Skip to Content

Magnesium Sulfate

Pronunciation

Class: Anticonvulsants, Miscellaneous
VA Class: CN400
CAS Number: 10034-99-8

Introduction

Anticonvulsant parenterally; electrolyte; required cofactor for numerous human enzyme systems.94 a

Uses for Magnesium Sulfate

Prevention and Control of Seizures

Used parenterally for prevention and control of seizures in toxemias (preeclampsia or eclampsia) of pregnancy and in various other conditions.58 67 91 95 (See Preeclampsia and Eclampsia and also see Other Seizure Etiologies under Uses.)

Preeclampsia and Eclampsia

Generally considered anticonvulsant drug of choice for prevention and control of seizures in severe preeclampsia or in eclampsia;58 59 60 61 104 appears to be more effective than phenytoin in preeclampsia, and more effective than phenytoin and diazepam in eclampsia.58 60 61 101 102 104

The American College of Obstetricians and Gynecologists (ACOG) strongly recommends intrapartum/postpartum use of magnesium sulfate in women with severe preeclampsia to prevent eclampsia.58

Routine use not recommended in women with preeclampsia without severe features (e.g., systolic BP ≥160 mm Hg or diastolic BP ≥110 mm Hg, thrombocytopenia, impaired liver or renal function, pulmonary edema, new-onset cerebral or visual disturbances).58 Individualize decision to initiate therapy in these patients based on the presence of certain warning signs of seizures (e.g., headache, altered mental state, blurred vision, scotomata, clonus, right upper quadrant pain).58

Clinical course of preeclampsia may change rapidly and unexpectedly; monitor patients closely and initiate therapy if progression to severe preeclampsia occurs.58

ACOG strongly recommends administration of parenteral magnesium sulfate in patients with eclampsia; continue therapy for ≥24 hours after last seizure.58

Other Seizure Etiologies

May be used parenterally to control seizures associated with epilepsy, glomerulonephritis, or hypothyroidism, since low plasma concentrations of magnesium may be a contributing cause of seizures in these conditions.67

Has been used for immediate control of life-threatening seizures in children with acute nephritis.95

Prevention and Treatment of Hypomagnesemia

Used to correct or prevent hypomagnesemia in patients receiving total parenteral nutrition.67

Also used in the treatment of acute hypomagnesemia accompanied by signs of tetany similar to those of hypocalcemia; usually, serum magnesium concentrations are below the lower limits of normal (1.5–2.5 or 3 mEq/L), and serum calcium concentrations are either normal (4.3–5.3 mEq/L) or elevated in such cases.67

Preterm Labor and Fetal Neuroprotection

Has been used to inhibit uterine contractions in preterm labor (tocolysis) and prolong gestation when considered beneficial.14 69 However, efficacy and safety not established and not labeled by FDA for this use.67 69 75

ACOG and other experts support the short-term (≤48 hours) obstetric use of magnesium sulfate for appropriate conditions and durations of therapy.91 This includes short-term (i.e., ≤48 hours) prolongation of pregnancy to allow time for administration of antenatal corticosteroids; corticosteroid administration prior to anticipated preterm birth is strongly associated with decreased neonatal morbidity and mortality.69 71 72 73 91 92

Also may be used for fetal neuroprotection prior to preterm delivery to reduce the risk of cerebral palsy.28 29 69 89 91

May be contraindicated by maternal or fetal conditions.67 69 (See Contraindications under Cautions.)

Do not use for >5–7 days for tocolysis; such prolonged use in pregnant women has been associated with adverse fetal effects (e.g., hypocalcemia, osteopenia, bone demineralization, fractures).67 75 77 78 79 80 81 82 83 84 85 86 91 (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

ACOG states that maintenance treatment with tocolytic drugs is not recommended because it is not effective in preventing preterm birth and improving neonatal outcomes.69

Limited data indicate that combination therapy with another tocolytic agent may be more effective than single-agent therapy, but may increase risk of maternal morbidity; use with caution.19 24 25 27 69

Concurrent use of magnesium sulfate and nifedipine may be particularly risky and potentially harmful.32 69 (See Specific Drugs under Interactions.)

Arrhythmias

Used IV successfully for the treatment of life-threatening arrhythmias such as atypical VT (torsades de pointes).8 9 10 94 400 401

Considered one of several preferred drugs in the treatment of polymorphic VT suspected of being torsades de pointes in patients in whom initial attempts at correcting or managing potential precipitating factors (e.g., ischemic cardiac events, electrolyte imbalance, drugs known to prolong the QT interval) have not been successful.64 94 401

Should not be used routinely during cardiac arrest, but may be considered when arrest rhythm is associated with torsades de pointes.400 401 402 403

Has been used IV in the management of paroxysmal atrial tachycardia when other measures have failed and there is no evidence of myocardial damage.67

Acute MI

Has been administered IV adjunctively to reduce cardiovascular morbidity and mortality (e.g., through reduction in ventricular arrhythmias and/or limitation of infarct size and reperfusion injury) associated with acute MI;2 6 7 34 35 36 37 38 39 64 however, evidence of benefit is contradictory.34 44 45 46 47 64 106

Should not be used routinely in patients with acute MI, but may be reasonable in patients with documented magnesium deficiency or torsades de pointes.105 106

Acute Asthma

Has been used in the treatment of acute asthma.96 98 99 100 196

There is some evidence that the drug may improve pulmonary function (i.e., peak expiratory flow rate and forced expiratory volume in 1 second) and reduce hospitalizations, particularly in patients with severe exacerbations.98 99 196

Although current evidence does not support routine use in all patients with acute asthma, may be beneficial, and thus may be considered, in patients with severe acute asthma.98 99 100 196

Barium Poisoning

Has been administered IV to counteract the intense muscle stimulating effects of barium poisoning.67

Magnesium Sulfate Dosage and Administration

Administration

Administer IV or IM.67 68 95

Also has been administered by intraosseous (IO) infusion in the ACLS setting, generally when IV access is not readily available; onset of action and systemic concentrations are comparable to those achieved with venous administration.401 403

When used in pregnant women for conditions other than those labeled by the FDA such as for prevention of preterm labor, administer only by trained obstetric personnel in a hospital setting with appropriate obstetrical care facilities.67 75 Hospitals that use magnesium sulfate for fetal neuroprotection should develop uniform and specific guidelines for such use.69 89

IV Administration

Concentration should not exceed 200 mg/mL (20%) for IV administration.67

Must dilute magnesium sulfate 50% injection prior to IV administration;67 alternatively, may use a commercially available prediluted solution of magnesium sulfate in 5% dextrose or sterile water for injection.68 97

Rate of Administration

Usually, do not exceed 150 mg/minute (e.g., 1.5 mL/minute of a 10% concentration or equivalent) except in patients with seizures associated with severe eclampsia.67

IM Administration

Adults: Generally, use concentration of 250 mg/mL (25%) or 500 mg/mL (50%).a

Infants and children: Usually, use concentration ≤200 mg/mL (20%).67 However, higher concentrations (e.g., 50%) have been used.95

Dosage

Adjust dosage carefully according to individual requirements and response; discontinue as soon as the desired effect is obtained.67

Each gram of magnesium sulfate heptahydrate contains 8.1 mEq of magnesium.67

Use caution when switching between different parenteral formulations to ensure that patients receive the correct dose.90

Pediatric Patients

Pediatric Advanced Life Support (PALS)
Torsades de Pointes or Suspected Hypomagnesemia
IV/IO

Some experts recommend 25–50 mg/kg (up to 2 g) over 10–20 minutes (or faster in torsades de pointes).403

Hypomagnesemia
Prevention
Additive in Total Parenteral Infusion

Infants: Usually, 2–10 mEq of magnesium daily.67

Maintenance requirements not precisely known.67

Treatment
IV or IM

Some experts recommend 25–50 mg/kg (up to 2 g) every 4–6 hours for 3–4 doses; repeat as needed.96

For deficiency that is not severe in older children, some manufacturers have recommended 1 g (2 mL of 50% solution) once or twice daily by IM injection.95

Use serum magnesium values to guide continued dosage.95

Acute Asthma
IV

Single dose of 25–75 mg/kg (maximum 2 g) over 20 minutes recommended for moderate to severe exacerbation of reactive airway disease.96

Adults

Prevention and Control of Seizures
Preeclampsia and Eclampsia

Various dosing regimens have been recommended.58 67 68 103 104

For management of preeclampsia or eclampsia, dilute (1–8%) solutions are often given by IV infusion in combination with IM injections using 50% magnesium sulfate.68

IV with IM

Severe preeclampsia or eclampsia: Manufacturer states that an IV dose of 4–5 g diluted in 250 mL of 5% dextrose injection or 0.9% sodium chloride injection may be given simultaneously with IM injections of up to 10 g (5 g or 10 mL of undiluted 50% solution administered into each buttock).67 Total initial dose: 10–14 g.67 68

Alternatively, initial dose of 4 g may be given IV by diluting the 50% solution to a concentration of 10 or 20%; may then inject 40 mL of a 10% solution or 20 mL of a 20% solution IV over 3–4 minutes.67 Administer subsequent 4- to 5-g doses (8–10 mL of the undiluted 50% injection) IM into alternate buttocks every 4 hours as needed, depending on the continuing presence of the patellar reflex and adequate respiratory function.67

After the initial IV dose, some clinicians administer a maintenance IV infusion of 1–2 g/hour.58 68

Continue therapy until paroxysms cease.67

Serum magnesium concentration of 6 mg/dL is considered optimal for seizure control.67

IV

For prevention or treatment of eclamptic seizures, ACOG recommends IV loading dose of 4–6 g, followed by a maintenance IV infusion of 1–2 g/hour for ≥24 hours.58

Other Seizure Etiologies
IM or IV

For seizures associated with epilepsy, glomerulonephritis, or hypothyroidism: Usually, 1 g.67

Hypomagnesemia
Prevention
IV Infusion

Additive in total parenteral nutrition: Usually, 8–24 mEq daily.67

Maintenance requirements are not precisely known.67

Treatment
IM

Mild deficiency: Usually, 1 g (8.12 mEq or 2 mL of the 50% solution) every 6 hours for 4 doses.67

Alternatively, for deficiency that is not severe: 1 g (2 mL of the 50% solution) once or twice daily has been given; use serum magnesium concentrations to guide continued dosing.95

Severe deficiency: If necessary, may administer up to 250 mg (about 2 mEq or 0.5 mL of the 50% solution) per kg of body weight within a 4-hour period.a 67

Alternatively, for severe deficiency: 1–5 g (2–10 mL of the 50% solution) daily in divided doses has been given and repeated daily until serum levels are normal.95

Use caution to prevent exceeding the renal excretory capacity.67

IV infusion

For severe deficiency: 5 g (approximately 40 mEq) added to 1 L of 5% dextrose injection or 0.9% sodium chloride injection infused slowly over 3 hours.67

Preterm Labor

Carefully adjust rate and duration of infusion according to the patient’s response as indicated (by uterine response, maternal and fetal tolerance).13 14 15 16 17 18

Administration for prolonged periods (i.e., >5–7 days) may cause adverse fetal effects.67 75 77 78 79 80 81 82 83 84 85 86 (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

Monitoring of serum magnesium concentrations may be useful to minimize the risk of toxicity (e.g., respiratory depression, cardiotoxicity, maternal tetany, muscular paralysis, hypotension) and to determine the maximum safe infusion rate.13 33

Monitor amount and rate of IV fluid administration to avoid circulatory overload.13

Observe for signs and symptoms of pulmonary edema.13

IV Infusion

Acute tocolytic therapy: Loading dose of 4–6 g over 20 minutes; after contractions cease, follow with maintenance infusions of 2–4 g/hour for 12–24 hours as tolerated.13 14 15 16 17 18 69

Arrhythmias
Atypical VT (Torsades de Pointes)
IV

Some experts recommend 1–2 g over 15 minutes.401

Dose of 1–6 g over several minutes also used, followed in some cases by 3–20 mg/minute by IV infusion for 5–48 hours, depending on response and serum magnesium concentrations.8 9 10 64

Torsades de pointes associated with cardiac arrest: Some experts recommend 1–2 g bolus dose in 10 mL 5% dextrose injection.401

IO

Torsades de pointes associated with cardiac arrest: Some experts recommend 1–2 g bolus dose in 10 mL 5% dextrose injection.401

Acute Asthma
IV

Usually, 2 g over 20 minutes.96 196

Barium Poisoning
IV

Usually, 1–2 g to counteract the intense muscle stimulating effects of barium.67

Prescribing Limits

Pediatric Patients

Pediatric Advanced Life Support (PALS)
Torsades de Pointes or Suspected Hypomagnesemia
IV/IO

Maximum single dose of 2 g.403

Hypomagnesemia
IV or IM

Maximum single dose of 2 g.96

Acute Asthma
IV

Maximum single dose of 2 g.96

Adults

Prevention and Control of Seizures
Preeclampsia and Eclampsia
IV with IM

Do not exceed total dosage of 30–40 g daily.67

Special Populations

Renal Impairment

Prevention and Control of Seizures
Preeclampsia and Eclampsia
IV with IM

Maximum 20 g/48 hours in severe renal impairment.67

Geriatric Patients

Often require reduced dosage because of impaired renal function.67 In severe renal impairment, do not exceed 20 g in a 48-hour period; monitor serum magnesium concentrations.67

Cautions for Magnesium Sulfate

Contraindications

  • Parenteral administration in heart block or myocardial damage.67 95

  • Tocolytic therapy in general may be contraindicated by some maternal or fetal conditions (e.g., nonreassuring fetal status, chorioamnionitis, fetal demise, lethal congenital or chromosomal abnormalities, maternal bleeding with hemodynamic instability, severe preeclampsia or eclampsia, preterm premature rupture of membranes [may consider use in the absence of maternal infection for maternal transport and/or corticosteroid administration]).69

  • Tocolytic therapy with magnesium sulfate may be contraindicated in myasthenia gravis.69 72

  • In toxemia of pregnancy during 2 hours prior to delivery.67 68

Warnings/Precautions

Warnings

Fetal/Neonatal Morbidity and Mortality

May cause fetal harm; hypocalcemia and related skeletal abnormalities (e.g., bone demineralization, osteopenia, fractures) observed in neonates with prolonged (>5–7 days) in utero exposure to parenterally administered magnesium sulfate.67 75 77 78 79 80 81 82 83 84 85 86 87 88 Evidence of such fetal toxicity based principally on case reports and epidemiologic studies.67 75 77 78 79 80 81 82 83 84 85 86 87 In these reports, magnesium sulfate was administered IV for periods >5–7 days for prevention of preterm labor (tocolysis), which is not an FDA-labeled use.75 77 78 79 80 85 86 88

Increased possibility of neonatal toxicity (including neuromuscular or respiratory depression) with prolonged continuous IV infusion before delivery (especially for >24 hours); IM use does not usually compromise neonate.67 87 a

Neonatal hypermagnesemia management may require resuscitation and assisted ventilation via endotracheal intubation and/or intermittent positive-pressure ventilation, as well as IV calcium.a

If administered for preterm labor, inform patient that efficacy and safety of magnesium sulfate for this use have not been established and that use of the drug for >5–7 days in this setting may cause fetal harm.67 75 The shortest duration of use that can result in fetal harm is not known.67 75

Toxicity

Principal hazard is hypermagnesemia, most immediate life-threatening effect is respiratory depression; have IV calcium (e.g., calcium gluconate) readily available for use as antidote.95 a

Adverse effects of parenteral therapy are caused by magnesium intoxication.a

Toxic manifestations (may begin at serum magnesium concentrations of 4 mEq/L) include neurologic symptoms (e.g., muscular weakness, flaccid paralysis, ataxia, drowsiness, confusion, depression of reflexes), flushing, sweating, vasodilation, hypotension, hypothermia, depression of cardiac function, bradycardia, cardiac arrhythmias, circulatory collapse, hypoventilation, and CNS depression; can proceed to fatal respiratory paralysis.a 70

Observe carefully, and monitor serum magnesium concentrations to avoid overdosage and toxicity.a

During tocolytic therapy, observe carefully and monitor serum magnesium concentrations to minimize the risk of toxicity (e.g., respiratory depression, cardiotoxicity, maternal tetany, muscular paralysis, hypotension).13 21 22 23

Hypocalcemia with signs of tetany can occur during tocolytic use.a

Patellar reflex disappearance is useful to detect intoxication onset.a Test knee jerk reflexes before each dose; if absent, give no additional magnesium until they return.a

Make sure respiration rate is ≥16/minute prior to each dose.a

Do not continue dosage unless urine output is 100 mL or more during the 4 hours preceding each dose.a

If overdosage occurs, provide artificial ventilation until a calcium salt can be given IV.a

In adults, IV administration of 5–10 mEq of calcium (e.g., 10–20 mL of 10% calcium gluconate) usually will reverse respiratory depression or heart block caused by magnesium intoxication.a

Peritoneal dialysis or hemodialysis may be required in extreme cases of hypermagnesemia.a

Some preparations contain aluminum; risk of aluminum accumulation and associated toxicity (e.g., CNS and bone toxicities) with prolonged parenteral administration in patients with impaired renal function.67 Premature neonates are at particularly high risk.67

Maternal Pulmonary Edema

Risk of maternal pulmonary edema with tocolytic therapy; development during the initial 24 hours is uncommon.13 69

Etiology is unclear;13 risk factors include excessive hydration, multiple gestation, occult sepsis, and underlying cardiac disease.13

Adjunctive corticosteroid therapy apparently is not an important risk factor .13

Reduce risk by limiting fluid intake to 2.5–3 L daily, limiting sodium intake, and maintaining maternal pulse <130 bpm.13

Monitor amount and rate of IV fluid administration to avoid circulatory overload; observe carefully for signs/symptoms of pulmonary edema.13

Hypocalcemia

Clinically important hypocalcemia with signs of tetany has occurred after use for eclampsia.a Changes in calcium and phosphorus balance should be anticipated in each case of parenteral magnesium administration.a

Major Toxicities

Respiratory Depression

See Warnings under Cautions.

General Precautions

Use with caution if flushing and sweating occur.95

CNS Depressants

Adjust dosage carefully with concomitant use; have IV calcium (e.g., calcium gluconate) readily available for use as antidote for magnesium toxicity.95 a (See Specific Drugs under Interactions.)

Laboratory Tests

Confirm hypomagnesemia, monitor serum magnesium concentrations.95 (See Warnings under Cautions.)

Specific Populations

Pregnancy

Category D.67 75 (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

Use during pregnancy only if clearly needed; apprise patient of potential hazard to fetus.67 75

Do not give IV during the 2 hours preceding delivery.a

Lactation

Distributed into milk.67 87 a Caution if used in nursing women,67 a but generally considered compatible with breast-feeding.87

Milk magnesium concentrations increased for only about 24 hours after discontinuance of parenteral magnesium; amount ingested by a nursing infant during this period is probably too small to be of clinical importance.87 a

Pediatric Use

Although one manufacturer states safety and efficacy not established in children, other manufacturers make no pediatric restrictions.67 68

Geriatric Use

Often requires reduced dosage because of impaired renal function.67 (See Geriatric Patients under Dosage and Administration.)

Renal Impairment

Administer with caution in renal impairment; danger of magnesium intoxication.67 a

Reduce dosage and obtain frequent serum magnesium concentrations in severe renal impairment.a (See Renal Impairment under Dosage and Administration.)a

Common Adverse Effects

Flushing, sweating, hypotension, depression of reflexes, flaccid paralysis, hypothermia, circulatory collapse, depression of cardiac function, CNS depression, respiratory paralysis, hypocalcemia, tetany.67

Interactions for Magnesium Sulfate

Specific Drugs

Drug

Interaction

Comments

β-Adrenergic agonists

Risk of serious adverse maternal effects when used for preterm labor69

Use concomitantly with caution69

Calcium-channel blocking agents (e.g., nifedipine)

Risk of serious adverse maternal effects (reduced heart rate, contractility, and left ventricular systolic pressure; neuromuscular blockade) when used for preterm labor69

Use concomitantly with caution69

CNS depressants (e.g., barbiturates, opiates, general anesthetics)

Additive central depressant effects with concomitant usea

Adjust dosage carefullya

Have IV calcium (e.g., calcium gluconate) preparation readily available for use as antidote95

Digoxin

Serious changes in cardiac conduction; may cause heart block if IV calcium is required to treat magnesium toxicitya

Use with extreme caution in digitalized patientsa

Neuromuscular blocking agents

Excessive neuromuscular blockade a

Use concomitantly with cautiona

Magnesium Sulfate Pharmacokinetics

Absorption

Onset

IV administration: Immediate onset.a

IM administration: About 1 hour.a

Duration

IV administration: About 30 minutes.a

IM administration: 3–4 hours.a

Plasma Concentrations

Effective anticonvulsant serum magnesium concentrations: 2.5–7.5 mEq/L.a

Monitor for hypermagnesemia (serum concentrations >2.5 mEq/L); toxic effects (e.g., depression of deep-tendon reflexes) may begin at 4 mEq/L.a

At 10 mEq/L, deep-tendon reflexes disappear and respiratory paralysis may occur; complete heart block can occur at about 10 mEq/L.a

Serum magnesium >12 mEq/L may be fatal.

Distribution

Extent

Crosses the placenta.75 87 a

Distributes into milk.67 87 a

Elimination

Elimination Route

Excreted by the kidneys; interindividual variability in rate but directly proportional to serum concentration and glomerular filtration.94 a

Stability

Storage

Parenteral

Injection

20–25°C; avoid freezing.67

Magnesium Sulfate in 5% Dextrose Injection

20–25°C; avoid freezing.68

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Incompatible with alkali hydroxides (forming insoluble magnesium hydroxide), with alkali carbonates (forming basic carbonates), and with salicylates (forming basic salicylates).a

Reacts with arsenates, phosphates, and tartrates, precipitating the corresponding magnesium salts.a

Lead, barium, strontium, and calcium react with magnesium sulfate resulting in precipitation of the respective sulfates.a

Parenteral

Solution CompatibilityHID

Compatible

Dextrose 5% in water

Ringer’s injection, lactated

Sodium chloride 0.9%

Drug Compatibility
Admixture CompatibilityHID

Compatible

Chloramphenicol sodium succinate

Cisplatin

Heparin sodium

Hydrocortisone sodium succinate

Isoproterenol HCl

Meropenem

Methyldopate HCl

Norepinephrine bitartrate

Penicillin G potassium

Potassium chloride

Verapamil HCl

Incompatible

Amphotericin B

Cyclosporine

Dobutamine HCl

Polymyxin B sulfate

Variable

Calcium chloride

Calcium gluconate

Sodium bicarbonate

Y-Site CompatibilityHID

Compatible

Acyclovir sodium

Aldesleukin

Amifostine

Amikacin sulfate

Ampicillin sodium

Aztreonam

Bivalirudin

Caspofungin acetate

Cefazolin sodium

Cefotaxime sodium

Cefoxitin sodium

Chloramphenicol sodium succinate

Cisatracurium besylate

Clindamycin phosphate

Clonidine HCl

Co-trimoxazole

Dexmedetomidine HCl

Dobutamine HCl

Docetaxel

Doripenem

Doxorubicin HCl liposome injection

Doxycycline hyclate

Enalaprilat

Erythromycin lactobionate

Esmolol HCl

Etoposide phosphate

Famotidine

Fenoldopam mesylate

Fludarabine phosphate

Gallium nitrate

Gentamicin sulfate

Granisetron HCl

Heparin sodium

Hetastarch in lactated electrolyte injection (Hextend)

Hydrocortisone sodium succinate

Hydromorphone HCl

Hydroxyethyl starch 130/0.4 in sodium chloride 0.9%

Idarubicin HCl

Insulin, regular

Labetalol HCl

Levofloxacin

Linezolid

Meperidine HCl

Metronidazole

Micafungin sodium

Milrinone lactate

Morphine sulfate

Nafcillin sodium

Nicardipine HCl

Ondansetron HCl

Oxacillin sodium

Oxaliplatin

Paclitaxel

Penicillin G potassium

Piperacillin sodium–tazobactam sodium

Potassium chloride

Propofol

Remifentanil HCl

Sargramostim

Sodium nitroprusside

Telavancin HCl

Thiotepa

Tobramycin sulfate

Vancomycin HCl

Incompatible

Amphotericin B cholesteryl sulfate complex

Variable

Amiodarone

Ceftaroline fosamil

Ciprofloxacin

Actions

  • Hypermagnesemia (serum magnesium concentrations >2.5 mEq/L) may depress the CNS and block peripheral neuromuscular transmission, producing anticonvulsant effects.a

  • Exact mechanism is not fully known; excess magnesium appears to decrease the amount of acetylcholine liberated by the motor nerve impulse.a

  • Magnesium ions slow the rate of the SA node impulse formation and prolong conduction time in animals.a

  • IV infusion prolongs PR interval, H (atria-His bundle) interval, antegrade AV nodal effective refractory period, and SA conduction time in humans.a

  • Required cofactor for >300 enzyme systems.94

  • Required for both anaerobic and aerobic energy generation and for glycolysis.94

  • Described as nature’s physiologic calcium-channel blocking agent.94

  • During magnesium depletion, intracellular calcium increases, which can cause muscle cramps, hypertension, and coronary and cerebral vasospasms.94

  • Plays an important role in BP regulation; hypertension may be associated with magnesium deficiency and magnesium may decrease BP in hypertension.94

  • Important role in bone and mineral homeostasis and can directly affect bone cell formation and influence hydroxyapatite crystal formation and growth; deficiency may be risk factor for osteoporosis.94

  • Insulin resistance and impaired insulin secretion with deficiency.94

Advice to Patients

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses.a

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.a If administered for preterm labor, inform patient that efficacy and safety for this use have not been established and that use of the drug for >5–7 days may cause fetal harm.67 75

  • Importance of informing patients of other important precautionary information.67 a (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Magnesium Sulfate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Crystals

Parenteral

Injection

50%*

Magnesium Sulfate Injection

Injection, for IV use only

4% (2, 4, 20, and 40 g)*

Magnesium Sulfate Injection

8% (4 g)*

Magnesium Sulfate Injection

Magnesium Sulfate in Dextrose

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection, for IV use only

1% (1 g) in 5% Dextrose*

Magnesium Sulfate in 5% Dextrose Injection

2% (10 and 20 g) in 5% Dextrose*

Magnesium Sulfate in 5% Dextrose Injection

AHFS DI Essentials. © Copyright 2017, Selected Revisions June 19, 2017. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

2. Abraham AS, Rosenmann D, Kramer M et al. Magnesium in the prevention of lethal arrhythmias in acute myocardial infarction. Arch Intern Med. 1987; 147:753-5. [PubMed 3548627]

6. Rasmussen HS, Norregard P, McNair P et al. Intravenous magnesium in acute myocardial infarction. Lancet. 1986; 1:234-6. [PubMed 2868254]

7. Rasmussen HS, Grnbaek M, Cintin C et al. One-year death rate in 270 patients with suspected acute myocardial infarction, initially treated with intravenous magnesium or placebo. Clin Cardiol. 1988; 11:377-81. [PubMed 3396238]

8. Allen BJ, Brodsky MA, Capparelli EV et al. Magnesium sulfate therapy for sustained monomorphic ventricular tachycardia. Am J Cardiol. 1989; 64:1202-4. [PubMed 2816773]

9. Banai S et al. Magnesium sulfate is the treatment of choice for torsades de pointes if the right dose is given. Am J Cardiol. 1989; 65:266.

10. Tzivoni D, Banai S, Schuger C et al. Treatment of torsade de pointes with magnesium sulfate. Circulation. 1988; 79:392-7.

11. Skobeloff EM, Spivey WH, McNamara RM et al. Intravenous magnesium sulfate for the treatment of acute asthma in the emergency department. JAMA. 1989; 262:1210-3. [PubMed 2761061]

12. Okayama H, Aikawa T, Okayama M et al. Bronchodilating effect of intravenous magnesium sulfate in bronchial asthma. JAMA. 1987; 257:1076-8. [PubMed 3806898]

13. American College of Obstetricians and Gynecologists (AGOG) Committee on Technical Bulletins. Preterm labor. Technical Bulletin No. 206. Washington, DC: American College of Obstetricians and Gynecologists; 1995 Jun:1-10.

14. Morales WJ, Madhav H. Efficacy and safety of indomethacin compared with magnesium sulfate in the management of preterm labor: a randomized study. Am J Obstet Gynecol. 1993; 169:97-102. [PubMed 8333483]

15. Glock JL, Morales WJ. Efficacy and safety of nifedipine versus magnesium sulfate in the management of preterm labor: a randomized study. Am J Obstet Gynecol. 1993; 169:960-4. [PubMed 8238157]

16. Beall MH, Edgar BW, Paul RH et al. A comparison of ritodrine, terbutaline, and magnesium sulfate for the suppression of preterm labor. Am J Obstet Gynecol. 1985; 153:854-9. [PubMed 4073155]

17. Hollander DI, Nagey DA, Pupkin MJ. Magnesium sulfate and ritodrine hydrochloride: a randomized comparison. Am J Obstet Gynecol. 1987; 156:631-7. [PubMed 3548382]

18. Wilkins IA, Lynch L, Mehalek KE et al. Efficacy and side effects of magnesium sulfate and ritodrine as tocolytic agents. Am J Obstet Gynecol. 1988; 159:685-9. [PubMed 3048103]

19. Lewis DF, Grimshaw A, Brooks GG et al. A comparison of magnesium sulfate and indomethacin to magnesium sulfate only for tocolysis in preterm labor with advanced cervical dilation. Southern Med J. 1995; 88:737-40. [PubMed 7597478]

20. Travis BE, McCullough JM. Pharmacotherapy of preterm labor. Pharmacotherapy. 1993; 13:28-36. [PubMed 8437965]

21. Cox SM, Sherman ML, Leveno KJ. Randomized investigation of magnesium sulfate for prevention of preterm birth. Am J Obstet Gynecol. 1990; 163:767-72. [PubMed 2206069]

22. Elliott JP. Subtherapeutic doses of magnesium sulfate do not inhibit preterm labor. Am J Obstet Gynecol. 1992; 167:568. [PubMed 1497070]

23. Madden C, Owen J, Hauth JC. Magnesium tocolysis: serum levels versus success. Am J Obstet Gynecol. 1990; 162:1177-80. [PubMed 2339717]

24. Kosasa TS, Busse R, Wahl N et al. Long-term tocolysis with combined intravenous terbutaline and magnesium sulfate: a 10-year study of 1000 patients. Obstet Gynecol. 1994; 84:369-73. [PubMed 8058233]

25. Hatjis CG, Swain M, Nelson LH et al. Efficacy of combined administration of magnesium sulfate and ritodrine in the treatment of premature labor. Obstet Gynecol. 1987; 69:317-22. [PubMed 3822278]

26. Dudley D, Gagnon D, Varner M. Long-term tocolysis with intravenous magnesium sulfate. Obstet Gynecol. 1989; 73:373-8. [PubMed 2915861]

27. Ferguson JE II, Hensleigh PA, Kredenster D. Adjunctive use of magnesium sulfate with ritodrine for preterm labor tocolysis. Am J Obstet Gynecol. 1984; 148:166-71. [PubMed 6362416]

28. Schendel DE, Berg CJ, Yeargin-Allsopp M et al. Prenatal magnesium sulfate exposure and the risk for cerebral palsy or mental retardation among very low-birth-weight children aged 3 to 5 years. JAMA. 1996; 276:1805-10. [PubMed 8946900]

29. Nelson KB, Grether JK. Can magnesium sulfate reduce the risk of cerebral palsy in very low birthweight infants? Pediatrics. 1995; 95:263-9. (IDIS 342455)

30. Nelson KB. Magnesium sulfate and risk of cerebral palsy in very low-birth-weight infants. JAMA. 1996; 276:1843-4. [PubMed 8946908]

31. Astra USA, Inc. Yutopar (ritodrine hydrochloride) injection prescribing information (dated April 1995). In: Physicians’ desk reference. 51st ed. Montvale, NJ; Medical Economics Inc; 1997:566-7.

32. Snyder SW, Cardwell MS. Neuromuscular blockade with magnesium sulfate and nifedipine. Am J Obstet Gynecol. 1989; 161:35-6. [PubMed 2750819]

33. Reviewers’ comments (personal observations).

34. Antman EM. Magnesium in acute MI: timing is critical. Circulation. 1995; 92:2367-72. [PubMed 7586332]

35. Ceremuzynski L, Jurgiel R, Kulakowski P et al. Threatening arrhythmias in acute myocardial infarction are prevented by intravenous magnesium sulfate. Am Heart J. 1989; 118:1333-4. [PubMed 2589170]

36. Feldstedt M, Boesgaard S et al. Magnesium substitution in acute ischaemic heart syndromes. Eur Heart J. 1991; 12:1215-8. [PubMed 1782952]

37. Morton BC, Nair RC, Smith FM et al. Magnesium therapy in acute myocardial infarction—a double-blind study. Magnesium. 1984; 3:346-52. [PubMed 6399346]

38. Smith LF, Heagerty AM, Bing RF et al. Intravenous infusion of magnesium sulphate after acute myocardial infarction: effects on arrhythmias and mortality. Int J Cardiol. 1986; 12:175-83. [PubMed 2427458]

39. Shechter M, Hod H, Marks N et al. Beneficial effect of magnesium sulfate in acute myocardial infarction. Am J Cardiol. 1990; 66:271-4. [PubMed 2195862]

40. Woods KL, Fletcher S, Roffe C et al. Intravenous magnesium sulphate in suspected acute myocardial infarction: results of the second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2). Lancet. 1992; 339:1553-8. [PubMed 1351547]

41. ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group. ISIS-4: a randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction. Lancet. 1995; 345:669-85. [PubMed 7661937]

42. Horner SM. Efficacy of intravenous magnesium in acute myocardial infarction in reducing arrhythmias and mortality: meta-analysis of magnesium in acute myocardial infarction. Circulation. 1992; 86:774-9. [PubMed 1387591]

43. Teo KK, Yusuf S, Collins R et al. Effects of intravenous magnesium in suspected acute myocardial infarction: overview of randomised trials. BMJ. 1991; 303:1499-503. [PubMed 1838289]

44. Antman EM. Randomized trials of magnesium in acute myocardial infarction: big numbers do not tell the whole story. Am J Cardiol. 1995; 75:391-3. [PubMed 7856535]

45. Woods KL. Mega-trials and management of acute myocardial infarction. Lancet. 1995; 346:611-4. [PubMed 7651008]

46. Seelig MS, Elin RJ. Is there a place for magnesium in the treatment of acute myocardial infarction? Am Heart J. 1996; 132:471-7.

47. Baxter GF, Sumeray MS, Walker JM. Infarct size and magnesium: insights into LIMIT-2 and ISIS-4 from experimental studies. Lancet. 1996; 348:1424-6. [PubMed 8937284]

48. Yusuf S, Teo K, Woods K. Intravenous magnesium in acute myocardial infarction: an effective, safe, simple, and inexpensive intervention. Circulation. 1993; 87:2043-6. [PubMed 8504519]

49. Singh RB, Sircar AR, Rastogi SS et al. Magnesium and potassium administration in acute myocardial infarction. Magnesium Trace Elem. 1990; 9:198-204.

50. Shechter M, Hod H, Chouraqui P et al. Magnesium therapy in acute myocardial infarction when patients are not candidates for thrombolytic therapy. Am J Cardiol. 1995; 75:321-3. [PubMed 7856520]

51. Thögersen AM, Johnson O, Wester PO. Effects of magnesium infusion on thrombolytic and non-thrombolytic treated patients with acute myocardial infarction. Int J Cardiol. 1993; 39:13-22. [PubMed 7691765]

52. Abraham AS, Balkin J, Rosenmann D et al. Long-term follow-up after acute myocardial infarction in patients randomized to treatment with intravenous magnesium or intravenous propranolol in the acute phase. Magnesium Res. 1994; 7:273-6.

53. Thögersen AM, Johnson O, Wester PO. Effects of intravenous magnesium sulphate in suspected acute myocardial infarction on acute arrhythmias and long-term outcome. Int J Cardiol. 1995; 49:143-51. [PubMed 7543083]

54. Borzak S, Ridker PM. Discordance between meta-analyses and large-scale randomized, controlled trials. Ann Intern Med. 1995; 123:873-7. [PubMed 7486471]

55. Heesch CM, Eichhorn EJ. Magnesium in acute myocardial infarction. Ann Emerg Med. 1994; 24:1154-60. [PubMed 7978600]

56. Herzog WR, Schlossberg ML, MacMurdy KS et al. Timing of magnesium therapy affects experimental infarct size. Circulation. 1995; 92:2622-6. [PubMed 7586365]

57. Christensen CW, Rieder MA, Silverstein EL et al. Magnesium sulfate reduces myocardial infarct size when administered before but not after coronary reperfusion in a canine model. Circulation. 1995; 92:2617-21. [PubMed 7586364]

58. ACOG task force on hypertension in pregnancy: hypertension in pregnancy. Washington, DC: American College of Obstetricians and Gynecologists; 2013.

59. Rey E, LeLorier J, Burgess E et al. Report of the Canadian Hypertension Society consensus conference: 3. Pharmacologic treatment of hypertensive disorders during pregnancy. CMAJ. 1997; 157:1245-54. [PubMed 9361646]

60. The Eclampsia Trial Collaborative Group. Which anticonvulsant for women with eclampsia? Evidence from the eclampsia collaborative trial. Lancet. 1995; 345:1455-63. [PubMed 7769899]

61. Lucas MJ, Leveno KJ, Cunningham FG. A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia. N Engl J Med. 1995; 33:201-5.

62. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Bethesda, MD: National Institutes of Health. (NIH publication No. 98-4080.)

63. Stamler R, Stamler J, Grandits GA. Relation of body mass and alcohol, nutrient, fiber, and caffeine intakes to blood pressure in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial. Am J Clin Nutr. 1997; 65(Suppl):338-65S.

64. Ryan TJ, Antman EM, Brooks NH et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on Management of Acute Myocardial Infarction). From ACC web site.

65. Thel MC, Armstrong AL, McNulty SE et al. Randomised trial of magnesium in in-hospital cardiac arrest. Lancet. 1997; 350:1272-6. [PubMed 9357406]

66. American Heart Association in collaboration with the International Liaison Committee on Resuscitation. Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. Part 6: advanced cardiovascular life support. Circulation. 2000; 102(Suppl I):I1-384.

67. Hospira. Magnesium sulfate injection, Ansyr plastic syringe prescribing information.Lake Forest, IL; 2013 May.

68. Hospira. Magnesium sulfate in 5% dextrose injection for intravenous use prescribing information. Lake Forest, IL; 2016 Mar.

69. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins–Obstetrics. Management of preterm labor. Washington, DC; American College of Obstetricians and Gynecologists: 2012 Jun. Practice Bulletin No. 127.

70. The American Heart Association. Guidelines 2005 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005; 112(Suppl I): IV1-211.

71. Simhan HN, Caritis SN. Prevention of preterm delivery. N Engl J Med. 2007; 357:477-87. [PubMed 17671256]

72. Sayres WG. Preterm labor. Am Fam Physician. 2010; 81:477-84. [PubMed 20148502]

73. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006; 3:CD004454. [PubMed 16856047]

74. Berkman ND, Thorp JM, Lohr KN et al. Tocolytic treatment for the management of preterm labor: a review of the evidence. Am J Obstet Gynecol. 2003; 188:1648-59. [PubMed 12825006]

75. US Food and Drug Administration. FDA drug safety communication: FDA recommends against prolonged use of magnesium sulfate to stop pre-term labor due to bone changes in exposed babies. Rockville, MD; 2013 May 30. From FDA website.

77. Yokoyama K, Takahashi N, Yada Y et al. Prolonged maternal magnesium administration and bone metabolism in neonates. Early Hum Dev. 2010; 86:187-91. [PubMed 20226604]

78. Wedig KE, Kogan J, Schorry EK et al. Skeletal demineralization and fractures caused by fetal magnesium toxicity. J Perinatol. 2006; 26:371-4. [PubMed 16724078]

79. Malaeb SN, Rassi AI, Haddad MC et al. Bone mineralization in newborns whose mothers received magnesium sulphate for tocolysis of premature labour. Pediatr Radiol. 2004; 34:384-6. [PubMed 14985884]

80. Kaplan W, Haymond MW, McKay S et al. Osteopenic effects of MgSO4 in multiple pregnancies. J Pediatr Endocrinol Metab. 2006; 19:1225-30. [PubMed 17172083]

81. Nassar AH, Sakhel K, Maarouf H et al. Adverse maternal and neonatal outcome of prolonged course of magnesium sulfate tocolysis. Acta Obstet Gynecol Scand. 2006; 85:1099-103. [PubMed 16929415]

82. Matsuda Y, Maeda Y, Ito M et al. Effect of magnesium sulfate treatment on neonatal bone abnormalities. Gynecol Obstet Invest. 1997; 44:82-8. [PubMed 9286718]

83. Holcomb WL, Shackelford GD, Petrie RH. Magnesium tocolysis and neonatal bone abnormalities: a controlled study. Obstet Gynecol. 1991; 78:611-4. [PubMed 1923163]

84. Schanler RJ, Smith LG, Burns PA. Effects of long-term maternal intravenous magnesium sulfate therapy on neonatal calcium metabolism and bone mineral content. Gynecol Obstet Invest. 1997; 43:236-41. [PubMed 9194621]

85. Santi MD, Henry GW, Douglas GL. Magnesium sulfate treatment of preterm labor as a cause of abnormal neonatal bone mineralization. J Pediatr Orthop. 1994 Mar-Apr; 14:249-53.

86. Lamm CI, Norton KI, Murphy RJ et al. Congenital rickets associated with magnesium sulfate infusion for tocolysis. J Pediatr. 1988; 113:1078-82. [PubMed 3193315]

87. Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011:866-8.

88. Tsukahara H, Kobata R, Tamura S et al. Neonatal bone abnormalities attributable to maternal administration of magnesium sulphate. Pediatr Radiol. 2004; 34:673-4. [PubMed 15221242]

89. American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice. Magnesium sulfate before anticipated preterm birth for neuroprotection. Washington, DC; American College of Obstetricians and Gynecologists: 2010 Mar. Committee Opinion No. 455.

90. American Society of Health-System Pharmacists. Current drug shortage bulletin: magnesium sulfate injection. Bethesda, MD; 2013 Aug 26. From ASHP website.

91. American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice. Magnesium sulfate use in obstetrics. Washington, DC; American College of Obstetricians and Gynecologists: 2016 Jan. Committee Opinion No. 652.

92. American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice. Antenatal corticosteroid therapy for fetal maturation. Washington, DC; American College of Obstetricians and Gynecologists: 2016 Oct. Committee Opinion No. 677.

94. Magnesium. In: Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Institute of Medicine Food and Nutrition Board. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington, DC: National Academy Press; 1997:190-261.

95. American Regent. Magnesium sulfate injection, USP 50% prescribing information. Shirley, NY; 2011 Jul.

96. The Harriet Lane handbook: a manual for pediatric house officers. 19th ed. Tschudy MM, Arcara KM, eds. Baltimore, MD: Mosby; 2012:706-7.

97. Hospira. Magnesium sulfate in water for injection prescribing information. Lake Forest, IL; 2013 May.

98. Griffiths B, Kew KM. Intravenous magnesium sulfate for treating children with acute asthma in the emergency department. Cochrane Database Syst Rev. 2016; 4:CD011050. [PubMed 27126744]

99. Rowe BH, Bretzlaff JA, Bourdon C et al. Magnesium sulfate for treating exacerbations of acute asthma in the emergency department. Cochrane Database Syst Rev. 2000; :CD001490. [PubMed 10796650]

100. Kew KM, Kirtchuk L, Michell CI. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014; :CD010909. [PubMed 24865567]

101. Lucas MJ, Leveno KJ, Cunningham FG. A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia. N Engl J Med. 1995; 333:201-5. [PubMed 7791836]

102. Duley L, Henderson-Smart DJ, Walker GJ et al. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev. 2010; :CD000127. [PubMed 21154341]

103. Duley L, Gülmezoglu AM, Henderson-Smart DJ et al. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev. 2010; :CD000025. [PubMed 21069663]

104. Duley L, Henderson-Smart DJ, Chou D. Magnesium sulphate versus phenytoin for eclampsia. Cochrane Database Syst Rev. 2010; :CD000128. [PubMed 20927719]

105. Antman EM, Anbe DT, Armstrong PW et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation. 2004; 110:588-636. [PubMed 15289388]

106. Magnesium in Coronaries (MAGIC) Trial Investigators. Early administration of intravenous magnesium to high-risk patients with acute myocardial infarction in the Magnesium in Coronaries (MAGIC) Trial: a randomised controlled trial. Lancet. 2002; 360:1189-96. [PubMed 12401244]

196. Vanden Hoek TL, Morrison LJ, Shuster M et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122(18 Suppl 3):S829-61. [PubMed 20956228]

400. Link MS, Berkow LC, Kudenchuk PJ et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(18 Suppl 2):S444-64. [PubMed 26472995]

401. Neumar RW, Otto CW, Link MS et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122(18 Suppl 3):S729-67. [PubMed 20956224]

402. de Caen AR, Berg MD, Chameides L et al. Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(18 Suppl 2):S526-42. [PubMed 26473000]

403. Kleinman ME, Chameides L, Schexnayder SM et al. Part 14: pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122(18 Suppl 3):S876-908. [PubMed 20956230]

HID. Trissel LA. Handbook on injectable drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013:721-6.

a. AHFS drug information 2018. McEvoy GK, ed. Magnesium sulfate. Bethesda, MD: American Society of Health-System Pharmacists; 2018.

Hide