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

When parenteral administration has anticonvulsant, antiarrhythmic, antihypertensive action, spasmolytic effect, in high doses inhibits neuromuscular transmission, has tocolytic effect, suppresses the respiratory center: Magnesium is a physiological calcium antagonist and is able to displace it from the binding sites. Regulates metabolic processes, interneuronal transmission and muscular excitability,prevents the entry of calcium ions through the presynaptic membrane, reduces the amount of acetylcholine in the peripheral nervous system and central nervous system. Relaxes smooth muscles, lowers blood pressure (mostly increased), increases diuresis. Anticonvulsant action - magnesium ions reduce the release of acetylcholine from neuromuscular synapses, suppressing neuromuscular transmission, has a direct inhibitory effect on the central nervous system.

Antiarrhythmic action - magnesium ions reduce the excitability of cardiomyocytes, restore ionic equilibrium, stabilize cell membranes, disrupt the current of sodium ions, slow incoming calcium ions and a one-way current of potassium ions. The cardioprotective effect is due to the expansion of the coronary arteries, a decrease in the total peripheral narrowing of the vessels and the aggregation of thrombocytes. Tocolytic action - magnesium ions inhibit contractile ability of myometrium (decrease, absorption, binding and distribution of calcium ions in smooth muscle cells), 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 administration. Duration of action with intravenous injection - 30 minutes.

Pharmacokinetics:The equilibrium concentration of Css is 2-3.5 mmol / l. Penetrates through the blood-brain barrier and placental barrier, creates in breast milk concentrations of 2 times higher than those in plasma. Excretion by the kidneys, its speed is proportional to the concentration in the 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 with severe preeclampsia, to remove severe uterine contractions), poisoning with salts of heavy metals (mercury, arsenic, tetraethyl lead), hypomagnesemia (including increased demand for magnesium and acute hypomagnesemia-tetany).

Contraindications:Hypersensitivity to the components of the drug, severe arterial hypotension, respiratory center depression, pronounced bradycardia, AV blockade of I-III degree,severe chronic renal failure (creatinine clearance less than 20 ml / min), prenatal period (2 hours prior to delivery). Conditions associated with calcium deficiency - tachycardia, arrhythmia whitening of the fingers and toes, muscle pain, vomiting, constipation, renal colic, hepatic colic, increased irritability, disorientation; hallucination; confusion of consciousness; memory loss; stupidity.

Carefully:Myasthenia gravis, respiratory diseases, chronic renal failure (if creatinine clearance is more than 20 ml / min), acute inflammatory diseases of the gastrointestinal tract, pregnancy, lactation, age under 18, elderly.

Pregnancy and lactation:Carefully. It is not recommended to take a solution of magnesium sulfate, during breastfeeding, because magnesium sulfate excreted in breast milk.

Dosing and Administration:

Solution for intravenous administration 250 mg / ml.

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

Preeclampsia and eclampsia. The dose of saturation is 2-4 g after 5-20 minutes (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).The maintenance dose-first - 1 - 2 g per hour, later - 1 g per hour (you can drip 24-72 hours).

Hypomagnesemia.

In newborns. The daily dose is 0.2-0.8 ml / kg intravenously slowly.

In adults. Lightweight. 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 of disturbed resorption in the stomach, etc.) A daily dose of 1-2 g. This dose is administered once or in 2-3 doses.

Heavy. The initial dose is 5 g, which is delivered to 1 liter of infusion solution and slowly administered intravenously. 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 is 1.5-4 g. Usually 1 g of magnesium sulfate is added to 1 liter of parenteral nutrition solution. The maximum daily intake of magnesium sulfate for adults is 40 g.

With hypertensive crises (slowly) 5-20 ml of a 25% solution of magnesium sulfate.

For arresting arrhythmias intravenously injected 1-2 g for about 5 minutes, possibly repeated administration.Doses of magnesium sulfate are indicated in grams. They correspond to the amount of 25% solution: 1 g - 4 ml; 2 g - 8 ml; 3 g, 12 ml; 4 g -16 ml; 5 g-20 ml; 10 g-40 ml; 15 g -60 ml; 20 g - 80 ml; 30 g - 120 ml; 40 g -160 ml. the 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 of hypermagnesemia: bradycardia, diplopia, sudden "tide" of blood to the skin of the face, headache, lowering of blood pressure, nausea, shortness of breath, blurred speech, vomiting, asthenia. Symptoms of hypermagnesia, ranked, in order of increasing the concentration of magnesium ions in the blood serum: a decrease in deep tendon reflexes (2- 3.5 mmol / l), prolongation of the PQ interval and expansion of the QRS complex on the ECG (2.5-5 mmol / l), loss of deep tendon reflexes (4-5 mmol / L), inhibition of the respiratory center (5-6.5 mmol / l), impaired conduction of the heart (7.5 mmol / l), cardiac arrest (12.5 mmol / l) . In addition, hyperhidrosis, anxiety, deep hedonia, polyuria, atony of the uterus. The drug lowers the excitability of the respiratory center, large doses of the drug, with parenteral administration can cause paralysis of the respiratory center.

Overdose:

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

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

Interaction:Strengthens the effect of other drugs that depress the central nervous system. Cardiac glycosides increase the risk of disruption of conduction and AV blockade (especially with simultaneous intravenous administration of salts of calcium ions). Muscle relaxants and nifedipine strengthen the neuromuscular blockade. With the joint use of magnesium sulfate for parenteral administration with other vasodilators, an increase in the hypotensive effect is possible. Barbiturates, narcotic analgesics, hypotensive 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.It is pharmaceutically incompatible with calcium preparations, ethanol (in high concentrations), carbonates, bicarbonates and phosphates of alkali metals, arsenic acid salts, barium, strontium, clindamycin phosphate, hydrocortisone sodium succinate, polymyxin sulfate, procaine hydrochloricates and tartrates. At concentrations of magnesium ions above 10 mmol / ml in mixtures for complete parenteral nutrition, separation of fatty emulsions is possible.

Special instructions:If it is necessary to simultaneously administer intravenous magnesium and calcium, they are injected into different veins. It is possible to use magnesium sulfate for relief of epileptic status (as part of complex therapy). Patients with severe renal dysfunction should not receive more than 20 g of magnesium sulfate (81 mmol of magnesium ions) for 48 hours, patients with oliguria or severe renal dysfunction should not be administered magnesium sulfate intravenously too fast. It is recommended to control the concentration 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 (not less than 16 / min), blood pressure.When parenteral application should be very careful not to create toxic concentrations of the drug. Elderly patients often require a reduction in dose (impaired function, kidney). When magnesium sulfate is used, the results of radiological studies for which technetium is applied may be distorted. The solution can also be used for oral administration (as a laxative drug).

Effect on the ability to drive transp. cf. and fur:Patients should be warned about the need to take care when working with potentially dangerous mechanisms and when driving a car, as the drug in large doses depresses neuromuscular transmission.

Form release / dosage:Solution for intravenous and intramuscular injection 250 mg / ml.

Packaging:

5 ml into neutral glass ampoules.

5 ampoules are placed in a contour cell pack.

1 or 2 contour squares are placed in a pack of cardboard.

5, 10 ampoules are placed in a pack of cardboard for consumer containers with partitions or lattices, or a separator made from cardboard or sack paper.

10 ampoules are placed in a box of cardboard for consumer containers.Each instruction pack or box is supplied with instructions for use, an ampoule knife or ampoule scarifier.

In the case of using ampoules with incisions, dots or rings of a fracture, the ampoule knife or ampoule scaper is not inserted.

Storage conditions:In a place protected from light and inaccessible to children at a temperature of no higher than 25 ° C.

Shelf life:3 years. Do not use after expiry date.

Terms of leave from pharmacies:On prescription

Registration number:LS-001207

Date of registration:24.06.2011 / 13.09.2017

Expiration Date:Unlimited

The owner of the registration certificate:Promomed Rus, Open CompanyPromomed Rus, Open Company Russia

Manufacturer: & nbsp

BIOCHEMIST, OJSC Russia

Information update date: & nbsp24.03.2018

Illustrated instructions

Instructions

Magnesium sulfate (Magnesium sulfate)