Medical uses of magnesium sulfate explained

Drug Name:Magnesium sulfate
Tradename:Epsom salt, others
Routes Of Administration:IV, IM, by mouth, topical
Atc Prefix:A06
Atc Suffix:AD04
Cas Number:7487-88-9
Pubchem:24083
Drugbank:DB00653
Chemspiderid:22515
Chebi:32599
Chembl:2021423
Unii:ML30MJ2U7I
Index2 Label:heptahydrate
Cas Number2:10034-99-8
Unii2:SK47B8698T
Chemical Formula:MgSO4 – 7H2O
Molecular Weight:120.366
Smiles:[O-]S(=O)(=O)[O-].[Mg+2]
Stdinchi:1S/Mg.H2O4S/c;1-5(2,3)4/h;(H2,1,2,3,4)/q+2;/p-2
Stdinchikey:CSNNHWWHGAXBCP-UHFFFAOYSA-L

Magnesium sulfate as a medication is used to treat and prevent low blood magnesium and seizures in women with eclampsia. It is also used in the treatment of torsades de pointes, severe asthma exacerbations, constipation, and barium poisoning.[1] It is given by injection into a vein or muscle as well as by mouth.[2] [1] As epsom salts, it is also used for mineral baths.[3]

Common side effects include low blood pressure, skin flushing, and low blood calcium.[2] Other side effects may include vomiting, muscle weakness, and decreased breathing.[4] While there is evidence that use during pregnancy may harm the baby, the benefits in certain conditions are greater than the risks. Its use during breastfeeding is deemed to be safe.[5] The way it works is not fully understood, but is believed to involve depressing the action of neurons.[2]

Magnesium sulfate came into medical use at least as early as 1618.[6] It is on the World Health Organization's List of Essential Medicines.[7] [8] In 2021, magnesium salts were the 211th most commonly prescribed medication, with more than 2million prescriptions.[9] [10]

Forms

Magnesium sulfate is available as magnesium sulfate dihydrate,[11] magnesium sulfate heptahydrate,[1] [12] and magnesium sulfate monohydrate.[13]

Heptahydrate

The World Health Organization recommends magnesium sulfate heptahydrate for medical injection.[14]

External uses

Bath salts

Magnesium sulfate is used in bath salts, especially for foot baths to soothe sore feet. The reason for the inclusion of the salt is partially cosmetic: the increase in ionic strength prevents some of the temporary skin wrinkling (partial maceration) which would occur with plain water baths.

Epsom salt baths have been claimed to also soothe and hasten recovery of muscle pain, soreness, or injury. However, these claims have not been scientifically confirmed.[15] The solubility of magnesium sulfate water is inhibited by lipids in lotions resulting in variable absorption rates when applied to the skin. Temperature and concentration are also factors.[16]

Research

Research on topical magnesium (for example epsom salt baths) is limited.[17]

Isolation tanks

Magnesium sulfate is commonly used in flotation therapy to prepare the concentrated solutions that fill the isolation tanks. Its high solubility in water yields baths with high specific gravity that make the body more buoyant. Its negligible toxicity is an important asset in that application.

Mineral waters

Magnesium and sulfate ions are naturally present in some mineral waters.[18]

Drawing paste

In the United Kingdom, a medication containing magnesium sulfate, called "drawing paste", is claimed to be useful for small boils or localised infections, and removing splinters.[19] The standard British Pharmacopoeia composition is dried magnesium sulfate 47.76% (by mass), phenol 0.49%, and glycerol to balance.[20]

Internal uses

Magnesium sulfate can be administered internally by oral, respiratory, intravenous, or intrathecal routes.

Magnesium deficiency

Injected magnesium sulfate is used as a replacement therapy for magnesium deficiency.[21]

Orally administered magnesium sulfate is laxative and thus the magnesium is not well absorbed.

Arrhythmia

Magnesium sulfate may be used as an antiarrhythmic agent for torsades de pointes in cardiac arrest under the ECC guidelines and for managing quinidine-induced arrhythmias.[22]

Asthma

Magnesium sulfate may be used as bronchodilator after beta-agonist and anticholinergic agents have been tried, e.g. in severe exacerbations of asthma,[23] The salt can be administered by nebulization or by intravenous injection.

Eclampsia

Magnesium sulfate is effective in decreasing the risk that pre-eclampsia progresses to eclampsia.[24] Intravenous magnesium sulfate is used to prevent and treat seizures of eclampsia. It reduces the systolic blood pressure but does not alter the diastolic blood pressure, so the blood perfusion to the fetus is not compromised. It is also commonly used for eclampsia where compared to diazepam or phenytoin it results in better outcomes.[25] [26]

Early delivery

Magnesium sulfate was once used as a tocolytic,[27] [28] but meta-analyses have failed to support it as an anti-contraction medication.[29] [30] Usage for prolonged periods (more than five to seven days) may result in health problems for the baby.[31]

In those at risk of an early delivery, magnesium sulfate appears to decrease the risk of cerebral palsy.[32] [33] It is unclear if it helps those who are born at term.[34] Guidelines for the use of magnesium sulfate in mothers at risk of preterm labour are not strongly adhered to.[35]

Barium chloride poisoning

Magnesium sulfate is used to treat barium chloride poisoning,[36] where sulfate binds to barium to form insoluble barium sulfate.

Lead poisoning

Magnesium sulfate was historically used as a treatment for lead poisoning. Prior to the development of chelation therapy, cases of accidental lead ingestion were often immediately treated with magnesium sulfate, which would cause the lead to be precipitated out and, with a high enough dose, literally purged from the digestive system as insoluble lead(II) sulfate.[37] [38] In this application, magnesium sulfate saw particular use in veterinary medicine of the early-to-mid 20th century; Epsom salt was already available on many farms for agricultural purposes, and it was often prescribed in the treatment of farm animals which inadvertently ingested lead.[39] [40]

Adjuvant to local anesthetics

Magnesium sulfate can be administered intrathecally with opioids to prolong their analgesic duration.[41]

Research

Magnesium sulfate has been used as an experimental treatment of Irukandji syndrome caused by envenomation by certain species of Irukandji jellyfish, but the efficacy of this treatment remains unproven.[42]

Safety

An abnormally elevated plasma concentration of magnesium is called hypermagnesemia.

See also

Notes and References

  1. Book: British national formulary : BNF 69. 2015. British Medical Association. 9780857111562. 696. 69.
  2. Web site: Magnesium Sulfate. The American Society of Health-System Pharmacists. 8 January 2017. live. https://web.archive.org/web/20160521092310/http://www.drugs.com/monograph/magnesium-sulfate.html. 21 May 2016.
  3. Book: Kogel JE, Trivedi NC, Barker JM, Krukowski ST . Magnesium Minerals and Compounds . Industrial Minerals & Rocks: Commodities, Markets, and Uses. 2006. SME. 9780873352338. 625. https://books.google.com/books?id=zNicdkuulE4C&pg=PA625. en. live. https://web.archive.org/web/20170918183706/https://books.google.ca/books?id=zNicdkuulE4C&pg=PA625. 18 September 2017.
  4. Book: WHO Model Formulary 2008 . 2009 . 9789241547659 . ((World Health Organization)) . Stuart MC, Kouimtzi M, Hill SR . 10665/44053 . World Health Organization . World Health Organization . free . 75 .
  5. Web site: Magnesium sulfate Use During Pregnancy . Drugs.com. live. https://web.archive.org/web/20170702132006/https://www.drugs.com/pregnancy/magnesium-sulfate.html. 2 July 2017.
  6. Book: Willett E . Magnesium. 2006. The Rosen Publishing Group. 9781404210073. 5. en. live. https://web.archive.org/web/20170918183706/https://books.google.ca/books?id=gttR8o5wYJIC&pg=PT5. 18 September 2017.
  7. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 21st list 2019 . 2019 . 10665/325771 . World Health Organization . World Health Organization . Geneva . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO . free .
  8. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 22nd list (2021) . 2021 . 10665/345533 . World Health Organization . World Health Organization . Geneva . WHO/MHP/HPS/EML/2021.02 . free .
  9. Web site: The Top 300 of 2021 . ClinCalc . 14 January 2024 . 15 January 2024 . https://web.archive.org/web/20240115223848/https://clincalc.com/DrugStats/Top300Drugs.aspx . live .
  10. Web site: Magnesium Salts - Drug Usage Statistics . ClinCalc . 14 January 2024.
  11. Web site: Magnesium sulfate dihydrate . DrugBank Online . 27 March 2022.
  12. Web site: Magnesium sulfate heptahydrate . DrugBank Online . 27 March 2022.
  13. Web site: Magnesium sulfate monohydrate . DrugBank Online . 27 March 2022.
  14. Web site: WHO-PQ RECOMMENDED PATIENT INFORMATION LEAFLET . June 2020.
  15. Web site: Ingraham P . Does Epsom Salt Work? The science of Epsom salt bathing for recovery from muscle pain, soreness, or injury. Pain Science. 29 August 2016. live. https://web.archive.org/web/20160910223001/https://www.painscience.com/articles/epsom-salts.php. 10 September 2016.
  16. News: Does Epsom Salt Work?. www.PainScience.com. 5 May 2018.
  17. Web site: Rath L . Why Take an Epsom Salts Bath? . WebMD . en.
  18. Web site: Bath – Hot Springs . 16 October 2016 . dead . https://web.archive.org/web/20071027140014/http://www.bathnes.gov.uk/BathNES/environmentandplanning/hotsprings/ . 27 October 2007 .
  19. Web site: Removing a splinter with Magnesium Sulphate . TipKing . Ryan .
  20. Web site: Boots Magnesium Sulfate Paste B.P. – Patient Information Leaflet (PIL) – (eMC). www.medicines.org.uk. 14 April 2018. en.
  21. Web site: Pharmaceutical Information – Magnesium Sulfate. RxMed. 6 July 2009. live. https://web.archive.org/web/20090403180025/http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20M)/MAGNESIUM%20SULFATE.html. 3 April 2009.
  22. Web site: CPR and First Aid: Antiarrhythmic Drugs During and Immediately After Cardiac Arrest (section). American Heart Association. 29 August 2016. Previous ACLS guidelines addressed the use of magnesium in cardiac arrest with polymorphic ventricular tachycardia (ie, torsades de pointes) or suspected hypomagnesemia, and this has not been reevaluated in the 2015 Guidelines Update. These previous guidelines recommended defibrillation for termination of polymorphic VT (ie, torsades de pointes), followed by consideration of intravenous magnesium sulfate when secondary to a long QT interval..
  23. Blitz M, Blitz S, Hughes R, Diner B, Beasley R, Knopp J, Rowe BH . Aerosolized magnesium sulfate for acute asthma: a systematic review . Chest . 128 . 1 . 337–344 . July 2005 . 16002955 . 10.1378/chest.128.1.337 . .
  24. Duley L, Gülmezoglu AM, Henderson-Smart DJ, Chou D . Magnesium sulphate and other anticonvulsants for women with pre-eclampsia . The Cochrane Database of Systematic Reviews . 2010 . 11 . CD000025 . November 2010 . 21069663 . 7061250 . 10.1002/14651858.CD000025.pub2 .
  25. Duley L, Henderson-Smart DJ, Walker GJ, Chou D . Magnesium sulphate versus diazepam for eclampsia . The Cochrane Database of Systematic Reviews . 2010 . 12 . CD000127 . December 2010 . 21154341 . 7045443 . 10.1002/14651858.CD000127.pub2 .
  26. Duley L, Henderson-Smart DJ, Chou D . Magnesium sulphate versus phenytoin for eclampsia . The Cochrane Database of Systematic Reviews . 10 . CD000128 . October 2010 . 20927719 . 10.1002/14651858.CD000128.pub2 .
  27. Web site: Magnesium sulfate for preterm labor . Webmd.com . 19 January 2007 . 6 July 2009 . live . https://web.archive.org/web/20090624104459/http://www.webmd.com/baby/magnesium-sulfate-for-preterm-labor . 24 June 2009 .
  28. Lewis DF . Magnesium sulfate: the first-line tocolytic . Obstetrics and Gynecology Clinics of North America . 32 . 3 . 485–500 . September 2005 . 16125045 . 10.1016/j.ogc.2005.03.002 .
  29. Simhan HN, Caritis SN . Prevention of preterm delivery . The New England Journal of Medicine . 357 . 5 . 477–487 . August 2007 . 17671256 . 10.1056/NEJMra050435 .
  30. Grimes DA, Nanda K . Magnesium sulfate tocolysis: time to quit . Obstetrics and Gynecology . 108 . 4 . 986–989 . October 2006 . 17012463 . 10.1097/01.AOG.0000236445.18265.93 . 30014199 .
  31. Web site: Magnesium Sulfate: Drug Safety Communication – Recommendation Against Prolonged Use in Pre-term Labor . FDA . 2 June 2013 . live . https://web.archive.org/web/20130603020709/https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm354603.htm . 3 June 2013 .
  32. Doyle LW, Crowther CA, Middleton P, Marret S, Rouse D . Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus . The Cochrane Database of Systematic Reviews . 1 . CD004661 . January 2009 . 19160238 . 10.1002/14651858.CD004661.pub3 .
  33. Wolf HT, Hegaard HK, Greisen G, Huusom L, Hedegaard M . Treatment with magnesium sulphate in pre-term birth: a systematic review and meta-analysis of observational studies . Journal of Obstetrics and Gynaecology . 32 . 2 . 135–140 . February 2012 . 22296422 . 10.3109/01443615.2011.638999 . 24012925 .
  34. Nguyen TM, Crowther CA, Wilkinson D, Bain E . Magnesium sulphate for women at term for neuroprotection of the fetus . The Cochrane Database of Systematic Reviews . 2 . 2 . CD009395 . February 2013 . 23450601 . 10.1002/14651858.cd009395.pub2 .
  35. Shih ST, Tonmukayakul U, Imms C, Reddihough D, Graham HK, Cox L, Carter R . Economic evaluation and cost of interventions for cerebral palsy: a systematic review . Developmental Medicine and Child Neurology . 60 . 6 . 543–558 . June 2018 . 29319155 . 10.1111/dmcn.13653 . free . 10536/DRO/DU:30106090 . free .
  36. Web site: BARIUM CHLORIDE DIHYDRATE 4. First Aid Measures . Jtbaker.com . 6 July 2009. usurped. https://archive.today/20120709175208/http://hazard.com/msds/mf/baker/baker/files/b0372.htm. 9 July 2012.
  37. Book: Wood HC . Horatio C. Wood Jr. . 1877 . A Treatise on Therapeutics, Comprising Materia Medica and Toxicology, with Especial Reference to the Application of the Physiological Action of Drugs to Clinical Medicine . Philadelphia . . 34 . The treatment of acute lead-poisoning consists in the evacuation of the stomach, if necessary, the exhibition of the sulphate of sodium or of magnesium, and the meeting of the indications as they arrive. The Epsom and Glauber's salts act as chemical antidotes, by precipitating the insoluble sulphate of lead, and also, if in excess, empty the bowel of the compound formed..
  38. Lead and Mercury . Rangan C . 27 January 2016 . Children's Environmental Health Symposium San Diego 2016: Protecting Children's Environmental Health in the U.S.-Mexico Border Region . https://www.epa.gov/usmexicoborder/childrens-environmental-health-symposium-san-diego-2016 . . San Diego, CA . 2 August 2020.
  39. Barker CA . Experience with Lead Poisoning . Canadian Journal of Comparative Medicine and Veterinary Science . 9 . 1 . 6–8 . January 1945 . 17648099 . 1660962 . Udall (1) suggests sodium citrate as of some value together with Epsom salts which will bring about a precipitation of the lead in the form of an insoluble compound. Nelson (3) reported a case that survived following the use of a 20% magnesium sulphate solution intravenously, subcutaneously and orally. McIntosh (5) has suggested that purgative doses of Epsom salts may be effective in combining with the lead and overcoming the toxicity. .
  40. Book: Herriot J . James Herriot . 1972 . All Creatures Great and Small . New York . . 157 . The specific antidotes to metal poisoning had not been discovered and the only thing which sometimes did a bit of good was magnesium sulphate which caused the precipitation of insoluble lead sulphate. The homely term for magnesium sulphate is, of course, epsom salts. . 0-312-08498-6.
  41. Nath MP, Garg R, Talukdar T, Choudhary D, Chakrabarty A . To evaluate the efficacy of intrathecal magnesium sulphate for hysterectomy under subarachnoid block with bupivacaine and fentanyl: A prospective randomized double blind clinical trial . Saudi Journal of Anaesthesia . 6 . 3 . 254–258 . July 2012 . 23162399 . 3498664 . 10.4103/1658-354x.101217 . free .
  42. Corkeron MA . Magnesium infusion to treat Irukandji syndrome . The Medical Journal of Australia . 178 . 8 . 411 . April 2003 . 12697017 . 10.5694/j.1326-5377.2003.tb05263.x . 28335891 .

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