Magnesium sulfate

General characteristics. Structure:

Active ingredient: 250 g of magnesium of sulfate in 1 l.

Excipients: water for injections.

At parenteral administration renders sedative, diuretic, arteriodilatiruyushchy, anticonvulsant, antiarrhytmic, hypotensive, spasmolytic, in high doses - kurarepodobny (the oppressing influence on neyorvno-muscular transfer), tokolitichesky, somnolent and narcotic action, suppresses a respiratory center.

Pharmacological properties:

Pharmacodynamics. Magnesium is a physiological antagonist of calcium and is capable to force out it from places of binding. Regulates exchange processes, interneural transfer and muscular irritability, interferes with intake of calcium through a presynaptic membrane, reduces quantity of acetylcholine in a peripheral nervous system and the central nervous system (CNS). Relaxes smooth muscles, reduces the arterial pressure (AP) which is (preferential increased) strengthens a diuresis.

Anticonvulsant action - magnesium reduces release of acetylcholine from neuromuscular synapses, suppressing at the same time neuromuscular transmission, has the direct oppressing effect on TsNS.
Antiarrhytmic action - magnesium reduces excitability of myocytes, recovers ionic balance, stabiyolizirut cellular membranes, breaks sodium current, the slow entering current of calcium and unilateral current of potassium.

The cardiotyre-tread effect is caused by expansion of coronary arteries, decrease in the general peripheric soyosudisty resistance and aggregation of thrombocytes.

Tokolitichesky action - magnesium oppresses sokratitelny ability of a myometrium (decrease in absorption, a svyazyyovaniye and distribution of calcium in cells of smooth muscles), strengthens a blood stream in a uterus as a result of expansion of its vessels.

Is an antidote at poisonings with salts of heavy metals. System effects develop almost instantly later intravenous (in/in) and in 1 h after intramuscular introduction (in oil). Action duration at in introduction - 30 min., at in oil - 3-4 h.

Pharmacokinetics. Equilibrium concentration (Css) - 2-3,5 mmol/l. Gets through hematoencephalic and placental barriers, sozdayot in maternal milk of concentration, the concentration twice exceeding in plasma.

Removal is carried out by kidneys, the speed of renal excretion is proportional to concentration in plasma and to the level of glomerular filtering.

Indications to use:

Arterial hypertension (including hypertensive crisis with the wet brain phenomena), a polymorphic ventricular takhikaryodiya (pirouette type), a convulsive syndrome (for suppression of spasms at an eclampsia; for the prevention of spasms at a heavy preeclampsia; for removal of strong reductions of a uterus), poisoning with salts of heavy metals (mercury, arsenic, tetraethyllead), a hypomagnesiemia (including the increased need for magnesium and an acute hypomagnesiemia tetany).

Route of administration and doses:

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

Preoklampsiya and eclampsias. The dose is established individually depending on a clinical situation a nasyyoshcheniye Dose - 2-4 g in 5-20 min. (infusion). A maintenance dose - 1-2 g an hour.

Uterus tetany. A saturation dose - 4 g in 20 min. (infusion). A maintenance dose - at first - 1 - 2 g an hour, later - 1 g an hour (it is possible to enter kapelno 24-72 h).

Hypomagnesiemia. At newborns. A daily dose - 0,2-0,8 ml/kg in oil or in/in slowly. At adults. Easy. Solution of magnesium of sulfate is applied parenterally if the peroral way of administration of drugs of magnesium is impossible or inexpedient (because of nausea, vomiting, the broken resorption in a stomach, etc.). The Sutochyony dose - 1-2 in oil. This dose is entered once or into 2-3 receptions. The injection site should be changed. Heavy. The Nachalyyony dose - 5 g. Pour in a dose in 1 l of infusion solution and slowly enter in / century. Dose depending on a drug kontsenyotration in blood serum. Prevention of a hypomagnesiemia at the patients receiving only parenteral food. If in nutrient solutions there is no magnesium, it is added in addition. A daily dose - 1,5-4 g. Usually in 1 l of solution of parenteral food add 1 g of magnesium of sulfate.

The maximum daily dose of magnesium of sulfate adult - 40 g. At hypertensive crises enter in oil or in/in (slowly!!) 5-20 ml of 25% of solution of magnesium of sulfate.

For stopping of arrhythmias in/in enter 1-2 g within about 5 minutes, perhaps repeated introduction.

Doses of Magnesium of sulfate are specified in grams. To them there corresponds the amount of solution: 1 g - 5 ml (20%) - 4 ml (25%), 2 g - 10 ml (20%) - 8 ml (25%); 3 g - 15 ml (20%) - 12 ml (25%); 4 g - 20 ml (20%) - 16 ml (25%), 5 g - 25 ml (20%) - 20 ml (25%), 10 g - 50 ml (20%) - 40 ml (25%); 15 g - 75 ml (20%) - 60 ml (25%), 20 g - 100 ml (20%) - 80 ml (25%), 30 g - 150 ml (20%) of-120 ml (25%), 40 g - 200 ml (20%) - 160 ml (25%).

Sulfate magnesium solution in ampoules is diluted with injection solutions: 0,9% of sodium of chloride or 5% of a dextrose (glucose).

Features of use:

It is necessary to consider that injections in oil are extremely painful and lead to formation of infiltrates. Magnesium sulfate should be applied carefully that there was no toxic concentration of drug. Elderly people usually should apply the reduced dose as at them function of kidneys is reduced. Patients with a renal failure (if clearance of creatinine more than 20 ml/min.) and an oliguria do not receive more than 20 g of magnesium of sulfate (81 mmol of Mg2+) during 48 h, it is not necessary to enter magnesium sulfate in/in too quickly. Control of concentration of ions of magnesium in blood serum (there have to be not higher than 0,8-1,2 mmol/l), a diuresis (not less than 100 ml/h), a respiration rate (not less than 16/mines) is recommended, to the ABP.

At administration of magnesium of sulfate it is necessary to have the calcium solution prepared for in/in introductions, for example, of 10% gluconate calcium solution. In need of magnesium, simultaneous in/in introductions, and calcium, they are entered into different veins At use of magnesium of sulfate results of radiological researches for which technetium primenyayotsya can be distorted.

Side effects:

Delay of a respiration rate, asthma, acute circulatory unefficiency; weakening of reflexes, hyperemia; arterial hypotension, hypothermia; weakening of a muscle tone, uterus atony, hyperhidrosis, uneasiness, vyrayozhenny sedation, polyuria; urezheniye of heart rate, change in the electrocardiogram. Drug lowers excitability of a respiratory center, high doses of drug at parenteral administration can easily cause paralysis of a respiratory center.

Precursory symptoms and symptoms of a gipermagniyemiya: bradycardia, a diplopia, sudden rush of blood to the person, a headache, decrease in the ABP, nausea, an asthma, the greased speech, vomiting, the general weakness.

The gipermagniyemiya signs ranged as increase in concentration of ions of magnesium in blood serum: decrease in deep tendon jerks (2-3,5 mmol/l), lengthening of an interval of PQ and expansion of the QRS complex on the electrocardiogram (2,5-5 mmol/l), decrease in tendon jerks (4-5 mmol/l), oppression of a respiratory center (5-6,5 mmol/l), disturbance of conductivity of heart (7,5 mmol/l), a cardiac standstill (12,5 mmol/l).

Interaction with other medicines:

Patients who together with magnesium sulfate apply also other medicines have to report about it to the doctor.

Strengthens effect of other medicines, the oppressing TsNS. Cardiac glycosides increase risk of a naruyosheniye of conductivity and atrioveitrikulyarny blockade (especially at simultaneous in administration of salts of calcium). Muscle relaxants and nifedipine strengthen neuromuscular blockade.

At combined use of magnesium of sulfate for parenteral administration with other vazodilatator strengthening of hypotensive effect is possible.

Barbiturates, narcotic analgetics, hypotensive drugs increase probability of oppression дыхательно­го the center.

Breaks absorption of antibiotics of group of tetracycline, weakens effect of streptomycin and a tobramntsin.

Salts of calcium reduce effect of magnesium of sulfate.

Pharmaceutical it is incompatible (forms a deposit) with calcium drugs, carbonates, bicarbonates and fosfayota of alkaline metals, clindamycin phosphate, a sodium hydrocortisone succinate, polymyxin B sulfate, Procainum a hydrochloride, salicylates and tartrates. At concentration of ions of magnesium higher than 10 mmol/ml in mixes for full parenteral food are possible division of fatty emulsions

Contraindications:

Hypersensitivity to drug, an atrioventricular block 1-3 degrees (AV blockade); the expressed renal failure (if clearance of creatinine less than 20 ml/min.); the expressed arterial hypotension; the states connected with defiyotsity calcium and oppression of a respiratory center; bradycardia; the predrodovy period (in 2 hours prior to childbirth).

With care: myasthenia, chronic renal failure (if clearance of creatinine more than 20 ml/min.), zaboleyovaniye of a respiratory organs, acute inflammatory diseases of digestive tract, advanced age, pregnancy, lactation period, children's age.

Overdose:

Symptoms: disappearance of a knee jerk, nausea, vomiting, sharp decrease in the ABP, bradycardia, respiratory depression and TsNS.

Treatment: it is necessary in/in to enter slowly solution of Calcii chloridum or calcium of a gluconate - 5-10 ml of 10%, carry out an oxygenotherapy, inhalation of Carbogenum, an artificial respiration, perntonealny dialysis or a hemodialysis, simptomatichesyoky therapy.

Storage conditions:

At a temperature not above 25 °C. In the place, unavailable to children. A period of validity - 3 years. Not to use after the expiry date specified on packaging.

Issue conditions:

According to the recipe

Packaging: