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VETERINARY
DRUG
HANDBOOK

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 Magnesium 837

MAGNESIUM
MAGNESIUM SULFATE PARENTERAL
For information on the use of oral magnesium hydroxide, refer to the monograph for Antacids.
Magnesium oxide and oral magnesium sulfate are also detailed in the monograph for
Saline/Hyperosmotic laxatives.
Prescriber Highlights -
• Parenteral electrolyte for hypomagnesemia, for adjunctive therapy of malignant
hyperthermia in swine, and also as an anticonvulsant
• Contraindications: myocardial damage or heart block. Caution: impaired renal
function.
• Adverse Effects: Usually as a result of OD: drowsiness or other CNS depressant
effects, muscular weakness, bradycardia, hypotension, respiratory depression and
increased Q-T intervals on ECG. Very high levels: neuromuscular blocking activity
and eventually cardiac arrest
• Must monitor to avoid hypermagnesemia
• Drug interactions
Chemistry - Magnesium sulfate occurs as small, usually needle-like, colorless crystals with a
cool, saline, bitter taste. It is freely soluble in water and sparingly soluble in alcohol. Magnesium
sulfate injection has a pH of 5.5-7. One gram of magnesium sulfate hexahydrate contains 8.1
mEq of magnesium. Magnesium sulfate is also known as Epsom salts.
Storage/Stability/Compatibility - Magnesium sulfate for injection should be stored at room
temperature (15-30°C); avoid freezing. Refrigeration may result in precipitation or
crystallization.
Magnesium sulfate is reportedly physically compatible with the following intravenous
solutions and drugs: dextrose 5%, calcium gluconate, cephalothin sodium, chloramphenicol
sodium succinate, cisplatin, hydrocortisone sodium succinate, isoproterenol HCl, methyldopate
HCl, metoclopramide HCl (in syringes), norepinephrine bitartrate, penicillin G potassium,
potassium phosphate, and verapamil HCl. Additionally, at Y-sites: acyclovir sodium, amikacin
sulfate, ampicillin sodium, carbenicillin disodium, cefamandole naftate, cefazolin sodium,
cefoperazone sodium, ceforanide, cefotaxime sodium, cefoxitin sodium, cephalothin sodium,
cephapirin sodium, clindamycin phosphate, doxycycline phosphate, erythromycin lactobionate,
esmolol HCl, gentamicin sulfate, heparin sodium, kanamycin sulfate, labetolol HCl,
metronidazole (RTU), moxalactam disodium, nafcillin sodium, oxacillin sodium, piperacillin
sodium, potassium chloride, tetracycline HCl, ticarcillin disodium, tobramycin sulfate,
trimethoprim/sulfamethoxazole, vancomycin HCl, and vitamin B-complex with C.
Magnesium sulfate is reportedly physically incompatible when mixed with alkali hydroxides,
alkali carbonates, salicylates and many metals, including the following solutions or drugs: fat
emulsion 10 %, calcium gluceptate, dobutamine HCl, polymyxin B sulfate, procaine HCl, and
sodium bicarbonate. Compatibility is dependent upon factors such as pH, concentration,
temperature and diluents used. It is suggested to consult specialized references for more specific
information (e.g., Handbook on Injectable Drugs by Trissel; see bibliography).
Pharmacology - Magnesium is used as a cofactor in a variety of enzyme systems and plays a
role in muscular excitement and neurochemical transmission.
 Magnesium 838

Uses/Indications - Parenteral magnesium sulfate is used as a source of magnesium in

magnesium deficient states (hypomagnesemia), for adjunctive therapy of malignant hyperthermia
in swine, and also as an anticonvulsant.
Pharmacokinetics - IV magnesium results in immediate effects, IM administration may require
about 1 hour for effect. Magnesium is about 30-35% bound to proteins and the remainder exists
as free ions. It is excreted by the kidneys at a rate proportional to the serum concentration and
glomerular filtration.
Contraindications/Precautions - Parenteral magnesium is contraindicated in patients with
myocardial damage or heart block. Magnesium should be given with caution to patients with
impaired renal function. Patients receiving parenteral magnesium should be observed and
monitored carefully to avoid hypermagnesemia.
Adverse Effects/Warnings - Magnesium sulfate (parenteral) adverse effects are generally the
result of magnesium overdosage and may include drowsiness or other CNS depressant effects,
muscular weakness, bradycardia, hypotension, respiratory depression and increased Q-T
intervals on ECG. Very high magnesium levels may cause neuromuscular blocking activity and
eventually cardiac arrest.
Overdosage/Acute Toxicity - See Adverse Effects above. Treatment of hypermagnesemia is
dependent on the serum magnesium level and any associated clinical effects. Ventilatory support
and administration of intravenous calcium may be required for severe hypermagnesemia.
Drug Interactions - When parenteral magnesium sulfate is used with other CNS depressant
agents (e.g., barbiturates, general anesthetics) additive CNS depression may occur.
Parenteral magnesium sulfate with nondepolarizing neuromuscular blocking agents has
caused excessive neuromuscular blockade.
Because serious conduction disturbances can occur, parenteral magnesium should be used with
extreme caution with digitalis cardioglycosides.
Concurrent use of calcium salts may negate the effects of parenteral magnesium.
Doses -
Dogs & Cats:
For hypomagnesemia:
a) Magnesium sulfate 25% solution: Dose is dependent on magnitude of intoxication,
but usually ranges from 5 - 15 ml IM or IV over 1-2 hours; have calcium gluconate
available should magnesium intoxication occur. (Seeler and Thurmon 1985)
b) 0.75 - 1 mEq/kg/day administered by a constant rate infusion in D5W. Concentrate
should be diluted to at least 20%. . A lower dose of 0.3 - 0.5 mEq/kg/day may be used
for an additional 3-5 days as complete repletion occurs slowly. If needed for life-
threatening ventricular arrhythmias: 0.15 - 0.3 mEq/kg may be administered over 5 -
15 minutes. (Holland and Chastain 1995)
Horses:
For VTach: 4 mg/kg IV boluses every 2 minutes or a 2 mg/kg/min IV infusion to a total
dose of 50 mg/kg (Note: Do not use magnesium plus calcium containing solutions) (Mogg
1999)