Drug-Drug Interaction

MAGNESIUM SALTS, INJECTABLE/NONDEPOLARIZING MUSCLE RELAXANTS

MECHANISM OF ACTION
Magnesium may reduce postjunctional membrane neuromuscular blocking action of nondepolarizing muscle relaxants. Parenterally administered magnesium may potentiate the effects of the nondepolarizing muscle relaxants.

DISCUSSION
The effects of nondepolarizing muscle relaxants have been reported to be increased in laboratory animals and in humans by concomitant administration of magnesium sulfate. Respiratory depression has been reported.

CLINICAL EFFECTS
Increased neuromuscular blockade with severe respiratory depression may occur.

SEVERITY LEVEL
3-Moderate Interaction: Assess the risk to the patient and take action as needed.

PATIENT MANAGEMENT
Monitor respiratory function when parenteral magnesium and nondepolarizing muscle relaxants are administered concurrently. Adjust the dose of the neuromuscular blocking agent accordingly.

PREDISPOSING FACTORS
None determined.

REFERENCES

  1. Giesecke AH Jr, Morris RE, Dalton MD, Stephen CR. Of magnesium, muscle .Giesecke AH Jr, Morris RE, Dalton MD, Stephen CR. Of magnesium, muscle relaxants, toxemic parturients, and cats. Anesth Analg 1968 Nov-Dec; 47(6):689-95.
  2. Morris R, Giesecke AH Jr. Potentiation of muscle relaxants by magnesium .Morris R, Giesecke AH Jr. Potentiation of muscle relaxants by magnesium sulfate therapy in toxemia of pregnancy. South Med J 1968 Jan;61(1):25-8.
  3. Aldrete JA, Zahler A, Aikawa JK. Prevention of succinylcholine-induced .Aldrete JA, Zahler A, Aikawa JK. Prevention of succinylcholine-induced hyperkalaemia by magnesium sulfate. Can Anaesth Soc J 1970 Sep; 17(5):477-84.
  4. Ghoneim MM, Long JP. The interaction between magnesium and other .Ghoneim MM, Long JP. The interaction between magnesium and other neuromuscular blocking agents. Anesthesiology 1970 Jan;32(1):23-7.
  5. Sinatra RS, Philip BK, Naulty JS, Ostheimer GW. Prolonged neuromuscular .Sinatra RS, Philip BK, Naulty JS, Ostheimer GW. Prolonged neuromuscular blockade with vecuronium in a patient treated with magnesium sulfate. Anesth Analg 1985 Dec;64(12):1220-2.
  6. Ostergaard D, Engbaek J, Viby-Mogensen J. Adverse reactions and .Ostergaard D, Engbaek J, Viby-Mogensen J. Adverse reactions and interactions of the neuromuscular blocking drugs. Med Toxicol Adverse Drug Exp 1989 Sep-Oct;4(5):351-68.