Version May 2024
Note: Serum magnesium is poor reflection of repletional status as the majority of magnesium is intracellular; serum levels may be transiently normal for a few hours after a dose is given; therefore, aim for consistently high normal serum levels in patients with normal renal function for most efficient repletion.
Hypomagnesemia, prevention (parenteral nutrition supplementation) (ASPEN [Mirtallo 2004]): IV (elemental magnesium): 8 to 20 mEq/day.
Dietary supplement: Oral: 2 tablets once daily.
According to the manufacturer's labeling, use is contraindicated in renal impairment.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Magnesium chloride: Pediatric drug information")
Note: Dosing presented in mg and mEq; verify dosing units; 1,000 mg of magnesium chloride = 119.7 mg elemental magnesium = 9.85 mEq elemental magnesium = 4.93 mmol elemental magnesium.
Hypomagnesemia: Limited data available: Note: Serum magnesium is a poor reflection of repletion status, as the majority of magnesium is intracellular; serum concentrations may be transiently normal for a few hours after a dose is given; therefore, aim for consistently high normal serum concentrations in patients with normal renal function for most efficient repletion.
Infants, Children, and Adolescents:
IV: Infants, Children, and Adolescents: Dose expressed as elemental magnesium: IV: 2.5 to 5 mg/kg/dose every 6 hours for 2 to 3 doses; dosing based on experience with magnesium sulfate salt, which is preferred (Greenbaum 2020).
Oral: Note: Achieving optimal magnesium levels using oral therapy may be difficult due to the propensity for magnesium to cause diarrhea; IV replacement may be more appropriate, particularly in situations of severe deficit.
Infants, Children, and Adolescents: Dose expressed as elemental magnesium: Oral: 10 to 20 mg/kg/dose up to 4 times daily (Gal 2007).
Parenteral nutrition, maintenance magnesium requirement: Note: Magnesium sulfate is the preferred salt for parenteral nutrition mixtures; however, magnesium chloride may be appropriate in certain situations (eg, shortages) (ASPEN 2023; ESPGHAN/ESPEN/ESPR/CSPEN [Mihatsch 2018]).
Infants and Children weighing ≤50 kg: Dose expressed as elemental magnesium: IV: 0.3 to 0.5 mEq/kg/day as an additive to parenteral nutrition (ASPEN 2020; ASPEN [Corkins 2015]; ASPEN [Mirtallo 2004]).
Children weighing >50 kg and Adolescents: Dose expressed as elemental magnesium: IV: 10 to 30 mEq/day as an additive to parenteral nutrition (ASPEN 2020; ASPEN [Corkins 2015]; ASPEN [Mirtallo 2004]).
According to the manufacturer's labeling, use is contraindicated in patients with renal impairment.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined: Gastrointestinal: Diarrhea (excessive oral doses)
IV: Renal impairment; myocardial disease; coma.
Disease-related concerns:
• Renal impairment: Oral: Use with caution in patients with renal impairment; accumulation of magnesium may lead to magnesium intoxication.
Special populations:
• Obstetrics: Vigilant monitoring and safe administration techniques (ISMP Medication Safety Alert 2005) recommended to avoid potential for errors resulting in toxicity. Monitor patient and fetal status, and serum magnesium levels closely.
Dosage form specific issues:
• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register 2002). See manufacturer's labeling.
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.
Other warnings/precautions:
• Electrolyte abnormalities: Concurrent hypokalemia or hypocalcemia can accompany a magnesium deficit. Hypomagnesemia is associated with hypokalemia and requires correction in order to normalize potassium.
• Parenteral administration: Monitor serum magnesium level, respiratory rate, blood pressure, deep tendon reflex, and renal function when administered parenterally, particularly with repeated dosing; magnesium toxicity can lead to fatal cardiovascular arrest and/or respiratory paralysis.
Multiple salt forms of magnesium exist; pay close attention to the salt form when ordering and administering magnesium; incorrect selection or substitution of one salt for another without proper dosage adjustment may result in serious over- or underdosing.
1 g magnesium chloride = elemental magnesium 119.7 mg = magnesium 9.85 mEq = magnesium 4.93 mmol
Elemental magnesium 64 mg = magnesium 5.27 mEq = magnesium 2.63 mmol
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Injection, as hexahydrate:
Generic: 200 mg/mL (50 mL)
Tablet Delayed Release, Oral:
Nu-Mag: Elemental magnesium 71.5 mg (plus calcium 119 mg) [DSC] [contains fd&c blue #2 (indigo carm) aluminum lake]
Slow Magnesium/Calcium: 535 mg (elemental magnesium 64 mg, plus calcium 106 mg)
Slow-Mag: Elemental magnesium 71.5 mg (plus calcium 119 mg) [contains fd&c blue #2 (indigo carm) aluminum lake]
SlowMag Mg Muscle/Heart: Elemental magnesium 71.5 mg (plus calcium 119 mg) [contains fd&c blue #2 (indigo carm) aluminum lake]
Yes
Solution (Magnesium Chloride Injection)
200 mg/mL (per mL): $0.38
Tablet, EC (Slow-Mag Oral)
71.5-119 mg (per each): $0.17
Tablet, EC (SlowMag Mg Muscle/Heart Oral)
71.5-119 mg (per each): $0.12
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Reconstituted, Hemodialysis:
Generic: 5.15 g (5.15 g)
IV: Intermittent IV infusion: After dilution (concentration: 16 mg/mL magnesium chloride), infuse slowly at a rate not to exceed 48 mg/minute of magnesium chloride.
Oral: Do not chew or crush delayed-release formulations. Administer (preferably with food) at least 2 hours apart from other medications.
Bariatric surgery: Tablet, delayed release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate.
If safety and efficacy can be effectively monitored, no change in formulation or administration is required after bariatric surgery; however, clinicians should be aware that bariatric vitamin supplementation is recommended lifelong and may include magnesium. Consider integrating part or all of magnesium supplementation requirements into the postsurgery bariatric vitamin regimen.
Oral: Tablet: Administration with food is preferred; do not chew or crush sustained-release formulations.
Parenteral: Intermittent IV infusion: After dilution (concentration: 16 mg/mL magnesium chloride), infuse slowly at a rate not to exceed 48 mg/minute of magnesium chloride.
Dietary supplement (oral): Dietary magnesium supplement.
Hypomagnesemia (IV): As an electrolyte replenisher in patients with magnesium deficiencies.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Alfacalcidol: May increase the serum concentration of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving alfacalcidol. If magnesium-containing products must be used with alfacalcidol, serum magnesium concentrations should be monitored closely. Risk D: Consider therapy modification
Alpha-Lipoic Acid: Magnesium Salts may decrease the absorption of Alpha-Lipoic Acid. Alpha-Lipoic Acid may decrease the absorption of Magnesium Salts. Management: Separate administration of alpha-lipoic acid from that of any magnesium-containing compounds by several hours. If alpha-lipoic acid is given 30 minutes before breakfast, then administer oral magnesium-containing products at lunch or dinner. Risk D: Consider therapy modification
Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Risk X: Avoid combination
Bictegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Bictegravir. Management: Administer bictegravir under fasting conditions at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Risk D: Consider therapy modification
Cabotegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Cabotegravir. Management: Administer polyvalent cation containing products at least 2 hours before or 4 hours after oral cabotegravir. Risk D: Consider therapy modification
Calcitriol (Systemic): May increase the serum concentration of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving calcitriol. If magnesium-containing products must be used with calcitriol, serum magnesium concentrations should be monitored closely. Risk D: Consider therapy modification
Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Risk D: Consider therapy modification
Dolutegravir: Magnesium Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral magnesium salts. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral magnesium salts. Risk D: Consider therapy modification
Doxercalciferol: May enhance the hypermagnesemic effect of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving doxercalciferol. If magnesium-containing products must be used with doxercalciferol, serum magnesium concentrations should be monitored closely. Risk D: Consider therapy modification
Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Risk D: Consider therapy modification
Elvitegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Elvitegravir. Management: Administer elvitegravir 2 hours before or 6 hours after the administration of polyvalent cation containing products. Risk D: Consider therapy modification
Gabapentin: Magnesium Salts may enhance the CNS depressant effect of Gabapentin. Specifically, high dose intravenous/epidural magnesium sulfate may enhance the CNS depressant effects of gabapentin. Magnesium Salts may decrease the serum concentration of Gabapentin. Management: Administer gabapentin at least 2 hours after use of a magnesium-containing antacid. Monitor patients closely for evidence of reduced response to gabapentin therapy. Monitor for CNS depression if high dose IV/epidural magnesium sulfate is used. Risk D: Consider therapy modification
Levonadifloxacin: Magnesium Salts may decrease the serum concentration of Levonadifloxacin. Risk X: Avoid combination
Levothyroxine: Magnesium Salts may decrease the serum concentration of Levothyroxine. Management: Separate administration of oral levothyroxine and oral magnesium salts by at least 4 hours. Risk D: Consider therapy modification
Multivitamins/Fluoride (with ADE): Magnesium Salts may decrease the serum concentration of Multivitamins/Fluoride (with ADE). Specifically, magnesium salts may decrease fluoride absorption. Management: To avoid this potential interaction separate the administration of magnesium salts from administration of a fluoride-containing product by at least 1 hour. Risk D: Consider therapy modification
Neuromuscular-Blocking Agents: Magnesium Salts may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy
PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Risk D: Consider therapy modification
Phosphate Supplements: Magnesium Salts may decrease the serum concentration of Phosphate Supplements. Management: Administer oral phosphate supplements as far apart from the administration of an oral magnesium salt as possible to minimize the significance of this interaction. Risk D: Consider therapy modification
Quinolones: Magnesium Salts may decrease the serum concentration of Quinolones. Management: Administer oral quinolones several hours before (4 h for moxi/pe/spar/enox-, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome/pe/enox-, 3 h for gemi-, and 2 h for levo-, nor-, or ofloxacin or nalidixic acid) oral magnesium salts. Risk D: Consider therapy modification
Raltegravir: Magnesium Salts may decrease the serum concentration of Raltegravir. Management: Avoid the use of oral / enteral magnesium salts with raltegravir. No dose separation schedule has been established that adequately reduces the magnitude of interaction. Risk X: Avoid combination
Roxadustat: Polyvalent Cation Containing Products may decrease the serum concentration of Roxadustat. Management: Administer roxadustat at least 1 hour after the administration of oral polyvalent cation containing products. Risk D: Consider therapy modification
Tetracyclines: Magnesium Salts may decrease the absorption of Tetracyclines. Only applicable to oral preparations of each agent. Management: Avoid coadministration of oral magnesium salts and oral tetracyclines. If coadministration cannot be avoided, administer oral magnesium at least 2 hours before, or 4 hours after, oral tetracyclines. Monitor for decreased tetracycline therapeutic effects. Risk D: Consider therapy modification
Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant use of trientine and polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. For other oral polyvalent cations, give trientine 1 hour before, or 1 to 2 hours after the polyvalent cation. Risk D: Consider therapy modification
Unithiol: May diminish the therapeutic effect of Polyvalent Cation Containing Products. Risk X: Avoid combination
Animal reproduction studies have not been conducted. Magnesium crosses the placenta; serum levels in the fetus correlate with those in the mother (Idama 1998; Osada 2002).
Magnesium is found in breast milk; concentrations remain constant during the first year of lactation and are not influenced by dietary intake under normal conditions. Magnesium requirements are the same in lactating and non-lactating females (IOM 1997).
Whole grains, legumes, and dark-green leafy vegetables are dietary sources of magnesium.
Dietary reference intake (elemental magnesium) (IOM 1997):
1 to 6 months: Adequate intake: 30 mg/day.
7 to 12 months: Adequate intake: 75 mg/day.
1 to 3 years: Recommended dietary allowance (RDA): 80 mg/day.
4 to 8 years: RDA: 130 mg/day.
9 to 13 years: RDA: 240 mg/day.
14 to 18 years: RDA:
Females: 360 mg/day.
Pregnancy: 400 mg/day.
Lactation: 360 mg/day.
Males: 410 mg/day.
19 to 30 years: RDA:
Females: 310 mg/day.
Pregnancy: 350 mg/day.
Lactation: 310 mg/day.
Males: 400 mg/day.
≥31 years: RDA:
Females: 320 mg/day.
Pregnancy: 360 mg/day.
Lactation: 320 mg/day.
Males: 420 mg/day.
IV: Rapid administration: ECG monitoring, vital signs, deep tendon reflexes; magnesium, calcium, and potassium levels; renal function during administration
Oral: Renal function; magnesium levels; bowel movements
Adults: Serum magnesium: 1.5 to 2.5 mg/dL; slightly different ranges are reported by different laboratories.
Magnesium is important as a cofactor in many enzymatic reactions in the body involving protein synthesis and carbohydrate metabolism (at least 300 enzymatic reactions require magnesium). Actions on lipoprotein lipase have been found to be important in reducing serum cholesterol and on sodium/potassium ATPase in promoting polarization (eg, neuromuscular functioning).
Absorption: Oral: Inversely proportional to amount ingested; 40% to 60% under controlled dietary conditions; 15% to 36% at higher doses
Distribution: Bone (50% to 60%); extracellular fluid (1% to 2%)
Protein binding: 30%, to albumin
Excretion: Urine (as magnesium)
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