Ginger/magnesium sulfate/pyridoxine Disease Interactions

Antiepileptic drugs can increase depression and suicidal thoughts or behaviors in patients receiving these drugs for any indication. Patients should be monitored for the emergence or worsening of depression, suicidal thoughts and unusual changes in mood or behavior. Caregivers and family should be alert for the emergence or worsening of symptoms. Behaviors of concern should be reported immediately to the healthcare providers.

The use of laxatives is contraindicated in patients with inflammatory bowel disease. Patients with inflammatory bowel disease may experience colonic perforation with use of stimulant laxatives.

The use of laxatives is contraindicated in patients with intestinal obstruction disorders. Patients with intestinal obstruction disorders may need their underlying condition treated to correct the constipation. Some laxatives require reduction in the colon to their active form to be effective which may be a problem in patients with intestinal obstruction.

The parenteral administration of magnesium is contraindicated in patients with heart block or heart damage from myocardial infarction. These conditions may be exacerbated during magnesium infusion. High serum levels of magnesium (> 4.5 mEq/L) can cause sinus bradycardia, AV block, nodal rhythms, and bundle branch block, which can progress to asystole and cardiac arrest at magnesium levels of approximately 14 mEq/L to 15 mEq/L. If parenteral magnesium is used in patients with preexisting conduction disturbances, it should be infused at a slower rate, and cardiac function and serum magnesium level should be closely monitored. The usual precautionary measures should be observed to prevent hypermagnesemia, and IV calcium salts (e.g., calcium gluconate), pressors, cardiac pacemakers, and equipment for supportive care should be immediately available in case of acute magnesium intoxication.

Magnesium is eliminated by the kidney. The serum concentration of magnesium is increased in patients with renal impairment. Magnesium toxicity includes CNS depression, muscular paralysis, respiratory depression, hypotension and prolonged cardiac conduction time. Disappearance of the patellar reflex is a useful clinical sign of magnesium intoxication. Therapy with magnesium should be administered cautiously and dosages should be modified in patients with compromised renal function. Clinical monitoring of serum magnesium levels is recommended.

The use of magnesium sulfate is contraindicated in patients with myasthenia gravis as it can precipitate a myasthenic crisis. Myasthenic crisis is a life-threatening condition characterized by neuromuscular respiratory failure. Symptoms of myasthenic crisis may include difficulty swallowing, ptosis, facial droop, weakness and/or difficulty breathing that may require intubation.

The use of osmotic laxatives preparations, containing sodium sulfate, potassium sulfate, and magnesium sulfate may cause cardiac arrhythmias. There have been rare reports of serious arrhythmias associated with the use of ionic osmotic laxative products for bowel preparation. Patients with electrolyte abnormalities should have them corrected before treatment is initiated. Use caution when prescribing preparations in patients at increased risk of arrhythmias or with a history of seizures. It is recommended to conduct a pre-dose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias.

The B vitamins are readily absorbed in the GI tract following oral administration. However, GI absorption may be decreased in patients with malabsorption syndromes and other conditions. For example, the absorption of thiamine and pyridoxine may commonly be decreased in alcoholics and in patients with cirrhosis. Likewise, riboflavin absorption may be impaired in patients with hepatitis, cirrhosis, or biliary obstruction. When malabsorption of these vitamins is suspected, parenteral administration may be appropriate.