dismiss Magnesium Chloride Overview Side Effects Professional Interactions Pregnancy More User Reviews Drug Images Support Group Q & A Pricing & Coupons Pronunciation (mag NEE zhum KLOR ide) Dosage Forms Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product Solution, Injection, as hexahydrate: Chloromag: 200 mg/mL (50 mL [DSC]) [contains benzyl alcohol] Generic: 200 mg/mL (50 mL) Tablet, Oral: Generic: Elemental magnesium 64 mg (plus calcium 112 mg) Tablet Delayed Release, Oral: Mag-SR Plus Calcium: 535 mg (elemental magnesium 64 mg, plus calcium 106 mg) [starch free, sugar free] Magdelay: Elemental magnesium 70 mg (plus calcium 118 mg) Nu-Mag: Elemental magnesium 71.5 mg (plus calcium 119 mg) [contains fd&c blue #2 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 aluminum lake] Tablet Extended Release, Oral: Mag-SR: 535 mg (elemental magnesium 64 mg) [DSC] [starch free, sugar free] Slideshow The Dangers Of DVT: Don't Ignore The Signs Brand Names: U.S. Chloromag [DSC] Mag-SR Plus Calcium [OTC] Mag-SR [OTC] [DSC] Magdelay [OTC] Nu-Mag [OTC] Slow Magnesium/Calcium [OTC] Slow-Mag [OTC] Pharmacologic Category Electrolyte Supplement, Oral Electrolyte Supplement, Parenteral Magnesium Salt Pharmacology 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%) Excretion Urine (as magnesium) Protein Binding 30%, to albumin Use: Labeled Indications Correction or prevention of hypomagnesemia; dietary supplement Contraindications Hypersensitivity to any component of the formulation; renal impairment; myocardial disease; coma Dosing: Adult 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. Dietary supplement: Oral (Mag 64, Mag-Delay, Slow-Mag): 2 tablets once daily Hypomagnesemia, prevention (parenteral nutrition supplementation) (ASPEN [Mirtallo 2004]): IV (elemental magnesium): 8 to 20 mEq/day RDA (elemental magnesium) (IOM 1997): Oral: 19 to 30 years: Females: 310 mg/day Pregnancy: 350 mg/day Lactation: 310 mg/day Males: 400 mg/day 31 years: Females: 320 mg/day Pregnancy: 360 mg/day Lactation: 320 mg/day Males: 420 mg/day Dosing: Geriatric Refer to adult dosing. Dosing: Pediatric 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. Infants, Children, and Adolescents: Hypomagnesemia, prevention (parenteral nutrition supplementation) (ASPEN [Mirtallo, 2004]): IV (elemental magnesium): 50 kg: 0.3 to 0.5 mEq/kg/day >50 kg: 10 to 30 mEq/day RDA (elemental magnesium) (IOM, 1997): Oral: 1 to 3 years: 80 mg/day 4 to 8 years: 130 mg/day 9 to 13 years: 240 mg/day 14 to 18 years: Females: 360 mg/day Pregnancy: 400 mg/day Lactation: 360 mg/day Males: 410 mg/day Dosing: Renal Impairment According to the manufacturer s labeling, use is contraindicated in patients with renal impairment Dosing: Hepatic Impairment No dosage adjustment provided in manufacturer s labeling. Reconstitution Dilute magnesium chloride 4 g in 250 mL D 5 W. Dietary Considerations Whole grains, legumes, and dark-green leafy vegetables are dietary sources of magnesium. Storage Injection: Prior to reconstitution, store at controlled room temperature of 15 C to 30 C (59 F to 86 F). Drug Interactions Alfacalcidol: May increase the serum concentration of Magnesium Salts. 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. Consider therapy modification Bisphosphonate Derivatives: Magnesium Salts may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral magnesium salts within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Exceptions: Pamidronate; Zoledronic Acid. 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. Consider therapy modification Calcium Channel Blockers: May enhance the adverse/toxic effect of Magnesium Salts. Magnesium Salts may enhance the hypotensive effect of Calcium Channel Blockers. Monitor therapy Deferiprone: Magnesium Salts 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. 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. 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. Consider therapy modification Eltrombopag: Magnesium Salts may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any magnesium-containing product. 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 oral magnesium salts administration. Monitor patients closely for evidence of reduced response to gabapentin therapy. Monitor for CNS depression if high dose IV/epidural magnesium sulfate is used. Consider therapy modification 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. 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. Consider therapy modification Mycophenolate: Magnesium Salts may decrease the serum concentration of Mycophenolate. Management: Separate doses of mycophenolate and oral magnesium salts. Monitor for reduced effects of mycophenolate if taken concomitant with oral magnesium salts. Consider therapy modification Neuromuscular-Blocking Agents: Magnesium Salts may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy 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. Exceptions: Sodium Glycerophosphate Pentahydrate. Consider therapy modification Quinolones: Magnesium Salts may decrease the serum concentration of Quinolones. Management: Administer oral quinolones several hours before (4 h for moxi- and sparfloxacin, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome-, 3 h for gemi-, and 2 h for levo-, nor-, or ofloxacin or nalidixic acid) oral magnesium salts. Exceptions: LevoFLOXacin (Oral Inhalation). 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. Avoid combination Tetracyclines: Magnesium Salts may decrease the absorption of Tetracyclines. Only applicable to oral preparations of each agent. Consider therapy modification Trientine: May decrease the serum concentration of Magnesium Salts. Magnesium Salts may decrease the serum concentration of Trientine. Consider therapy modification Adverse Reactions Frequency not defined: Gastrointestinal: Diarrhea (excessive oral doses) Warnings/Precautions Disease-related concerns: Neuromuscular disease: Use with extreme caution in patients with myasthenia gravis or other neuromuscular disease. Renal impairment: 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. Monitoring Parameters 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 Pregnancy Risk Factor C Pregnancy Considerations 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). Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Have patient report immediately to prescriber flushing, sweating a lot, dizziness, passing out, loss of strength and energy, shortness of breath, sensation of cold, severe nausea, severe vomiting, or severe diarrhea (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients. Next Interactions Print this page Add to My Med List More about magnesium chloride Side Effects During Pregnancy Drug Images Drug Interactions Support Group Pricing & Coupons 0 Reviews Add your own review/rating Drug class: minerals and electrolytes Consumer resources Magnesium Chloride Sustained-Release Tablets Magnesium Chloride Injection Professional resources Magnesium Chloride Injection (FDA) Other brands: Chloromag Related treatment guides Heart Attack Hypomagnesemia} Drug Status Rx OTC Availability Rx and/or OTC C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Magnesium chloride Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Manufacturers Mylan Pharmaceuticals Inc. Pfizer Inc. Drug Class Minerals and electrolytes Related Drugs minerals and electrolytes potassium chloride , calcium carbonate , Caltrate , magnesium oxide , Klor-Con , sodium chloride Hypomagnesemia magnesium oxide , Epsom Salt , Chelated Magnesium , Mag-G , Mag-200 , More... Heart Attack Plavix , aspirin , lisinopril , metoprolol , atenolol , clopidogrel , warfarin , nitroglycerin , valsartan , propranolol , More... Magnesium chloride Images Magnesium chloride systemic 64 mg (MAG 64 ) View larger images} } expenditures
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