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 the respiratory center.

Magnesium is a "physiological" calcium antagonist (by blocking "slow" calcium channels) and is able to displace it from binding sites.It 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 the central nervous system (CNS), which leads to the inhibition of neuromuscular transmission. Relaxes the smooth muscles of the internal organs, uterus and blood vessels, lowers blood pressure (AD) (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 incoming calcium current and unilateral potassium current.

Tocolytic action. Magnesium inhibits the contractility of the myometrium (by reducing the 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 (C_ss) - 2-3.5 mmol / l. Penetrates through blood-brain and placental barriers. In breast milk, concentrations of 2 times the concentration in the blood plasma are created.

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 the phenomena of cerebral edema).

- Polymorphic ventricular tachycardia (of the "pirouette" type).

- Eclampsia (to suppress seizures) and pre-eclampsia (to prevent seizures in severe pre-eclampsia).

- Theta of the uterus.

- The poisoning with salts of heavy metals (mercury, arsenic, tetraethyl lead).

- Hypomagnesemia (including increased need for magnesium and acute hypomagnesemia - tetany).

Contraindications:

Hypersensitivity to the drug, severe arterial hypotension, respiratory center depression, severe bradycardia, atrioventricular blockade (AV blockade) I-III degree, severe chronic renal failure (creatinine clearance less than 20 ml / min), pre-natal period (2 hours before delivery), conditions associated with calcium deficiency.

Carefully:

Myasthenia gravis, chronic renal failure (creatinine clearance 20-60 ml / min), respiratory diseases, acute inflammatory diseases of the gastrointestinal tract, old age, pregnancy, breastfeeding, age under 18.

Pregnancy and lactation:

The use of the drug during pregnancy and during breastfeeding is possible only according to the doctor's prescription, if the intended benefit for the mother exceeds the potential risk to the fetus or baby.

If you need to use the drug during lactation, breastfeeding should be discontinued.

The use of the drug is contraindicated in the prenatal period (2 hours before delivery).

Dosing and Administration:

Intravenously (slowly or driply). The patient should be in the lying position.

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

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

For arresting arrhythmias intravenously injected 1-2 g (4-8 ml of the drug) for about 5 minutes, possibly repeated administration.

Preeclampsia and eclampsia. The dose is set individually depending on the clinical situation. The dose of saturation is 2-4 g (8-16 ml of the drug) after 5-20 min (infusion). The maintenance dose is 1-2 g (4-8 ml of the drug) per hour.

Theta of the uterus. The dose of saturation is 4 g (16 ml of the preparation) after 20 min (infusion). Supportive dose - first 1-2 g (4-8 ml of the drug) per hour, later - 1 g (4 ml of the drug) per hour (can be administered drip 24-72 hours).

Hypomagnesemia.

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

In adults.Light. 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 absorption in the stomach, etc.). The daily dose is 1-2 g (4-8 ml of the drug). This dose is administered once or in 2-3 doses.

In adults. Heavy. The initial dose is 5 g (20 ml of the drug) intravenously slowly in 1 liter of the infusion solution (0.9% solution of sodium chloride or 5% solution of dextrose (glucose)). Dosed depending on the content of magnesium ions in blood serum.

With prolonged use, it is recommended to monitor blood pressure, heart activity, tendon reflexes, kidney activity, respiratory rate.

If it is necessary to simultaneously enter calcium and magnesium salts, the drugs should be injected into different veins.

Side effects:

Slowing of respiratory rate, shortness of breath, acute circulatory failure, weakening of reflexes, hyperemia, marked decrease in arterial pressure, hypothermia, weakening of muscle tone, atony of uterus, hyperhidrosis, anxiety, severe sedation, polyuria, decrease in heart rate, changes in electrocardiogram.

The drug lowers the excitability of the respiratory center, large doses of the drug with parenteral administration can cause paralysis of the respiratory center.

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 concentration of magnesium ions in the blood serum: a decrease in deep tendon reflexes (2-3.5 mmol / l), lengthening of the interval PQ and expansion of the complex QRS on the 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), impaired conduction of the heart (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 activity.

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

Interaction:

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

Magnesium sulfate enhances the effect of other drugs that depress the central nervous system.

Cardiac glycosides increase the risk of conduction disruption and atrioventricular blockade (especially with simultaneous intravenous 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 tobramycin.

Calcium salts reduce the effect of magnesium sulfate.

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

Special instructions:

Magnesium sulfate should be used carefully so that the toxic concentration of the drug does not appear.

Elderly patients should usually take a reduced dose, because they have decreased kidney function.

Patients with impaired renal function (creatinine clearance greater 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 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 / h), respiratory rate (at least 16 / min), blood pressure, tendon reflexes.

When magnesium sulfate is administered, it is necessary to have a calcium solution prepared for intravenous administration, for example, a 10% calcium gluconate solution.

When magnesium sulfate is used, the results of radiological studies for which technetium is applied may be distorted.

Effect on the ability to drive transp. cf. and fur:

In connection with the fact that the drug in large doses depresses the neuromuscular transmission, during the treatment period it is necessary to be cautious when driving vehicles and engaging in potentially dangerous activities that require an increased concentration of attention and speed of psychomotor reactions.

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

Packaging:

5 ml, 10 ml into ampoules of colorless neutral glass.

For 10 ampoules with instructions for use and ampoule scarifier are placed in a box of cardboard.

5 ampoules per circuit cell box made of polyvinyl chloride film and foil of aluminum printed lacquered or foil-free.

1 or 2 contourcell packs with instructions for use and ampoule ampoule are placed in a pack of cardboard.

At packing of ampoules with a ring of a break or with an incision and a point the scarifier ampoule

Do not invest.

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:LP-003835

Date of registration:14.09.2016

Expiration Date:14.09.2021

The owner of the registration certificate:SYNTHESIS, OJSC SYNTHESIS, OJSC Russia

Manufacturer: & nbsp

SYNTHESIS, OJSC Russia

Representation: & nbspSYNTHESIS JSC Joint-Stock Kurgan Society of Medical Preparations and Products SYNTHESIS JSC Joint-Stock Kurgan Society of Medical Preparations and Products Russia

Information update date: & nbsp25.03.2018

Illustrated instructions

Instructions

Magnesium sulfate (Magnesium sulfate)