Magnesium sulfate powder BAA 25g, No. 1

For oral administration: constipation, cholangitis, cholecystitis, hypotonic dyskinesia of the gallbladder (for tyubage), duodenal intubation (to obtain a vesical portion of bile), bowel cleansing before diagnostic manipulations.

For parenteral administration: arterial hypertension (including hypertensive crisis with symptoms of cerebral edema), hypomagnesemia (including increased need for magnesium and acute hypomagnesemia - tetany, myocardial dysfunction), polymorphic ventricular tachycardia (pirouette type) ), urinary retention, encephalopathy, epileptic syndrome, threat of premature birth, convulsions with preeclampsia, eclampsia.

Poisoning with salts of heavy metals (mercury, arsenic, tetraethyl lead, barium).

The method of application and dosage regimen of a particular drug depends on its form of release and other factors. The optimal dosage regimen is determined by the doctor. It is necessary to strictly observe the compliance of the used dosage form of a particular drug with the indications for use and the dosage regimen.

Administered orally, intramuscularly and intravenously (jet slowly or drip). The dose, method and scheme of use, the duration of therapy are determined individually, depending on the indications, clinical situation and the patient's age.

• Hypersensitivity to magnesium sulfate; chronic renal failure, severe.

• For oral administration: appendicitis, rectal bleeding (including undiagnosed), intestinal obstruction, dehydration, hypermagnesemia; pregnancy, breastfeeding period; children under 18 years of age.

With care: impaired cardiac conduction, heart failure, chronic renal failure.

For parenteral administration:

• severe arterial hypotension, depression of the respiratory center, severe bradycardia, AV block I-III degree;

• prenatal period (2 hours before delivery);

• conditions associated with calcium deficiency.

With care: myasthenia gravis; chronic renal failure (creatinine clearance 20-60 ml / min); respiratory diseases; acute inflammatory diseases of the gastrointestinal tract; old age, pregnancy, breastfeeding period, age up to 18 years.

Pharmaco-therapeutic group: Laxative

pharmachologic effect

When taken orally, it has a choleretic (reflex effect on the receptors of the duodenal mucosa) and a laxative effect (due to the poor absorption of magnesium sulfate in the intestine, a high osmotic pressure is created in it, water accumulates in the intestine, the contents of the intestine liquefy, peristalsis increases). It is an antidote for poisoning with salts of heavy metals. The onset of the effect is 0.5-3 hours, the duration is 4-6 hours.

When administered parenterally, it has a hypotensive, sedative and anticonvulsant effect, as well as a diuretic, arteriodilatory, antiarrhythmic, vasodilatory (on arteries) effect, in high doses - curariform (depressing effect on neuromuscular transmission), tocolytic, hypnotic and narcotic effect, suppresses Centre. Magnesium is a physiological blocker of slow calcium channels and is able to displace it from binding sites. Regulates metabolic processes, interneuronal transmission and muscle excitability, prevents the flow of calcium through the presynaptic membrane, reduces the amount of acetylcholine in the peripheral nervous system and central nervous system. Relaxes smooth muscles, lowers blood pressure (mainly increased), increases urine output.

The mechanism of anticonvulsant action is associated with a decrease in the release of acetylcholine from neuromuscular synapses, while magnesium suppresses neuromuscular transmission, has a direct inhibitory effect on the central nervous system.

The antiarrhythmic effect of magnesium is due to a decrease in the excitability of cardiomyocytes, restoration of ionic equilibrium, stabilization of cell membranes, disruption of sodium current, slow incoming calcium current and unilateral potassium current. The cardioprotective effect is due to the expansion of the coronary arteries, a decrease in systemic vascular resistance and platelet aggregation.

The tocolytic effect develops as a result of inhibition of the contractility of the myometrium (a decrease in the absorption, binding and distribution of calcium in smooth muscle cells) under the influence of magnesium ion, increased blood flow in the uterus as a result of the expansion of its vessels. Magnesium is an antidote for poisoning with salts of heavy metals.

Systemic effects develop almost instantly after i / v and 1 hour after i / m administration. The duration of action with intravenous administration is 30 minutes, with intramuscular injection - 3-4 hours.

Pharmacokinetics

After oral administration, no more than 20% of the dose taken is absorbed.

Css, at which the anticonvulsant effect develops, is 2-3.5 mmol / l.

Penetrates the BBB and the placental barrier, is excreted in breast milk at a concentration 2 times higher than the plasma concentration. It is excreted by the kidneys, the rate of renal excretion is proportional to the plasma concentration and the level of glomerular filtration.

Indications of active substances of the drug Magnesium sulfate

For oral administration: constipation, cholangitis, cholecystitis, hypotonic dyskinesia of the gallbladder (for tyubage), duodenal intubation (to obtain a vesical portion of bile), bowel cleansing before diagnostic manipulations.

For parenteral administration: arterial hypertension (including hypertensive crisis with symptoms of cerebral edema), hypomagnesemia (including increased need for magnesium and acute hypomagnesemia - tetany, myocardial dysfunction), polymorphic ventricular tachycardia (pirouette type) ), urinary retention, encephalopathy, epileptic syndrome, threat of premature birth, convulsions with preeclampsia, eclampsia.

Poisoning with salts of heavy metals (mercury, arsenic, tetraethyl lead, barium).

Dosage regimen

The method of application and dosage regimen of a particular drug depends on its form of release and other factors. The optimal dosage regimen is determined by the doctor. It is necessary to strictly observe the compliance of the used dosage form of a particular drug with the indications for use and the dosage regimen.

Administered orally, intramuscularly and intravenously (jet slowly or drip). The dose, method and scheme of use, the duration of therapy are determined individually, depending on the indications, clinical situation and the patient's age.

Side effect

Early signs and symptoms of hypermagnesemia: bradycardia, diplopia, sudden flushing of the face, headache, dizziness, decreased blood pressure, nausea, shortness of breath, blurred speech, vomiting, asthenia.

Signs of hypermagnesemia (in order of increasing serum magnesium concentration): decreased deep tendon reflexes (2-3.5 mmol / L), lengthening 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), depression of the respiratory center (5-6.5 mmol / L), impaired cardiac conduction (7.5 mmol / L), cardiac arrest (12.5 mmol / L).

Ingestion: nausea, vomiting, diarrhea, exacerbation of inflammatory diseases of the gastrointestinal tract, electrolyte imbalance (increased fatigue, asthenia, confusion, arrhythmia, convulsions), flatulence, abdominal pain of a spastic nature, thirst, signs of hypermagnesemia in the presence of renal failure.

With the on / in the introduction: slowing down the respiratory rate, shortness of breath; acute circulatory failure; weakening of reflexes; hyperemia; marked decrease in blood pressure; hypothermia; weakening of muscle tone; atony of the uterus; hyperhidrosis; anxiety; severe sedation; polyuria; decrease in heart rate; ECG changes. Magnesium sulfate reduces the excitability of the respiratory center; high doses, when administered parenterally, can cause paralysis of the respiratory center.

Contraindications for use

Hypersensitivity to magnesium sulfate; chronic renal failure, severe.

For oral administration: appendicitis, rectal bleeding (including undiagnosed), intestinal obstruction, dehydration, hypermagnesemia; pregnancy, breastfeeding period; children under 18 years of age.

With care: impaired cardiac conduction, heart failure, chronic renal failure.

For parenteral administration: severe arterial hypotension, depression of the respiratory center, severe bradycardia, AV block I-III degree; prenatal period (2 hours before delivery); conditions associated with calcium deficiency.

With care: myasthenia gravis; chronic renal failure (creatinine clearance 20-60 ml / min); respiratory diseases; acute inflammatory diseases of the gastrointestinal tract; old age, pregnancy, breastfeeding period, age up to 18 years.

Application during pregnancy and lactation

The use of magnesium sulfate by mouth during pregnancy is contraindicated. Parenteral use during pregnancy is possible only as directed by a doctor if the intended benefit to the mother outweighs the potential risk to the fetus; use is contraindicated in the prenatal period (2 hours before childbirth).

If necessary, use during lactation, breastfeeding should be discontinued.

Application for impaired renal function

Contraindicated in severe chronic renal failure. Take with caution orally or parenterally in chronic renal failure.

Application in children

It is possible to use in children according to indications, in doses and dosage forms recommended according to age. It is necessary to strictly follow the instructions in the instructions for magnesium sulfate preparations for contraindications to the use of specific dosage forms of magnesium sulfate in children of different ages.

Use in elderly patients

Use with caution parenterally in elderly patients; in this category of ballroom, a reduced dose should usually be used, since they have reduced renal function.

special instructions

With caution, take orally or parenterally in case of heart block, myocardial damage, chronic renal failure, respiratory diseases, acute inflammatory diseases of the gastrointestinal tract, pregnancy.

Magnesium sulfate should be used with caution in elderly patients. In this category of ballroom, a reduced dose should usually be used, since they have reduced renal function.

Magnesium sulfate can be used to relieve status epilepticus (as part of complex treatment).

In case of an overdose, it causes depression of the central nervous system. As an antidote for an overdose of magnesium sulfate, calcium preparations are used - calcium chloride or calcium gluconate.

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

Influence on the ability to drive vehicles and use mechanisms

During the period of treatment, patients should refrain from driving vehicles and engaging in other potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions (risk of developing diplopia, dizziness, headache).

Drug interactions

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

With parenteral administration of magnesium sulfate and the simultaneous use of peripheral muscle relaxants, the effects of peripheral muscle relaxants are enhanced.

A case of respiratory arrest with the use of gentamicin in an infant with an increased concentration of magnesium in the blood plasma against the background of magnesium sulfate therapy is described.

With simultaneous use with nifedipine, severe muscle weakness is possible.

Reduces the effectiveness of oral anticoagulants (including coumarin derivatives or derivatives of indandione), cardiac glycosides, phenothiazines (especially chlorpromazine). Reduces the absorption of ciprofloxacin, etidronic acid, weakens the action of streptomycin and tobramycin.

With the combined use of magnesium sulfate for parenteral administration with other vasodilators, an increase in the hypotensive effect is possible.

Barbiturates, narcotic analgesics, antihypertensive drugs increase the likelihood of respiratory depression.

Violates the absorption of antibiotics of the tetracycline group, weakens the action of streptomycin and tobramycin. Calcium salts reduce the effects of magnesium sulfate.

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

As an antidote for an overdose of magnesium sulfate, calcium preparations are used - calcium chloride or calcium gluconate.

Pharmaceutically incompatible (precipitate is formed) with calcium preparations, ethanol (in high concentrations), carbonates, hydrocarbonates and phosphates of alkali metals, salts of arsenic acid, barium, strontium, clindamycin phosphate, sodium hydrocortisone succinate, polymyxin B sulfate, procaine hydrochloride and salicylates ...