magnesium sulfate

Brand name:
Price:
 250 mg/mL, 10 mL Ampule (Highest-Lowest Tender Price: 5.22 - 26.50 Php; Drug Price
Reference: 9. 05 Php)
 250 mg/mL, 2 mL Ampule (Highest-Lowest Tender Price: 8.92 - 27.00 Php; Drug Price
Reference: 18.37 Php)
 250 mg/mL, 20 mL Vial (Highest-Lowest Tender Price: 8.00 - 65.00 Php; Drug Price
Reference: 17.85 Php)

Therapeutic Class: Electrolyte Replacement

Pharmacologic Class: Minerals
Available Forms:
Injectable: 4%, 8%, 50% in 2-, 10-, 20-, and 50-mL ampules, vials, and prefilled syringes.
Injection Solution: 1% in D5W; 2% in D5W or NSS; 4% in water for injection, D5W, or NSS;
8% in water for injection, D5W, or NSS
Indications and Dosages:
 Mild Hypomagnesemia: Adults (1 g I.M. every 6 hours for four doses, depending on
magnesium level.
 Symptomatic severe hypomagnesemia, with magnesium level of 0.8 mEq/L or
less: Adults (5 g I.V. in 1 L of D5W or NSS over 3 hours. Base subsequent doses on
magnesium level)
 Magnesium supplementation in total parenteral nutrition (TPN): Adults (8 to 24 mEq
I.V. daily added to TPN solution); Infants (2 to 10 mEq/day I.V. added to TPN solution.
 Seizures in preeclampsia or eclampsia: Adults (Total initial dose is 10 to 14 g I.V. To
accomplish this, give 4 to 5 g I.V. in 250 mL of solution and simultaneously give up to 10
g I.M. (5 g or 10 mL of the undiluted 50% solution in each buttock). After initial IV dose,
some clinicians administer 1 to 2 g / hour by constant I.V. infusion. Base subsequent
doses on magnesium level; serum magnesium level of 6 mg/ 100 mL is considered
optimal for seizure control. Don’t exceed 40 g in a 24-hour period. Maximum dose in
patients with severe renal insufficiency is 20 g/ 48 hours.
Action: Replaces magnesium and maintain magnesium level; as an anticonvulsant, reduces
muscle contractions by interfering with release of acetylcholine at myoneural junction.
Adverse Reactions:
 CNS: toxicity, weak or absent deep tendon reflexes, flaccid paralysis, drowsiness, stupor
 CV: slow, weak pulse; arrhythmias; hypotension; circulatory collapse; flushing
 GI: diarrhea
 Metabolic: hypocalcemia
 Respiratory: respiratory paralysis
 Skin: diaphoresis
 Other: hypothermia
Interactions:

 Drug-Drug: Calcium channel blockers: may increase magnesium-related adverse

effects. Monitor therapy.
 Cardiac glycosides: May cause serious cardiac conduction changes. Use together with
caution.
 CNS depressants: May increase CNS depression. Use together cautiously.
 Neuromuscular blockers: May cause increase neuromuscular blockage. Use together
cautiously. Closely monitor clinical response.
 Drug-lifestyle: Alcohol use (May decrease magnesium level. Discourage use together.)
Effects on Lab Test Results: May decrease calcium level.
Contraindications and Cautions:
 Contraindicated in patients with myocardial damage, heart block, or coma.
 Use cautiously in patients with impaired renal function.
 Alert: Using magnesium sulphate to stop preterm labor is not an FDA-approved use of
the drug; safety and effectiveness of drug for this indication have not been established.
 Overdose S&S: hypotension, facial flushing, feeling of warmth, thirst, nausea, vomiting,
lethargy, dysarthria, drowsiness, diminished deep tendon reflexes, shallow respirations,
apnea, coma, cardiac arrest, respiratory paralysis, disappearance of patellar reflex
Nursing Considerations:
 Keep I.V. calcium available to reverse magnesium intoxication.
 Test knee-jerk and patellar reflexes before each additional dose. If absent, notify
prescriber and give no more magnesium until reflexes return; otherwise, patient may
develop temporary respiratory failure and need cardiopulmonary resuscitation or I.V.
administration of calcium.
 Check magnesium level after repeated doses. Monitor levels hourly in patients with
severe hypomagnesemia. Normal plasma magnesium is 1.5-2.5 mEq/L.
 Monitor fluid intake and output. Output should be 100 mL or more during 4-hour period
before dose.
 Monitor renal function.
 Drug may contain aluminium. Premature neonate are at high risk for aluminium toxicity
due to immature renal function. Aluminum exposure of more than 4 to 5 mcg/kg/day is
associated with CNS and bone toxicity.
 Patients with prolonged exposure to magnesium sulphate who have impaired renal
function are at risk for aluminium toxicity.
 Look alike-sound alike: Don’t confuse magnesium sulphate with manganese sulphate.
Patient Teaching:
 Explain use and administration of drug to patient and family.
 Tell patient to report all adverse effects.