Clinical pharmacokinetic properties of magnesium sulphate in women with pre-eclampsia and eclampsia
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Date
2016Author
Okusanya, BO
Oladapo, OT
Long, Q
Lumbiganon, P
Carroli, G
Qureshi, Z
Duley, L
Souza, JP
Gulmezoglu, AM
Type
ArticleLanguage
enMetadata
Show full item recordAbstract
Background
The pharmacokinetic basis of magnesium sulphate (MgSO4) dosing regimens for eclampsia prophylaxis and treatment is not clearly established.
Objectives
To review available data on clinical pharmacokinetic properties of MgSO4 when used for women with pre-eclampsia and/or eclampsia.
Search strategy
MEDLINE, EMBASE, CINAHL, POPLINE, Global Health Library and reference lists of eligible studies.
Selection criteria
All study types investigating pharmacokinetic properties of MgSO4 in women with pre-eclampsia and/or eclampsia.
Data collection and analysis
Two authors extracted data on basic pharmacokinetic parameters reflecting the different aspects of absorption, bioavailability, distribution and excretion of MgSO4 according to identified dosing regimens.
Main results
Twenty-eight studies investigating pharmacokinetic properties of 17 MgSO4 regimens met our inclusion criteria. Most women (91.5%) in the studies had pre-eclampsia. Baseline serum magnesium concentrations were consistently <1 mmol/l across studies. Intravenous loading dose between 4 and 6 g was associated with a doubling of this baseline concentration half an hour after injection. Maintenance infusion of 1 g/hour consistently produced concentrations well below 2 mmol/l, whereas maintenance infusion at 2 g/hour and the Pritchard intramuscular regimen had higher but inconsistent probability of producing concentrations between 2 and 3 mmol/l. Volume of distribution of magnesium varied (13.65–49.00 l) but the plasma clearance was fairly similar (4.28–5.00 l/hour) across populations.
Conclusion
The profiles of Zuspan and Pritchard regimens indicate that the minimum effective serum magnesium concentration for eclampsia prophylaxis is lower than the generally accepted level. Exposure–response studies to identify effective alternative dosing regimens should target concentrations achievable by these standard regimens.
Tweetable abstract
Minimum effective serum magnesium concentration for eclampsia prophylaxis is lower than the generally accepted therapeutic level.
URI
http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.13753/fullhttp://hdl.handle.net/11295/95898
Citation
BJOG: An International Journal of Obstetrics & Gynaecology, Volume 123, Issue 3 February 2016 Pages 356–366Rights
Attribution-NonCommercial-ShareAlike 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-sa/3.0/us/Collections
- Faculty of Health Sciences (FHS) [10378]
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