Observations placeholder
Clinical pharmacokinetic properties of magnesium sulphate in women with pre-eclampsia and eclampsia
Identifier
027623
Type of Spiritual Experience
Background
A description of the experience
BJOG. 2016 Feb;123(3):356-66. doi: 10.1111/1471-0528.13753. Epub 2015 Nov 24.
Clinical pharmacokinetic properties of magnesium sulphate in women with pre-eclampsia and eclampsia.
Okusanya BO1, Oladapo OT2, Long Q2, Lumbiganon P3, Carroli G4, Qureshi Z5, Duley L6, Souza JP7, Gülmezoglu AM2.
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.
© 2015 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.
KEYWORDS:
Eclampsia; magnesium sulphate; pharmacokinetics; pre-eclampsia; serum magnesium