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MAGNESIUM SULFATE (magnesium sulfate injection, USP) Drug Interactions

7 DRUG INTERACTIONS

Table 1 presents the potential clinical impact of medications that may be commonly administered concomitantly with Magnesium Sulfate in 5% Dextrose Injection in the clinical setting.

Table 1: Potential Clinically Significant Drug Interactions with Magnesium Sulfate in 5% Dextrose Injection*
*
For drug incompatibility information [see Dosage and Administration (2.4)].
Neuromuscular Blocking Agents
Clinical Impact:
  • Potentiation and prolongation of neuromuscular blockade is possible with the concomitant use of magnesium sulfate and neuromuscular blocking agents [see Clinical Pharmacology (12.2)].
  • The underlying mechanism of this interaction may involve suppression of peripheral neuromuscular function by decreasing acetylcholine release, reduction of endplate sensitivity, and decreased muscle fiber excitability with magnesium sulfate therapy.
Intervention:
  • Monitor respiration and the depth of neuromuscular blockade frequently (e.g., train-of-four monitoring) when a neuromuscular blocking agent is used concomitantly with Magnesium Sulfate in 5% Dextrose Injection.
  • Adjust the dosage of the neuromuscular blocking agent accordingly to maintain the desired level of musculoskeletal activity. The amount of reversal agent(s) required to achieve adequate reversal of the neuromuscular blocking agent(s) may also be increased.
Examples:
  • Depolarizing neuromuscular blockers: succinylcholine
  • Non-depolarizing neuromuscular blockers: atracurium, cisatracurium, pancuronium, rocuronium, vecuronium
Narcotics and/or Propofol
Clinical Impact:
  • Potentiation and prolongation of analgesia and CNS depression is possible with the concomitant use of Magnesium Sulfate in 5% Dextrose Injection with narcotics and/or propofol. The potential for magnesium sulfate to affect other CNS depressants is unknown [see Clinical Pharmacology (12.2)].
  • The underlying mechanism of this interaction may involve antagonism of N-methyl-D-aspartate (NMDA) by magnesium sulfate therapy.
Intervention:
  • Monitor the depth of CNS depression frequently using a reliable instrument.
  • Adjust the narcotic and/or propofol dosage accordingly to maintain the desired level of analgesia and sedation.
Examples:
  • Narcotics and propofol
Dihydropyridine Calcium Channel Blockers
Clinical Impact:
  • An exaggerated hypotensive response is possible with the concomitant use of Magnesium Sulfate in 5% Dextrose Injection with dihydropyridine calcium channel blockers. The potential for magnesium sulfate to affect other calcium channel blockers (e.g., diltiazem and verapamil) is unknown [see Clinical Pharmacology (12.2)].
Intervention:
  • Monitor vital signs (heart rate, blood pressure, respiration) frequently.
  • Supportive care and/or discontinuation of the calcium channel blocker may be required.
Examples:
  • Amlodipine, clevidipine, felodipine, isradipine, nicardipine, nifedipine, nimodipine, and nisoldipine
Drugs that May Induce Magnesium Loss
Clinical Impact:
  • Reduced magnesium concentrations may impact efficacy
Intervention:
  • Monitor magnesium concentrations frequently and adjust the Magnesium Sulfate in 5% Dextrose Injection dosage to maintain concentrations in the target range [see Dosage and Administration (2)].
Examples:
  • Alcohol, aminoglycosides, amphotericin B, cisplatin, cyclosporine, digitalis, loop diuretics, thiazide diuretics

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