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Magnesium

Class
Electrolytes
Subclass
Magnesium salts
Generic name
Magnesium, magnesium sulphate, mgSO4
Common formulations
Solution for injection
Dosage and administration
Adults patients
Treatment of asthma exacerbation • Severe • Off-label
•
2 g IV bolus over 15-30 minutes
Other off-label uses
•
Treatment of COPD
Indications for use
Labeled indications
Adults
•
Treatment of magnesium deficiency
•
Prevention and treatment of seizures in females with preeclampsia
•
Induction of parenteral nutrition
Off-label indications
Adults
•
Treatment of asthma exacerbation (severe)
•
Treatment of COPD
Safety risks
Contraindications
Heart block or myocardial damage.
Warnings and precautions
Aluminum toxicity
•
Use extreme caution in patients with renal insufficiency.
Fetal toxicity
•
Use extreme caution in pregnant females.
Increased serum magnesium
•
Use caution in patients with renal insufficiency.
Specific populations
Renal impairment
eGFR ≥ 60 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR 10-30 mL/min/1.73 m²
•
Use with caution. Reduce dose by 50%. Use with caution; frequent monitoring for hypermagnesemia is required.
eGFR < 10 mL/min/1.73 m²
•
Use with caution. Hypermagnesemia develops frequently in patients with CrCl <10 mL/minute. If necessary, administer 50% of the usual indication-specific dose with extreme caution; frequent monitoring for hypermagnesemia is required.
Renal replacement therapy
Any modality
•
Reduce dose. Use with caution. Reduce dose by 50%. Use with caution; frequent monitoring for hypermagnesemia is required.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters
•
Avoid use. Evidence of fetal harm in humans. Intravenous use beyond 5 to 7 days can cause fetal abnormalities.
•
Continuous IV infusion, especially more than 24 hours before delivery, can result in magnesium toxicity, including neuromuscular or respiratory depression, in the newborn.
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Use for preterm labor should be by obstetrical personnel in a hospital with appropriate obstetrical care facilities.
•
Inform women that efficacy and safety for preterm labor has not been established, and that use beyond 5 to 7 days can cause fetal abnormalities.
•
Avoid use in the 2 hours before delivery unless it is the only therapy available for eclamptic seizures.
•
Monitor fetal HR.
Breastfeeding
Use with caution during breastfeeding.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Some adverse effects on lactation reported.
Adverse reactions
Unknown frequency
•
AV block, central nervous system depression, ↓ body temperature, ↓ serum calcium, flaccid paralysis, hypermagnesemia, hypotension, nystagmus, blurred vision, diplopia, photophobia, skin flushing, sweating, shock,
Interactions
Drug(s)
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