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

When parenteral administration has anticonvulsant, antiarrhythmic, hypotensive, antispasmodic effect, in large doses depresses neuromuscular transmission, has tocolytic effect, suppresses the respiratory center.

Magnesium is a "physiological" blocker of "slow" calcium channels and is able to displace it from 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 periphyric nervous system and the central nervous system (CNS). Relaxes smooth muscles, lowers blood pressure (BP) (mostly increased), increases diuresis.

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

Antiarrhythmic action - magnesium reduces the excitability of cardiomyocytes, restores ion balance, stabilizes cell membranes, breaks sodium current, slow calcium current and unilateral potassium current.

The cardioprotective effect is due to the expansion of the coronary arteries, the reduction of the total peripheral vascular resistance and platelet aggregation.

Tocolytic action - magnesium inhibits the contractility of the myometrium (reduced absorption, binding and distribution of calcium 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 (IV).

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

Pharmacokinetics:

The equilibrium concentration (Css) is 2-3.5 mmol / l. Penetrates through the blood-brain and placental barriers, creates in the mother's milk concentrations of 2 times the concentration in the plasma.

Excretion is performed by the kidneys, the rate of renal excretion 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 (pirouette type), convulsive syndrome (for cramping convulsions with eclampsia, for preventing seizures in severe pre-eclampsia, for removing severe uterine contractions), poisoning compounds of heavy metals (mercury, arsenic, tetraethyl lead), hypomagnesemia (including an increased demand for magnesium and acute hypomagnesemia - tetany).

Contraindications:Hypersensitivity to the drug, atrioventricular blockade of I-III degree (AV blockade); severe renal failure (if creatinine clearance is less than 20 ml / min); severe arterial hypotension; state,The problems associated with calcium deficiency and respiratory center depression; bradycardia; prenatal period (2 hours before delivery).

Carefully:Myasthenia gravis, chronic renal failure (CRF), respiratory diseases, acute inflammatory diseases of the gastrointestinal tract (GIT), advanced 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 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 is first 1-2 grams per hour, later -1 g per hour (you can drip 24-72 hours).

Hypomagnesemia.

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

In adults. Light. A solution of magnesium sulfate is used parenterally if the oral route of administration of magnesium preparations is inadvisable or impractical (due to nausea, vomiting, disturbance of resorption in the stomach, etc.).

Heavy. The initial dose is 5 g. The dose is poured into 1 liter of infusion solution and slowly injected / in.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.

The maximum daily intake of magnesium sulfate for adults is 40 g.

With hypertensive crises 5-20 ml of 25% solution of magnesium sulfate is injected / in (slowly !!).

For arresting arrhythmias, I / v inject 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.

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

Side effects:

Slowing down the frequency of breathing; dyspnea; acute circulatory failure; weakening of reflexes; hyperemia; arterial hypotension; hypothermia; weakening of the muscle tone; atony of the uterus, hyperhidrosis; anxiety; marked sedation; polyuria; reduction of heart rate; changes in the electrocardiogram (ECG).

Early signs and symptoms of hypermagnesemia: bradycardia, diplopia, sudden, flush to the face, headache, decreased blood pressure, nausea, shortness of breath, blurred speech, vomiting, general weakness.

Signs 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) tendon reflexes (4-5 mmol / l), respiratory center depression (5-6.5 mmol / l), cardiac conduction disorder (7.5 mmol / l), cardiac arrest (12.5 mmol / l).

Overdose:

Symptoms: disappearance of the 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 %, Carry out 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 treat the central nervous system.

Cardiac glycosides increase the risk of conduction disruption and AV blockade (especially with simultaneous in / in the administration of calcium salts).

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 tobrampic acid.

Calcium salts reduce the effect of magnesium sulfate.

It is pharmaceutically incompatible with calcium preparations, carbonates, bicarbonates and phosphates of alkali metals, clindamycin phosphate, hydrocortisone sodium succinate, polymyxin sulfate, procaine hydrochloride, salicylates, tartrates, salts of arsenic acid, barium, strontium, ethanol in high concentrations.

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

Special instructions:

It should be administered only intravenously, given that intramuscular injections are extremely painful and lead to the formation of infiltrates.

Magnesium sulfate should be used with caution, so that the toxic concentration of the drug does not arise. Elderly people should usually take a reduced dose, because they have decreased kidney function. Patients with impaired renal function (if creatinine clearance is more than 20 ml / min) and oliguria should not receive more than 20 g of magnesium sulfate (81 mmol Mg²⁺) for 48 hours, do not enter magnesium sulfate I / O too fast. It is recommended to control the concentration of magnesium ions in the blood serum (should not be higher than 0.8-1.2 mmol / l), diuresis (not less than 100 ml / hour), respiratory rate (at least 16 / min), blood pressure.

When magnesium sulfate is administered, it is necessary to have a calcium solution prepared for intravenous administration, for example, a 10% solution of calcium gluconate. If it is necessary to simultaneously enter into the salts 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 may be distorted.

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

Packaging:

5 ml or 10 ml of the drug in ampoules.

For 5 or 10 ampoules in contour cell packs from a polyvinyl chloride film.

For 10 ampoules together with instructions for medical use and scarifier ampullum in a pack of cardboard with cardboard partitions.

When using ampoules with a notch or a fracture ring, the scarifier is not inserted.

For 1 or 2 contour pack together with instructions for medical use in a cardboard box.

Storage conditions:

In the dark place at a temperature of no higher than 25 ° C.

Keep out of the reach of children.

Shelf life:

3 years.

Do not use after the expiry date printed on the package.

Terms of leave from pharmacies:On prescription

Registration number:LSR-007707/08

Date of registration:25.09.2008 / 15.07.2009

Expiration Date:Unlimited

The owner of the registration certificate:ESKOM NPK, OAO ESKOM NPK, OAO Russia

Manufacturer: & nbsp

ESKOM NPK, OAO Russia

Information update date: & nbsp24.03.2018

Illustrated instructions

Instructions

Magnesium sulfate (Magnesium sulfate)