Epsom Salt Side Effects

Generic Name: magnesium sulfate

Note: This page contains information about the side effects of magnesium sulfate. Some of the dosage forms included on this document may not apply to the brand name Epsom Salt.

Not all side effects for Epsom Salt may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to magnesium sulfate: crystal, ointment, powder, powder for solution, powder for suspension

In addition to its needed effects, some unwanted effects may be caused by magnesium sulfate (the active ingredient contained in Epsom Salt). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking magnesium sulfate:

Incidence not known
  • Confusion
  • dizziness or lightheadedness
  • fast, slow, or irregular heartbeat
  • low blood pressure
  • muscle weakness
  • skin infection after soaking
  • sleepiness

Some of the side effects that can occur with magnesium sulfate may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

Incidence not known
  • Diarrhea
  • skin irritation after soaking

For Healthcare Professionals

Applies to magnesium sulfate: injectable solution, intravenous solution, oral and topical powder for reconstitution

General

Electrocardiograph changes with a magnesium sulfate (the active ingredient contained in Epsom Salt) overdose have included increased PR interval, increased QRS complex width and prolonged QT interval.[Ref]

Generally, magnesium sulfate is well tolerated. However, patient response to elevated serum magnesium levels is highly variable. The majority of adverse effects are associated with excessive serum levels. Rapid bolus infusions (i.e. 2 grams over 5 seconds) may cause cutaneous flushing and transient hypotension due to a direct vasodilating effect. As serum levels exceed 3 to 4 mEq/L, central nervous system depression, lethargy, confusion, disorientation, frank coma, flushing, sweating, dilated pupils, hypotension, flaccid paralysis, depressed reflexes, hypothermia, circulatory collapse and cardiovascular depression may occur. When serum levels exceed 11 to 13 mEq/L, respiratory depression or paralysis, heart block and/or asystole may occur. Intravenous calcium (5 to 10 mEq) quickly antagonizes the effects of magnesium.[Ref]

Metabolic

Shils and colleagues demonstrated that magnesium repletion can reverse the adverse neurological and gastrointestinal effects associated with hypocalcemia (due to low magnesium levels). Additionally, abnormal EKG changes during hypomagnesemia are most likely due to the associated hypocalcemia and hypokalemia. Six men were induced experimentally with hypomagnesemia and subsequently developed hypocalcemia despite an adequate intake of calcium and vitamin D. Magnesium is essential for proper mobilization of bone/soft tissue calcium and for the cellular retention of potassium. A blinded, controlled study investigated the relationship between maternal administration of intravenous magnesium sulfate (the active ingredient contained in Epsom Salt) (mean exposure 38.3 days, range 10 to 64 days) and radiographic abnormality of neonatal long bones. Maternal mean serum magnesium levels ranged from 4.9 to 6.5 mEq/L. Eleven neonates exposed to magnesium sulfate were compared to 22 unexposed neonates. Chest radiographs were examined by a blinded pediatric radiologist. None of the 22 unexposed neonates had abnormal films. In contrast, 6 of 11 exposed neonates exhibited definite abnormalities (p < 0.001), consisting of transverse radiolucent and/or sclerotic bands. There may be a causal relationship between long-term intravenous magnesium sulfate for tocolysis and abnormal fetal bone development; however, the clinical long-term significance is unknown.

A small, retrospective review reported the presence of radiographic abnormalities (rachitic changes, dental enamel hypoplasia) and hypocalcemia in 5 neonates born to mothers treated with magnesium sulfate (from 4 to 13 weeks prior to delivery). The authors hypothesize that prolonged administration of magnesium sulfate, especially in the second trimester, may suppress fetal parathyroid function leading to rickets.[Ref]

Metabolic side effects have included hypomagnesemia. Hypomagnesemia may be associated with hypocalcemia and/or hypokalemia leading to neurologic and/or gastrointestinal changes (weakness, lethargy, anorexia, nausea and vomiting). Rare metabolic abnormalities due to hypermagnesemia may include hypocalcemia (due to suppression of the parathyroid hormone) and hypercalciuria. Bone abnormalities in infants have been reported. Hyperkalemia in two pregnant intravenous drug abusers has been reported. Reversible maternal hypothermia occurred in 30-year-old woman receiving magnesium sulfate for tocolysis.[Ref]

Gastrointestinal

Gastrointestinal side effects have included primarily diarrhea, nausea (Mg levels of 4 to 5 mEq/L), and rare cases of paralytic ileus (Mg levels greater than 5 mEq/L).[Ref]

Nervous system

Central nervous system depression may occur at higher levels; however, therapeutic serum magnesium levels attained for control of seizure during preeclampsia or eclampsia (4 to 7 mEq/L) have not been shown to be harmful to mother or infant.

One study has reported that magnesium sulfate (the active ingredient contained in Epsom Salt) negatively affects attention and rapid information processing ability but not short term memory or comprehension in patients undergoing preterm labor.[Ref]

Nervous system side effects from hypermagnesemia result from suppression of neuromuscular transmission in the CNS and at the neuromuscular junction by magnesium. Clinically, serum levels above 4 to 7 mEq/L have lead to decreased deep tendon reflexes, muscle weakness, mental confusion or sedation. At levels of 7 to 10 mEq/L, slower respiratory rates and decreased blood pressure has been reported. At levels of 10 to 15 mEq/L, profound mental depression, areflexia, coma and respiratory paralysis has been a common occurrence. Magnesium has also been reported to have a curare-like effect at the neuromuscular junction at serum levels above 10 mEq/L. Death may occur at any serum level but has been especially common at levels above 15 mEq/L.[Ref]

Cardiovascular

A case report described a 65-year-old man who developed ventricular fibrillation following rapid (over 5 seconds) administration of 2 grams of magnesium sulfate (the active ingredient contained in Epsom Salt) for treatment of sustained monomorphic ventricular tachycardia. Ventricular fibrillation developed within 3 minutes of administration. The patient was successfully resuscitated with a single direct current shock; however, the patient died 3 days later. The authors caution against rapid intravenous administration of magnesium sulfate, even in the setting of ventricular arrhythmias.[Ref]

Cardiovascular side effects of magnesium are due to vasodilation, leading to flushing with rapid infusions and hypotension at serum levels of 7 to 10 mEq/L. Bradyarrhythmias have occurred at levels above 10 mEq/L. Asystole has occurred at levels above 25 mEq/L. The risk of cardiotoxicity from hypermagnesemia is increased in the presence of hypocalcemia, hyperkalemia, acidosis, digitalis therapy, and renal insufficiency. Chest pain and palpitations have also been reported.[Ref]

Respiratory

Respiratory side effects including respiratory arrest have been reported in patients with extremely elevated serum magnesium levels (> 13 mEq/L). Pulmonary edema occurred after magnesium sulfate (the active ingredient contained in Epsom Salt) administration as a tocolytic, which responded to diuretics.[Ref]

Ocular

Ocular side effects have included diplopia (double vision) reported in 2 women receiving magnesium sulfate (the active ingredient contained in Epsom Salt) for tocolysis. A decrease in dosage remedied the adverse effect.[Ref]

Hypersensitivity

Hypersensitivity side effects have included a dermatological urticarial eruption which cleared when intravenous magnesium sulfate (the active ingredient contained in Epsom Salt) was discontinued. The 2 case reports occurred in obstetrical nurses previously exposed occupationally to magnesium sulfate, but who received a therapeutic dose for preterm labor.[Ref]

Hematologic

Hematologic side effects have included reports of increased bleeding times after magnesium sulfate (the active ingredient contained in Epsom Salt) infusions in preeclamptic women.[Ref]

References

1. Garcia-Webb P, Bhagat C, Oh T, Hart G, Thompson W "Hypermagnesaemia and hypophosphataemia after ingestion of magnesium sulphate." Br Med J (Clin Res Ed) 288 (1984): 759

2. Pruett KM, Kirshon B, Cotton DB, Adam K, Doody KJ "The effects of magnesium sulfate therapy on Apgar scores." Am J Obstet Gynecol 159 (1988): 1047-8

3. Gerard SK, Hernandez C, Khayam-Bashi H "Extreme hypermagnesemia caused by an overdose of magnesium-containing cathartics." Ann Emerg Med 17 (1988): 728-31

4. Rizzo MA, Fisher M, Lock JP "Hypermagnesemic pseudocoma." Arch Intern Med 153 (1993): 1130-2

5. Collinson PO, Burroughs AK "Severe hypermagnesaemia due to magnesium sulphate enemas in patients with hepatic coma [published erratum appears in Br Med J (Clin Res Ed) 1986 Nov 8;293(6556):1222]." Br Med J (Clin Res Ed) 293 (1986): 1013-4

6. Weber CA, Santiago RM "Hypermagnesemia. A potential complication during treatment of theophylline intoxication with oral activated charcoal and magnesium- containing cathartics." Chest 95 (1989): 56-9

7. Fung MC, Weintraub M, Bowen DL "Hypermagnesemia: elderly over-the-counter drug users at risk." Arch Fam Med 4 (1995): 718-23

8. McLean RM "Magnesium and its therapeutic uses: a review." Am J Med 96 (1994): 63-76

9. Spital A, Greenwell R "Severe hyperkalemia during magnesium sulfate therapy in two pregnant drug abusers." South Med J 84 (1991): 919-21

10. Smilkstein MJ, Smolinske SC, Kulig KW, Rumack BH "Severe hypermagnesemia due to multiple-dose cathartic therapy." West J Med 148 (1988): 208-11

11. Wax JR, Segna RA, Vandersloot JA "Magnesium toxicity and resuscitation - an unusual cause of postcesarean evisceration." Int J Gynaecol Obstet 48 (1995): 213-4

12. Caritis SN, Darby MJ, Chan L "Pharmacologic treatment of preterm labor." Clin Obstet Gynecol 31 (1988): 635-51

13. Bourgeois FJ, Thiagarajah S, Harbert GM Jr, DiFazio C "Profound hypotension complicating magnesium therapy." Am J Obstet Gynecol 154 (1986): 919-20

14. Eisenbud E, LoBue CC "Hypocalcemia after therapeutic use of magnesium sulfate." Arch Intern Med 136 (1976): 688-91

15. Parsons MT, Owens CA, Spellacy WN "Thermic effects of tocolytic agents: decreased temperature with magnesium sulfate." Obstet Gynecol 69 (1987): 88-90

16. Cruikshank DP, Chan GM, Doerrfeld D "Alterations in vitamin D and calcium metabolism with magnesium sulfate treatment of preeclampsia." Am J Obstet Gynecol 168 (1993): 1170-6;disc. 1176-7

17. Lamm CI, Norton KI, Murphy RJ, Wilkins IA, Rabinowitz JG "Congenital rickets associated with magnesium sulfate infusion for tocolysis." J Pediatr 113 (1988): 1078-82

18. Mountokalakis TH, Tsiotras S, Skopelitis P, Alivisatos J "Hypocalcemia following magnesium sulfate therapy." JAMA 221 (1972): 195

19. Holcomb WL Jr, Shackelford GD, Petrie RH "Magnesium tocolysis and neonatal bone abnormalities: a controlled study." Obstet Gynecol 78 (1991): 611-4

20. Monif GR, Savory J "Iatrogenic maternal hypocalcemia following magnesium sulfate therapy." JAMA 219 (1972): 1469-70

21. Smith LG Jr, Burns PA, Schanler RJ "Calcium homeostasis in pregnant women receiving long-term magnesium sulfate therapy for preterm labor." Am J Obstet Gynecol 167 (1992): 45-51

22. Nanji AA "Symptomatic hypercalcaemia precipitated by magnesium therapy." Postgrad Med J 61 (1985): 47-8

23. Cholst IN, Steinberg SF, Tropper PJ, Fox HE, Segre GV, Bilezikian JP "The influence of hypermagnesemia on serum calcium and parathyroid hormone levels in human subjects." N Engl J Med 310 (1984): 1221-5

24. Rodis JF, Vintzileos AM, Campbell WA, Deaton JL, Nochimson DJ "Maternal hypothermia: an unusual complication of magnesium sulfate therapy." Am J Obstet Gynecol 156 (1987): 435-6

25. Shils ME "Experimental production of magnesium deficiency in man." Ann N Y Acad Sci 162 (1969): 847-55

26. Hill WC, Gill PJ, Katz M "Maternal paralytic ileus as a complication of magnesium sulfate tocolysis." Am J Perinatol 2 (1985): 47-8

27. Ghia N, Spong CY, Starbuck VN, Scialli AR, Ghidini A "Magnesium sulfate therapy affects attention and working memory in patients undergoing preterm labor." Am J Obstet Gynecol 183 (2000): 940-4

28. Belfort MA "The effect of magnesium sulphate on blood flow velocity in the maternal retina in mild pre-eclampsia: a preliminary colour flow Doppler study." Br J Obstet Gynaecol 99 (1992): 641-5

29. Belfort MA, Saade GR, Moise KJ Jr "The effect of magnesium sulfate on maternal retinal blood flow in preeclampsia: a randomized placebo-controlled study." Am J Obstet Gynecol 167 (1992): 1548-53

30. Bashuk RG, Krendel DA "Myasthenia gravis presenting as weakness after magnesium administration." Muscle Nerve 13 (1990): 708-12

31. Richards A, Stather-Dunn L, Moodley J "Cardiopulmonary arrest after the administration of magnesium sulphate. A case report." S Afr Med J 67 (1985): 145

32. Wilkins IA, Lynch L, Mehalek KE, Berkowitz GS, Berkowitz RL "Efficacy and side effects of magnesium sulfate and ritodrine as tocolytic agents." Am J Obstet Gynecol 159 (1988): 685-9

33. Sherer DM, Cialone PR, Abramowicz JS, Woods JR Jr "Transient symptomatic subendocardial ischemia during intravenous magnesium sulfate tocolytic therapy." Am J Obstet Gynecol 166 (1992): 33-5

34. Viskin S, Belhassen B, Laniado S "Deterioration of ventricular tachycardia to ventricular fibrillation after rapid intravenous administration of magnesium sulfate." Chest 101 (1992): 1445-7

35. Rogiers P, Vermeier W, Kesteloot H, Stroobandt R "Effect of the infusion of magnesium sulfate during atrial pacing on ECG intervals, serum electrolytes, and blood pressure." Am Heart J 117 (1989): 1278-83

36. Pritchard JA, Cunningham FG, Pritchard SA "The Parkland Memorial Hospital protocol for treatment of eclampsia: evaluation of 245 cases." Am J Obstet Gynecol 148 (1984): 951-63

37. Elliott JP, O'Keeffe DF, Greenberg P, Freeman RK "Pulmonary edema associated with magnesium sulfate and betamethasone administration." Am J Obstet Gynecol 134 (1979): 717-9

38. Semchyshyn S, Zuspan FP, O'Shaughnessy R "Pulmonary edema associated with the use of hydrocortisone and a tocolytic agent for the management of premature labor." J Reprod Med 28 (1983): 47-52

39. Hollander DI, Nagey DA, Pupkin MJ "Magnesium sulfate and ritodrine hydrochloride: a randomized comparison." Am J Obstet Gynecol 156 (1987): 631-7

40. Digre KB, Varner MW, Schiffman JS "Neuroophthalmologic effects of intravenous magnesium sulfate." Am J Obstet Gynecol 163 (1990): 1848-52

41. Thorp JM Jr, Katz VL, Campbell D, Cefalo RC "Hypersensitivity to magnesium sulfate." Am J Obstet Gynecol 161 (1989): 889-90

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