Magnesium sulfate - instructions for use, dose, side effects, contraindications

When parenteral administration has anticonvulsant, antiarrhythmic, antihypertensive, spasmolytic effect, in large doses depresses neuromuscular transmission, has tocolytic effect, suppresses respiratory center. Mg²⁺ is a physiological antagonist of Ca²⁺ and is able to displace it from the binding sites. Regulates metabolic processes, interneuronal transmission and muscular excitability, prevents the entry of Ca²⁺ through the presynaptic membrane, reduces the amount of acetylcholine in the peripheral nervous system and central nervous system (CNS). Relaxes smooth muscles, lowers blood pressure (BP) (mostly increased), increases diuresis.

Anticonvulsant action - Mg²⁺ reduces the release of acetylcholine from neuromuscular synapses, suppressing neuromuscular transmission, has a direct inhibitory effect on the central nervous system.

Antiarrhythmic action - Mg²⁺ reduces the excitability of cardiomyocytes, restores ionic equilibrium, stabilizes cell membranes, breaks the current of Na⁺, the slow incoming current Sa²⁺ and a unidirectional current K⁺.

Cardioprotective effect is caused by the expansion of the coronary arteries, a decrease in the total peripheral vascular resistance, and platelet aggregation.

Tocolytic action - Mg²⁺ inhibits the contractility of the myometrium. (decrease in absorption, binding and distribution of Ca²⁺ in cells of smooth muscles), increases blood flow in the uterus as a result of the expansion of its vessels.

It is an antidote for poisoning with salts of heavy metals.

Systemic effects develop almost instantly after intravenous (IV) administration.

Duration of action with / in the introduction - 30 minutes.

Pharmacokinetics:

The equilibrium concentration is 2-3.5 mmol / l. Penetrates through the blood-brain and placental barriers, creates concentrations in breast milk that are 2 times higher than those in the blood plasma.

Excretion is performed by the kidneys, the rate of renal excretion is proportional to the concentration in the blood plasma and the level of glomerular filtration.

Indications:Arterial hypertension (including hypertensive crisis with brain edema phenomena), polymorphic ventricular tachycardia (such as pirouette), convulsive syndrome (to suppress convulsions with eclampsia, to prevent seizures in severe pre-eclampsia, to relieve severe uterine contractions), poisoning salts of heavy metals (mercury, arsenic, tetraethyl lead), hypomagnesemia, (including increased - the need for magnesium and acute hypomagnesemia - tetany).

Contraindications:Hypersensitivity to the components of the drug; atrioventricular blockade (AV blockade); severe chronic renal failure (if creatinine clearance is less than 20 mL / min); arterial hypotension; conditions associated with calcium deficiency and respiratory center depression; severe bradycardia; prenatal period (2 hours before delivery).

Carefully:Myasthenia gravis, chronic renal failure (if creatinine clearance is more than 20 ml / min), respiratory diseases, acute inflammatory diseases, gastrointestinal tract, elderly age, pregnancy, lactation period, children's age.

Pregnancy and lactation:Take with caution during pregnancy and lactation.

Dosing and Administration:

Intravenously.

Doses are refined taking into account the therapeutic effect and the concentration of magnesium ions in the blood serum.

Preeclampsia and eclampsia. The dose is set individually depending on the clinical situation. The dose of saturation is 2-4, g after 5-20 min (infusion). The maintenance dose is 1-2 g per hour.

Theta of the uterus. The dose of saturation is 4 g after 20 min (infusion). Supportive dose - first - 1-2 grams per hour, later - 1 g per hour (you can enter drip 24-72 hours).

Hypomagnesemia.

In newborns. The daily dose is 0.2-0.8 mg / kg IV slowly.

In adults. Easy. A solution of magnesium sulfate is used parenterally if it is impossible or inappropriate to use the oral route of magnesium preparations (due to nausea, vomiting, impaired resorption in the stomach, etc.). The daily dose of -1-2 g / m. This dose is administered once or in 2-3 doses.The place of administration should be changed.

Heavy. The initial dose is 5 g intravenously slowly in 1 liter of the infusion solution. Dosed depending on the concentration of the drug in the blood serum.

Prevention of hypomagnesemia in patients receiving only parenteral nutrition. If there are no magnesium in the nutrient solutions, it is added additionally. The daily dose - l, 5-4 g Usually, L c1 parenteral nutrition solution was added 1 g of magnesium sulfate.

The maximum urgent dose of magnesium sulfate to adults is 40 g.

With hypertensive crises injected-in / in (slowly !!) 5-20 ml of 250 mg / ml solution of magnesium sulfate.

For arresting arrhythmias iv injection of 1-2 g for about 5 minutes, possibly repeated administration.

Doses of magnesium sulfate are indicated in grams.

They correspond to the amount of solution: 1 g - 4 ml (250 mg / ml); 2 g - 8 ml (250 mg / ml) - 3 g - 12 ml (250 mg / ml); 4 g - 16 ml (250 mg / ml); 5 g - 20 ml (250 mg / ml); 10 g - 40 ml / (250 mg / ml); 15 g - 60 ml (250 mg / ml); 20 g - 80 ml (250 mg / ml); 30 g - 120 ml (250 mg / ml); > 40 g-160 ml (250 mg / ml).

A solution of magnesium sulfate in ampoules is diluted with injection solutions: 0.9% sodium chloride or 5% dextrose (glucose).

Side effects:

Early signs and symptoms hypermagnesemia: bradycardia, double vision, sudden "tide" of blood to the face, headache, marked reduction in blood pressure, nausea, shortness of breath, blurred speech, vomiting, asthenia.

Signs of hypermagnesia; Ranked in order of increasing the concentration of magnesium ions in the serum: a decrease in deep tendon reflexes (2-3.5 mmol / l), prolongation of the PQ interval and expansion of the QRS complex on an electrocardiogram (2.5-5 mmol / l), loss of deep tendon reflexes (4-5 mmol / l), inhibition of the respiratory center (5-6.5 mmol / l), cardiac conduction disorder (7.5 mmol / l), cardiac arrest (12.5 mmol / l). In addition, hyperhidrosis anxiety, deep / sedation / polyuria, atony of the uterus.

Overdose:

Symptoms: disappearance. knee reflex, nausea, vomiting, a sharp decrease in blood pressure, bradycardia, respiratory depression and central nervous system.

Treatment: I / slowly enter a solution of calcium chloride or calcium gluconate - 5-10 ml 10%, oxygen therapy, inhalation of carbogen, artificial respiration / peritoneal dialysis or hemodialysis, symptomatic therapy.

Interaction:

Patients who, together with magnesium sulfate, use other medicines should inform the doctor about this.

Strengthens the effect of other drugs that depress the central nervous system.

Cardiac glycosides increase the risk of impairment.conductivity and atrioventricular blockade (especially with simultaneous in / in the introduction of calcium salts).

Muscle relaxants and nifedipine strengthen the neuromuscular blockade.

With the joint application of magnesium sulfate for parenteral administration with other., Vasodilators, an increase in the hypotensive effect is possible.

Barbiturates, narcotic analgesics, antihypertensive drugs, drugs increase the likelihood of oppression of the respiratory center;

It interferes with the absorption of antibiotics of the tetracycline group, weakens the action of streptomycin and tobramycin. Calcium salts reduce the effect of magnesium sulfate.

Pharmaceutically incompatible with calcium preparations, ethanol (in high concentrations), carbonates, bicarbonates and phosphates of alkali metals, arsenic acid, barium, strontium, clindamycin phosphate, hydrocortazone sodium succinate, polymyxin sulfate, procaine hydrochloride, salicylates and tartrates .

At concentrations of magnesium ions above 10 mmol / ml in mixtures for total parenteral nutrition, fat emulsion separation is possible.

Special instructions:

Magnesium sulphate should be used carefully so that the toxic concentration of the drug does not appear: Older patients usually should use a reduced dose, since they have decreased kidney function. Patients with impaired renal function (if creatinine clearance is more than 20 ml / min) and oliguria should not; get more than 20 g of magnesium sulfate (81 mmol Mg2 +) for 48 hours, do not enter magnesium sulfate in / in - too fast. It is recommended to control the content of magnesium ions in blood serum (should not be higher than 0.8-1.2 mmol / l), diuresis (not less than 100 ml / 4 h), respiratory rate (at least 16 per min), blood pressure.

When magnesium sulfate is administered, it is necessary to have a calcium solution prepared for intravenous administration, for example a 10% calcium gluconate solution. If necessary, simultaneous in / in the introduction of magnesium and calcium, they are injected into different veins. When magnesium sulfate is used, the results of radiological studies, for which technetium is applied, can be distorted.

Effect on the ability to drive transp. cf. and fur:The effect of the drug on the ability to drive vehicles and mechanisms has not been studied.

Form release / dosage:Solution for intravenous administration 250 mg / ml.

Packaging:

In ampoules of 5 ml or 10 ml.

For 10 ampoules with instructions for use, with an ampoule or ampoule ampoule knife in a pack or box of cardboard.

When packaging ampoules that have a break ring or an opening point, the ampoule knife or the ampoule scapegrator is not put in.

5 ampoules in a cassette outline package. 2 cassette contour packs with instructions for use in a pack of cardboard.

Storage conditions:

At a temperature of 15 to 25 ° C.

Keep out of the reach of children.

Shelf life:

3 years.

Do not use after the expiration date indicated on the package.

Terms of leave from pharmacies:On prescription

Registration number:P N001826 / 01

Date of registration:25.11.2011 / 05.04.2017

Expiration Date:Unlimited

The owner of the registration certificate:MICROGEN FGUP Scientific and Production Association MICROGEN FGUP Scientific and Production Association Russia

Manufacturer: & nbsp

MICROGEN FGUP NGO Russia

Information update date: & nbsp24.03.2018

Illustrated instructions

Instructions

Magnesium sulfate (Magnesium sulfate)