizures Children IM / IV 10 to 14 g (as a combination of 4 to 5 g of undiluted 50% solution in each buttock and 4 to 5 g IV in 250 mL of dextrose 5% injection or sodium chloride 0. According to American College of Obstetricians and Gynecologists guidelines. 30 to 40 g per 24 h and less in anuric patients). followed by a maintenance dosage of 2 g/h continuous IV infusion. or 4 g of magnesium/dextrose 5% injection premixed solution). If torsades de pointes is associated with cardiac arrest. the dosage is 25 to 50 mg/kg (max dose. Use caution so as not to exceed the renal excretion capacity.9% injection. Alternatively. 2 g) IV/intraosseous over several min. repeat as needed. Alternatively.5 mL/kg of the undiluted 50% solution) may be given within a period of 4 h if necessary.Hyperalimentation Adults TPN 5 to 8 mEq of magnesium per 1 L of TPN solution. the initial IV dose of 4 g may be given by diluting the 50% solution to a 10% or 20% solution and the diluted fluid (40 mL of a 10% solution or 20 mL of a 20% solution) may be injected over 3 to 4 minutes. Severe hypomagnesemia IV / IM As much as 246 mg/kg (0. If seizures are present. General Advice . IV The following recommendations are according to AHA/ACC guidelines.25 to 0. Laxative Usually a one-time dose. 20 g per 48 h). After the initial dose.9% injection for slow IV infusion over a 3-h period. IV 3 to 4 g (30 to 40 mL of a 10% solution) over 30 sec with extreme caution. 2 g) over 20 min every 4 to 6 hours for 3 or 4 doses. If torsades de pointes is intermittent and not associated with cardiac arrest. Cerebral Edema Adults IV 2. Children Torsades de Pointes Adults PO 5 to 10 g.

Separate the administration times of eltrombopag and oral magnesium sulfate by at least 4 h. hypothermia. Unused portions of the undiluted 50% solution in the container should be discarded within 24 h of initial use.  When administering via IV route. polymyxin B. aminoglycosides. Monitor: Monitor serum magnesium levels and the patient's clinical status to guide need for continued dosage. depressed reflexes. arsenates. tetracycline.  Prior to repeat doses. IM administration is painful. alkali carbonates and bicarbonates.5 or 3 mEq/mL. flaccid paralysis. and warm sensation. digitalis. Penicillamine: Reduced penicillamine effects (oral magnesium). Closely monitor the clinical response. use with caution.  IV bolus may cause flushing. strontium.  Have an IV calcium preparation at hand as an antidote. circulatory collapse. No special precautions are needed.5 mL of a 2% concentration or its equivalent). heavy metals. barium.5 to 2.5 mEq/mL. alkali hydroxides. clindamycin. Protect from freezing. Use with caution and closely monitor magnesium concentrations. hypocalcemia with signs Respiratory: Respiratory depression. Monitor for respiratory depression. Tetracyclines: Decreased absorption of tetracyclines (oral magnesium). Rotate injection sites to reduce tissue irritation. Discard any unused solution. procaine. cyclosporine. Separate the administration times of chloroquine and oral magnesium sulfate by 2 to 4 h. calcium. use infusion pump. Adverse Reactions Cardiovascular: Cardiac arrest. test for knee-jerk reflexes. Injection  For IM or IV administration only. hypotension. or intra-arterial administration. amphotericin B. respiratory of tetany. hydrocortisone sodium succinate. Neuromuscular blocking agents: Potentiation of neuromuscular blockade. cisplatin. Storage/Stability Store at 68° to 77°F. Separate the administration times by as much as possible. Metabolic: Hypermagnesemia. streptomycin. Be prepared to provide supportive treatment or to discontinue one or both drugs if needed.9% injection or dextrose 5% injection to a concentration of 20% or less before IV administration or IM administration in infants and children. Precautions Drug Interactions Alcohol. tartrates. Separate the administration times by 3 to 4 h. salicylates. Nifedipine: The risk of neuromuscular blockade and hypotension may be increased. avoid if possible. cardiac depression.  50% solution must be diluted with sodium chloride 0.  Incompatibilities: alcohol (in high concentrations). Chloroquine. Nitrofurantoin: Decreased absorption of nitrofurantoin (oral magnesium). Deliver in separate line and do not mix with other IV drugs unless compatibility has been established. eltrombopag: Oral magnesium sulfate may decrease the absorption and clinical effect of chloroquine or eltrombopag. no additional magnesium should be given until reflexes return.5 mL of a 10% concentration or 7.5 mEq/L (6 mg per 100 mL). phosphates. Monitor levels hourly for patients with severe hypomagnesemia until they reach 1. CNS: CNS depression. except in severe eclampsia with seizures. tobramycin. Adjust the neuromuscular blocking agent dose as needed. Not for intradermal. paralysis.  50% solution may be administered undiluted to adults if given by deep IM injection. sweating. Normal serum concentration is 1. If they are absent.  Rate of IV injection should generally not exceed 150 mg/min (1. avoid if possible. Effective anticonvulsant serum levels range from 2.5 or 3 to 7. . diuretics :Drug-induced renal losses of magnesium can occur. Miscellaneous: Flushing. sweating. subcutaneous. Be prepared to provide life support. Higher doses of chloroquine may be needed.

Reflexes may be absent at magnesium 10 mEq/L. symptoms of electrolyte imbalance (eg. Institute seizure precautions. Patients with impaired kidney function. Advise patient to mix with ice chips or flavor with lemon or orange juice to make more palatable. or dizziness occurs. ECG changes (ie. obtain the serum concentration daily. Tissue loading may occur at even lower rates of administration. regular exercise). sweating. When repeated doses of the drug are given parenterally. who receive parenteral levels of aluminum at more than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with CNS and bone toxicity. prolonged QRS complex. flushing. Urine output should be maintained at 100 mL every 4 h. Eclampsia: Use IV form only for immediate control of life- threatening convulsions. Elderly: May require reduced dosage because of renal impairment. depending on Excreted. Once stable. Clinical indications of a safe dosage regimen include the presence of the patellar reflex (knee-jerk) and absence of respiratory depression (approximately 16 or more breaths per minute). Category A / Category C .  Caution patient that drug is for short-term laxative use only and that prolonged use can lead to dehydration and electrolyte imbalance. Flushing/Sweating: and sweating occurs.then every 6 to 12 h for the next 24 h. Respirations should be at least 16/min before each dose. renal impairment may lead to magnesium intoxication. respiratory paralysis. hypotension. prolonged QT interval). Patellar reflex (knee jerk) should be tested before each parenteral dose of magnesium sulfate. 2. Renal Function: Use with caution. 3. The strength of the deep tendon reflexes begins to diminish when magnesium levels exceed 4 mEq/L. Monitor intake and output ratios. The American Academy of Pediatrics classifies magnesium as compatible with breast-feeding. and ECG frequently throughout administration of parenteral magnesium sulfate. kneejerk reflexes should be tested before each dose. muscle cramps or pain. prolonged PR interval. respirations.  Pregnancy: Advise patient to mix granules in at least a half glass of water before swallowing and to follow with a full glass of water. muscle weakness. where respiratory paralysis is a potential hazard. Monitor neurologic status before and throughout therapy. Carefully observe respiration and BP during and after administration of IV magnesium. no additional doses should be administered until positive response is obtained. blood pressure. heart block. if they are absent.  Educate patient regarding other measures that may help prevent constipation (eg. Overdosage Oral  manufacturer. Patient Information   Advise patient that medication will be prepared and administered by a health care provider in a hospital setting.  Instruct patient to notify health care provider if drowsiness.  Advise patient to discontinue use and notify health care provider of the following: unrelieved constipation. Hypomagnesemia/Anticonvulsant: Monitor pulse. . dietary fiber. Urine out put should be maintained at a level of at least 100 ml/4 hr. Aluminum toxicity: Some of these products may contain aluminum that may be toxic. rectal bleeding. weakness. no additional magnesium should be given until they return. Lactation: Injection Administer with caution if flushing Nursing Management 1. If response is absent. dizziness). including premature neonates. disappearance of patellar reflex. adequate fluid intake. Symptoms Decreased deep tendon reflexes.

4. Explain purpose of medication to patient and family. .