Successful magnesium sulfate tocolysis: Is “weaning” the drug necessary?

Lewis, David F.; Bergstedt, S.; Edwards, Michael S. B.; Burlison, Scott; Gallaspy, J. W.; Brooks, G. G.; Adair, Charles

doi:10.1016/s0002-9378(97)70261-8

Cited by 25 publications

(6 citation statements)

References 11 publications

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“…Magnesium has been used for nearly 40 yr to treat premature labour and is the most commonly used agent in the USA, 104 but evidence for its use is unconvincing. In a recent review, Macones and colleagues examined the evidence comparing ritodrine, beta agonists and magnesium.…”

Section: Magnesium Sulphate In Tocolysismentioning

confidence: 99%

Magnesium: physiology and pharmacology

Fawcett

Haxby

Male

1999

British Journal of Anaesthesia

600

424

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Magnesium has an established role in obstetrics and an evolving role in other clinical areas, in particular cardiology. Many of the effects involving magnesium are still a matter of controversy. Over the next decade, it is likely that improvements in the measurement of magnesium, a clearer understanding of the mechanisms of its actions and further results of clinical studies will help to elucidate its role, both in terms of treating deficiency and as a pharmacological agent.

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Section: Magnesium Sulphate In Tocolysismentioning

confidence: 99%

Magnesium: physiology and pharmacology

Fawcett

Haxby

Male

1999

British Journal of Anaesthesia

600

424

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“…The ideal tocolytic agent should be specific to the common pathway of parturition (activated in the specific patient), easy to administer, effective in preventing preterm birth, and able to improve neonatal outcomes, with few maternal, fetal, and neonatal side effects and without long-term adverse effects. 7 A wide variety of agents have been used to suppress uterine contractions, including β 2 -adrenergic-receptor agonists, 8–12 magnesium sulfate, 13–16 cyclooxygenase inhibitors, 17–22 calcium channel blockers, 7,23–26 oxytocin-receptor antagonists 27–31 and nitric oxide donors. 32–35 Currently, there is no clear first-line tocolytic agent although a recent meta-analysis suggested that nifedipine appears to meet several characteristics of an ideal tocolytic agent.…”

Section: Introductionmentioning

confidence: 99%

Transdermal nitroglycerin for the treatment of preterm labor: a systematic review and metaanalysis

Conde-Agudelo

Romero

2013

American Journal of Obstetrics and Gynecology

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OBJECTIVE To evaluate the efficacy and safety of transdermal nitroglycerin as tocolytic agent in women with preterm labor. STUDY DESIGN Systematic review and meta-analysis of randomized controlled trials. RESULTS Thirteen studies (1302 women) were included. Two studies evaluated transdermal nitroglycerin versus placebo (N=186), 9 evaluated transdermal nitroglycerin versus β2-adrenergic-receptor agonists (N=1024), and 1 each evaluated transdermal nitroglycerin versus nifedipine (N=50) and transdermal nitroglycerin versus magnesium sulfate (N=42). There were no significant differences between transdermal nitroglycerin and placebo for delivery within 48 hours of initiation of treatment or before 28, 34 or 37 weeks’ gestation, adverse neonatal outcomes, and neurodevelopmental status at 24 months of age. Nevertheless, one study found a marginally significant reduction in the risk of a composite outcome of significant neonatal morbidity and perinatal mortality (3/74 [4.1%] versus 11/79 [13.9%]; relative risk 0.29, 95% confidence interval 0.08–1.00). When compared with β2-adrenergic-receptor agonists, transdermal nitroglycerin was associated with a significant reduction in the risk of preterm birth <34 and <37 weeks’ gestation, admission to the neonatal intensive care unit, use of mechanical ventilation, and maternal side effects. There were no significant differences between transdermal nitroglycerin and nifedipine and magnesium sulfate in delivery within 48 hours of treatment and pregnancy prolongation, respectively. Overall, women receiving transdermal nitroglycerin had a higher risk of headache. CONCLUSION Although transdermal nitroglycerin appears to be more effective than β 2-adrenergic-receptor agonists, the current evidence does not support its routine use as tocolytic agent for the treatment of preterm labor. Further additional double-blind placebo-controlled trials are needed.

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“…Magnesium ions are involved as a cofactor in about 300 known enzymatic reactions in the body and in several important processes such as hormone receptor binding, gating of calcium channels, transmembrane ion flux, regulation of the adenylcyclase system, muscle contraction, neuronal activity, vasomotor tone, cardiac excitability and neurotransmitter release [1]. As a pharmacological agent the use of magnesium sulphate is established for the treatment of supraventricular [2] and ventricular dysrhythmias [3], especially torsades de pointes [4], asthma [5], for tocolysis [6] and eclampsia [7,8]. The role of magnesium in the treatment of acute myocardial infarction remains unclear [1,9].…”

Section: Introductionmentioning

confidence: 99%

Magnesium as part of balanced general anaesthesia with propofol, remifentanil and mivacurium: a double-blind, randomized prospective study in 50 patients

et al. 2001

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We can recommend the use of magnesium sulphate as a safe and cost-effective supplement to a general anaesthetic regimen with propofol, remifentanil and mivacurium, although we cannot clearly distinguish between a mechanism as a (co)analgesic agent at the NMDA-receptor site or its properties as a sympatholytic. The effect of a single bolus dose of 50 mg kg(-1) on induction lasts for about 2 h. For longer cases, either a continuous infusion or repeated bolus doses might be necessary.

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Successful magnesium sulfate tocolysis: Is “weaning” the drug necessary?

Cited by 25 publications

References 11 publications

Magnesium: physiology and pharmacology

Magnesium: physiology and pharmacology

Transdermal nitroglycerin for the treatment of preterm labor: a systematic review and metaanalysis

Magnesium as part of balanced general anaesthesia with propofol, remifentanil and mivacurium: a double-blind, randomized prospective study in 50 patients

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