magnesium sulfate (Rx)

Brand and Other Names:MgSO4
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 40mg/mL
  • 80mg/mL
  • 50%

infusion solution

  • 1g/100mL
  • 2g/100mL

Hypomagnesemia

Mild: 1 g IM q6hr for 4 doses

Severe

  • Asymptomatic: 4-8 g at ≤1 g/hr
  • Symptomatic: 4-8 g at ≤4 g over 4-5 min

Toxemia of Pregnancy

Indicated to prevent seizures associated with pre-eclampsia, and for control of seizures with eclampsia

4-5 g (diluted in 250 mL NS/D5W) IV in combination with either (a) up to 10 g (20 mL of undiluted 50% solution) divided and administered IM into each buttock or (b) after initial IV dose, 1-2 g/hr IV; may administer q4hr as necessary

Torsades de Pointes

With pulse (ACLS): 1-2 g slow IV (diluted in 50-100 mL D5W) over 5-60 minutes, then 0.5-1 g/hr IV

Cardiac arrest (ACLS): 1-2 g slow IV (diluted in 10 mL D5W) over 5-20 minutes

Preterm Labor (Off-label)

Used as a tocolytic to stop preterm labor

Loading dose: 4-6 g IV over 20 minutes; maintenance: 2-4 g/hr IV for 12-24 hours as tolerated after contractions cease

Do not exceed 5-7 days of continuous treatment; longer treatment duration may lead to hypocalcemia in developing fetus resulting in neonates with skeletal abnormalities related to osteopenia

Dosing Modifications

Severe renal impairment: Do not exceed 20 g/48 hr

Dosage Forms & Strengths

injectable solution

  • 40mg/mL
  • 80mg/mL
  • 50%

infusion solution

  • 1g/100mL
  • 2g/100mL

Acute Nephritis

100 mg/kg IM q4-6hr PRN or 20-40 mg/kg IM PRN  

Severe: 100-200 mg/kg IV as 1-3% solution; administer total dose within 1 hr, one-half within first 15-20 minutes

Hypomagnesemia

IV/IM: 25-50 mg/kg q4-6hr for 3-4 doses PRN  

PO: 100-200 mg/kg q6hr

Bronchospasm (Off-label)

25-50 mg/kg IV over 10-20 minutes

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Interactions

Interaction Checker

and magnesium sulfate

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      Serious - Use Alternative

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            Contraindicated (0)

              Serious - Use Alternative (7)

              • baloxavir marboxil

                magnesium sulfate will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. Avoid or Use Alternate Drug. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Human studies not conducted.

              • demeclocycline

                magnesium sulfate decreases levels of demeclocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • doxycycline

                magnesium sulfate decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • eltrombopag

                magnesium sulfate decreases levels of eltrombopag by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Separate by at least 4 hours.

              • minocycline

                magnesium sulfate decreases levels of minocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • oxytetracycline

                magnesium sulfate decreases levels of oxytetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • tetracycline

                magnesium sulfate decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              Monitor Closely (21)

              • atracurium

                magnesium sulfate increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Interaction occurs with parenteral magnesium.

              • ciprofloxacin

                magnesium sulfate decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

              • cisatracurium

                magnesium sulfate increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Interaction occurs with parenteral magnesium.

              • delafloxacin

                magnesium sulfate will decrease the level or effect of delafloxacin by cation binding in GI tract. Modify Therapy/Monitor Closely. Oral delafloxacin form chelates with alkaline earth and transition metal cations. Administer oral delafloxacin at least 2 hr before or 6 hr after these agents.

              • dichlorphenamide

                dichlorphenamide and magnesium sulfate both decrease serum potassium. Use Caution/Monitor.

              • fleroxacin

                magnesium sulfate decreases levels of fleroxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • gemifloxacin

                magnesium sulfate decreases levels of gemifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • levofloxacin

                magnesium sulfate decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • moxifloxacin

                magnesium sulfate decreases levels of moxifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • nifedipine

                magnesium sulfate, nifedipine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, neuromuscular blockade.

              • ofloxacin

                magnesium sulfate decreases levels of ofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • onabotulinumtoxinA

                magnesium sulfate increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Interaction occurs with parenteral magnesium.

              • pancuronium

                magnesium sulfate increases effects of pancuronium by pharmacodynamic synergism. Use Caution/Monitor. Interaction occurs with parenteral magnesium.

              • penicillamine

                magnesium sulfate decreases levels of penicillamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • rapacuronium

                magnesium sulfate increases effects of rapacuronium by pharmacodynamic synergism. Use Caution/Monitor. Interaction occurs with parenteral magnesium.

              • rilpivirine

                magnesium sulfate decreases levels of rilpivirine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Coadministration of antacids with rilpivirine may cause significant decreases in rilpivirine plasma concentrations because of increased gastric pH. If antacids must be administered, they should given at least 2 hr before or at least 4 hr after rilpivirine.

              • rimabotulinumtoxinB

                magnesium sulfate, rimabotulinumtoxinB. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Anticholinergics may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • rocuronium

                magnesium sulfate increases effects of rocuronium by pharmacodynamic synergism. Use Caution/Monitor. Interaction occurs with parenteral magnesium.

              • sodium polystyrene sulfonate

                sodium polystyrene sulfonate increases levels of magnesium sulfate by decreasing renal clearance. Use Caution/Monitor. Risk of seizure.

              • succinylcholine

                magnesium sulfate increases effects of succinylcholine by pharmacodynamic synergism. Use Caution/Monitor. Interaction occurs with parenteral magnesium.

              • vecuronium

                magnesium sulfate increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Interaction occurs with parenteral magnesium.

              Minor (40)

              • amikacin

                amikacin decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • amiloride

                amiloride increases levels of magnesium sulfate by decreasing renal clearance. Minor/Significance Unknown.

              • amphotericin B deoxycholate

                amphotericin B deoxycholate decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • bazedoxifene/conjugated estrogens

                bazedoxifene/conjugated estrogens decreases levels of magnesium sulfate by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

              • bendroflumethiazide

                bendroflumethiazide decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • bumetanide

                bumetanide decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • calcitonin salmon

                calcitonin salmon increases levels of magnesium sulfate by decreasing renal clearance. Minor/Significance Unknown.

              • chlorothiazide

                chlorothiazide decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • chlorthalidone

                chlorthalidone decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • conjugated estrogens

                conjugated estrogens decreases levels of magnesium sulfate by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

              • conjugated estrogens, vaginal

                conjugated estrogens, vaginal decreases levels of magnesium sulfate by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

              • cyclopenthiazide

                cyclopenthiazide decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • dextrose

                dextrose decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • dextrose (Antidote)

                dextrose (Antidote) decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • digoxin

                digoxin decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • doxercalciferol

                doxercalciferol increases levels of magnesium sulfate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • drospirenone

                drospirenone increases levels of magnesium sulfate by decreasing renal clearance. Minor/Significance Unknown.

              • estradiol

                estradiol decreases levels of magnesium sulfate by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

              • estrogens conjugated synthetic

                estrogens conjugated synthetic decreases levels of magnesium sulfate by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

              • estrogens esterified

                estrogens esterified decreases levels of magnesium sulfate by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

              • estropipate

                estropipate decreases levels of magnesium sulfate by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

              • ethacrynic acid

                ethacrynic acid decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • furosemide

                furosemide decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • gentamicin

                gentamicin decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • glucagon intranasal

                glucagon intranasal increases levels of magnesium sulfate by decreasing renal clearance. Minor/Significance Unknown.

              • hydrochlorothiazide

                hydrochlorothiazide decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • ibandronate

                magnesium sulfate decreases levels of ibandronate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • indapamide

                indapamide decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • mannitol

                mannitol decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • mestranol

                mestranol decreases levels of magnesium sulfate by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

              • methyclothiazide

                methyclothiazide decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • metolazone

                metolazone decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • neomycin PO

                neomycin PO decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • nitrofurantoin

                magnesium sulfate decreases levels of nitrofurantoin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • paromomycin

                paromomycin decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • spironolactone

                spironolactone increases levels of magnesium sulfate by decreasing renal clearance. Minor/Significance Unknown.

              • streptomycin

                streptomycin decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • tobramycin

                tobramycin decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • torsemide

                torsemide decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • triamterene

                triamterene increases levels of magnesium sulfate by decreasing renal clearance. Minor/Significance Unknown.

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              Adverse Effects

              Frequency Not Defined

              Circulatory collapse

              Respiratory paralysis

              Hypothermia

              Pulmonary edema

              Depressed reflexes

              Hypotension

              Flushing

              Drowsiness

              Depressed cardiac function

              Diaphoresis

              Hypocalcemia

              Hypophosphatemia

              Hyperkalemia

              Visual changes

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              Warnings

              Contraindications

              Hypersensitivity

              Myocardial damage, diabetic coma, heart block

              Hypermagnesemia

              Hypercalcemia

              Administration during 2 hours preceding delivery for mothers with toxemia of pregnancy

              Cautions

              Fetal skeletal demineralization, hypocalcemia, and hypermagnesemia abnormalities reported with continuous long-term use (ie, longer than 5-7 days) for off-label treatment of preterm labor in pregnant women; the effect on the developing fetus may result in neonates with skeletal abnormalities

              In patients with renal impairment, ensure that renal excretory capacity is not exceeded

              Use with caution in digitalized patients

              Use with extreme caution in patients with myasthenia gravis or other neuromuscular disease

              Hypomagnesemia is usually associated with hypokalemia (potassium levels must be normalized)

              Monitor renal function, blood pressure, respiratory rate, and deep tendon reflex when magnesium sulfate is administered parenterally

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              Pregnancy & Lactation

              Pregnancy category: D

              Fetal skeletal demineralization, hypocalcemia, and hypermagnesemia reported with continuous long-term use (ie, longer than 5-7 days) for off-label treatment of preterm labor in pregnant women; the effect on the developing fetus may result in neonates with skeletal abnormalities

              Continuous administration of magnesium sulfate injection to treat preterm labor is not approved and that the safety and efficacy of use for this indication are not established

              Lactation: Safe

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Depresses CNS, blocks peripheral neuromuscular transmission, produces anticonvulsant effects; decreases amount of acetylcholine released at end-plate by motor nerve impulse

              Slows rate of SA node impulse formation in myocardium and prolongs conduction time

              Promotes movement of calcium, potassium, and sodium in and out of cells and stabilizes excitable membranes

              Promotes osmotic retention of fluid in colon, causing distention and increased peristaltic activity, which subsequently results in bowel evacuation

              Absorption

              Onset (anticonvulsant): IV, immediate; IM, 1 hr

              Duration (anticonvulsant): IV, 30 min; IM, 3-4 hr

              Distribution

              Protein bound: 30%

              Extracellular distribution: 1-2%

              Elimination

              Excretion: Urine

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              Administration

              IV Incompatibilities

              Solution: IV fat emulsion 10%

              Additive: Amphotericin B, cyclosporine, dobutamine, polymyxin B sulfate, procaine, sodium bicarbonate

              Y-site: Alatrofloxacin, amiodarone (at 500 mg/mL MgSO4; may be compatible at 20 mg/mL), amphotericin B cholesteryl sulfate, cefepime, ciprofloxacin (?)

              IV Preparation

              Intermittent infusion: Dilute to 60 mg/mL

              IV Administration

              Infuse over 2-4 hr (hypomagnesemia) or as otherwise specified; rate not to exceed 125 mg/kg/hr

              In severe cases, half of the dose may be infused over first 15-20 minutes

              Rapid infusions (over 10-20 minutes) may be used for treatment of severe asthma or torsades de pointes ventricular tachycardia

              Cautiously infuse diluted solution through patent IV line

              IM Administration

              Dilute to maximum concentration of 200 mg/mL before injection

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              BRAND FORM. UNIT PRICE PILL IMAGE
              magnesium sulfate injection
              -
              4 mEq/mL (50 %) vial
              magnesium sulfate injection
              -
              4 mEq/mL (50 %) vial
              magnesium sulfate injection
              -
              4 mEq/mL (50 %) vial
              magnesium sulfate injection
              -
              4 mEq/mL (50 %) vial
              magnesium sulfate injection
              -
              4 mEq/mL (50 %) vial
              magnesium sulfate injection
              -
              4 mEq/mL solution
              magnesium sulfate injection
              -
              4 mEq/mL (50 %) vial
              magnesium sulfate injection
              -
              4 mEq/mL (50 %) vial
              magnesium sulfate injection
              -
              4 mEq/mL (50 %) vial
              magnesium sulfate injection
              -
              4 mEq/mL (50 %) vial

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              Patient Handout

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              Patient Education
              magnesium sulfate oral

              MAGNESIUM SUPPLEMENT - ORAL

              (mag-NEE-zee-um)

              COMMON BRAND NAME(S): Uro-Mag

              USES: This medication is a mineral supplement used to prevent and treat low amounts of magnesium in the blood. Some brands are also used to treat symptoms of too much stomach acid such as stomach upset, heartburn, and acid indigestion. Magnesium is very important for the normal functioning of cells, nerves, muscles, bones, and the heart. Usually, a well-balanced diet provides normal blood levels of magnesium. However, certain situations cause your body to lose magnesium faster than you can replace it from your diet. These situations include treatment with "water pills" (diuretics such as furosemide, hydrochlorothiazide), a poor diet, alcoholism, or other medical conditions (such as severe diarrhea/vomiting, stomach/intestinal absorption problems, poorly controlled diabetes).

              HOW TO USE: Take this product by mouth as directed. Follow all directions on the product package. If you have any questions, ask your doctor or pharmacist.It is best to take magnesium supplements with a meal to reduce stomach upset and diarrhea unless otherwise directed by the product instructions or your doctor.Take each dose with a full glass (8 ounces or 240 milliliters) of water unless your doctor directs you otherwise. Swallow extended-release capsules and delayed-release/enteric coated tablets or capsules whole. Do not crush or chew extended-release or delayed-release/enteric coated capsules or tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.If you are taking the chewable tablets, chew each tablet thoroughly before swallowing.If you are using a liquid product, use a medication measuring device to carefully measure the dose. Do not use a household spoon because you may not get the correct dose. If you are using a suspension, shake the bottle well before each dose.Take this medication regularly in order to get the most benefit from it. Remember to take it at the same time(s) each day. Dosage is based on your medical condition and response to treatment. Do not increase your dose or take it more often than directed on the product package or by your doctor. Too much magnesium in the blood can cause serious side effects.Tell your doctor if symptoms of low magnesium blood levels (such as muscle cramps, tiredness, irritability, depression) last or get worse. If you think you may have a serious medical problem, get medical help right away.

              SIDE EFFECTS: Stomach upset and diarrhea may occur. Taking this product with a meal helps to reduce these effects. If either of these effects last or get worse, tell your doctor or pharmacist promptly.If your doctor has directed you to use this medication, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking a magnesium supplement, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.If you have the following health problem, consult your doctor or pharmacist before using this product: kidney disease.Liquids, powders, or some other forms of this product may contain sugar and/or aspartame. Liquid products may also contain alcohol. Caution is advised if you have diabetes, alcohol dependence, liver disease, phenylketonuria (PKU), or any other condition that requires you to limit/avoid these substances in your diet. Ask your doctor or pharmacist about using this product safely.During pregnancy, this product should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is not known whether this product passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: If you are taking this product under your doctor's direction, your doctor or pharmacist may already be aware of possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.Before using this product, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: cellulose sodium phosphate, digoxin, sodium polystyrene sulfonate.Magnesium can bind with certain medications, preventing their full absorption. If you are taking a tetracycline-type medication (such as demeclocycline, doxycycline, minocycline, tetracycline), separate the time of the dose from the time of the magnesium supplement dose by at least 2 to 3 hours. If you are taking a bisphosphonate (for example, alendronate), a thyroid medication (for example, levothyroxine), or a quinolone-type antibiotic (such as ciprofloxacin, levofloxacin), ask your doctor or pharmacist about how long you should wait between doses and for help finding a dosing schedule that will work with all your medications.Check the labels on all your prescription and nonprescription/herbal products (such as antacids, laxatives, vitamins) because they may contain magnesium. Ask your pharmacist about using those products safely.This document does not contain all possible interactions. Before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include slow heartbeat, severe drowsiness, dizziness, confusion, muscle weakness, loss of consciousness.

              NOTES: Keep all regular medical and laboratory appointments. If your doctor has directed you to take this medication, laboratory and/or medical tests (such as magnesium blood levels, kidney function tests) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.Magnesium supplements are available in different forms with different amounts of magnesium. Many are available without a prescription. Ask your doctor or pharmacist for help in selecting the best product for you.Eat a well-balanced diet. Foods high in magnesium include avocados, bananas, beans, whole grain cereals, green vegetables, and nuts.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Refer to the product package for details. Do not store in the bathroom. If you have any questions about storage, ask your pharmacist. Keep all drug products away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised March 2022. Copyright(c) 2022 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

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              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.