Zuspan's Scheme Versus an Alternative Magnesium Sulfate Scheme: Randomized Clinical Trial of Magnesium Serum Concentrations

Abbade, Joélcio Francisco; Costa, Roberto; Martins, Anice M. V. C.; Borges, Vera Therezinha Medeiros; Rudge, Marilza Vieira Cunha; Peraçoli, José Carlos

doi:10.3109/10641950902928704

Cited by 11 publications

(9 citation statements)

References 15 publications

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“…Full texts of 50 of these 53 studies (three could not be located) were retrieved and assessed. Twenty‐eight studies published over a span of seven decades and conducted in the Americas, Europe, Asia, and sub‐Saharan Africa met the inclusion criteria . The studies involved a total of 1466 women with pre‐eclampsia and/or eclampsia.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, 12 studies were assessed to be at low risk of bias, 13 at uncertain risk of bias and 3 at high risk of bias . For 23 studies that examined intravenous regimens, 10 were assessed to be at low risk of bias, 11 at uncertain risk of bias and two at high risk of bias . For the nine studies that examined only intramuscular regimens, three studies were assessed to be at low risk of bias five at uncertain risk of bias and one at high risk of bias…”

Section: Resultsmentioning

confidence: 99%

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Clinical pharmacokinetic properties of magnesium sulphate in women with pre‐eclampsia and eclampsia

Okusanya

Oladapo

Long

et al. 2015

BJOG

104

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BackgroundThe pharmacokinetic basis of magnesium sulphate (MgSO 4) dosing regimens for eclampsia prophylaxis and treatment is not clearly established.ObjectivesTo review available data on clinical pharmacokinetic properties of MgSO 4 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 criteriaAll study types investigating pharmacokinetic properties of MgSO 4 in women with pre‐eclampsia and/or eclampsia.Data collection and analysisTwo authors extracted data on basic pharmacokinetic parameters reflecting the different aspects of absorption, bioavailability, distribution and excretion of MgSO 4 according to identified dosing regimens.Main resultsTwenty‐eight studies investigating pharmacokinetic properties of 17 MgSO 4 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.ConclusionThe 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 abstractMinimum effective serum magnesium concentration for eclampsia prophylaxis is lower than the generally accepted therapeutic level.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clinical pharmacokinetic properties of magnesium sulphate in women with pre‐eclampsia and eclampsia

Okusanya

Oladapo

Long

et al. 2015

BJOG

104

View full text Add to dashboard Cite

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“…35,36 These above observations suggest that although the anticonvulsant effect of intravenous magnesium is immediate and serum levels peak in 15 minutes; it appears that a critical level of serum magnesium (close to or within the therapeutic range) needs to be attained in order to prevent convulsions. 37 Thus low serum magnesium levels consistently preceded occurrence of fits before commencing and during treatment of preeclampsia with magnesium sulphate.…”

Section: Discussionmentioning

confidence: 94%

Determinants of seizure occurrence in preeclampsia before commencing and during treatment with magnesium sulphate

Imaralu

Badejoko

Loto

et al. 2016

Int J Reprod Contracept Obstet Gynecol

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“…6,15,16, Four RCTs were included in the relevant Cochrane review. 13 The majority of studies were excluded because they did not evaluate MgSO 4 in an LMIC.…”

Section: Resultsmentioning

confidence: 99%

“…The two most commonly used regimens are the Zuspan regimen (a loading dose of 4 g IV, and maintenance dosing of 1 g/hr IV) and the Pritchard regimen (loading doses of 4 g IV and 10 g IM, and maintenance dosing of 5 g IM/4hr). 15,16 Although well-studied and widely used in high-income countries, MgSO 4 is underutilized in LMICs. This is because of many barriers, such as:…”

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confidence: 99%

Magnesium Sulphate for the Management of Preeclampsia and Eclampsia in Low and Middle Income Countries: A Systematic Review of Tested Dosing Regimens

Gordon¹,

Magee

Payne

et al. 2014

Journal of Obstetrics and Gynaecology Canada

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Objective: To review systematically the magnesium sulphate (MgSO 4 ) dosing regimens tested in low and middle income countries (LMICs) for women with preeclampsia (prevention) and/or eclampsia (treatment) . Data Sources:We searched Medline, EMBASE, IPA, CINAHL, CDSR, and CENTRAL databases for relevant English language publications .Study Selection: Our search yielded 753 publications, of which 26 (10 randomized controlled trials and 16 observational studies) evaluated MgSO 4 for preeclampsia and/or eclampsia in World Bank-classified LMICs.Data Extraction: Independent, by two authors .Data Synthesis: Twenty-five studies were conducted in hospital settings and one in the community . Rates of eclampsia were usually < 5% (median 3.0%, range 0.0% to 26.5%) even when MgSO 4 was administered for eclampsia . When dosage varied from the standard Pritchard or Zuspan regimens, almost all (n = 22) reduced the dose or duration of treatment, most commonly because of concerns about maternal safety, cost, or resource availability . Four trials of a loading dose only (4 g IV + 10 g IM) versus loading plus maintenance dosing of 5 g/4 hr IM found no difference in eclampsia recurrence (RR 1.64; 95% CI 0 .48 to 5 .65, n = 396) . One study documented less eclampsia recurrence associated with community administration of a MgSO 4 loading dose before referral to a care facility versus treatment in a care facility (RR 0.23; 95% CI 0.11 to 0.49, n = 265). Conclusion:Use of MgSO 4 for eclampsia treatment and prevention has been well-studied in LMICs, but concern remains about potential toxicity . Further studies are needed to identify the minimum effective dosage of MgSO 4 for management of preeclampsia and eclampsia and whether MgSO 4 loading can be safely administered in the community . RésuméObjectif : Procéder à une analyse systématique des schémas posologiques de sulfate de magnésium (MgSO 4 ) mis à l'essai dans des pays à revenu faible ou intermédiaire (PRFI) chez des femmes présentant une prééclampsie (prévention) et/ou une éclampsie (traitement) . Sources de données : Magnesium Sulphate for the Management of Preeclampsia and Eclampsia in Low and Middle Income Countriesla plus couramment citée étant la présence de préoccupations au sujet de la sûreté maternelle, des coûts ou de la disponibilité des ressources . Quatre essais ayant comparé le seul recours à une dose de mise en charge (4 g IV + 10 g IM) au recours à une dose de mise en charge et à une dose d'entretien de 5 g/4 h IM n'ont constaté aucune différence en matière de récurrence de l'éclampsie (RR,1,64; IC à 95 %, 0,65, n = 396

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Zuspan's Scheme Versus an Alternative Magnesium Sulfate Scheme: Randomized Clinical Trial of Magnesium Serum Concentrations

Abstract: The serum magnesium concentration of this randomized clinical trial doesn't support the use of the alternative scheme of magnesium sulfate to prevent or treat eclampsia.

Cited by 11 publications

References 15 publications

Clinical pharmacokinetic properties of magnesium sulphate in women with pre‐eclampsia and eclampsia

Clinical pharmacokinetic properties of magnesium sulphate in women with pre‐eclampsia and eclampsia

Determinants of seizure occurrence in preeclampsia before commencing and during treatment with magnesium sulphate

Magnesium Sulphate for the Management of Preeclampsia and Eclampsia in Low and Middle Income Countries: A Systematic Review of Tested Dosing Regimens

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