Magnesium citrate dosing, indications, interactions, adverse effects, and more

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

liquid

• 290mg/5mL

tablet

• 100mg (elemental)

Nutritional Supplementation

19-30 years: Men, 400 mg/day; women, 310 mg/day; pregnant women (≤50 years), 350 mg/day; breastfeeding women (≤50 years), 310 mg/day

>30 years: Men, 420 mg/day; women, 320 mg/day; pregnant women (≤50 years), 360 mg/day; breastfeeding women (≤50 years), 320 mg/day

Constipation/Laxative

195-300 mL PO in single daily dose or in divided doses with full glass of water

Alternative: 2-4 tablets PO at bedtime

Acid Indigestion

1 tablet twice daily or as directed by healthcare provider

Dosing Considerations

Should be refrigerated to maintain potency and palatability

Dosage Forms & Strengths

liquid

• 290mg/5mL

tablet

• 100mg (elemental)

Constipation/Laxative

2-6 years: 60-90 mL PO once or divided doses; not to exceed 90 mL/24hr

6-12 years: 90-210 mL in single dose or in divided doses with full glass of water

>12 years: 195-300 mL PO in single daily dose or in divided doses with full glass of water; alternatively, may administer 2-4 tablets PO at bedtime

Dosing Considerations

Should be refrigerated to maintain potency and palatability

Interactions

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Serious – Use Alternative (9)

• baloxavir marboxil

  magnesium citrate will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. Avoid or Use Alternate Drug. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Human studies not conducted.

• demeclocycline

  magnesium citrate decreases levels of demeclocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• dolutegravir

  magnesium citrate will decrease the level or effect of dolutegravir by cation binding in GI tract. Avoid or Use Alternate Drug. Administer dolutegravir 2 hr before or 6 hr after taking medications containing polyvalent cations

• doxycycline

  magnesium citrate decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• eltrombopag

  magnesium citrate decreases levels of eltrombopag by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Separate by at least 4 hours.

• minocycline

  magnesium citrate decreases levels of minocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• oxytetracycline

  magnesium citrate decreases levels of oxytetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• potassium phosphates, IV

  magnesium citrate decreases effects of potassium phosphates, IV by cation binding in GI tract. Avoid or Use Alternate Drug. Magnesium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.

• tetracycline

  magnesium citrate decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

Monitor Closely (16)

• bictegravir

  magnesium citrate will decrease the level or effect of bictegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Bictegravir can be taken under fasting conditions 2 hr before antacids containing Al, Mg, or Ca. Routine administration of bictegravir simultaneously with, or 2 hr after, antacids containing Al, Mg, or Ca is not recommended.

• cabotegravir

  magnesium citrate will decrease the level or effect of cabotegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Administer polyvalent cation products at least 2 hr before or 4 hr after taking oral cabotegravir.

• ciprofloxacin

  magnesium citrate decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

• deferiprone

  magnesium citrate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.

• deflazacort

  magnesium citrate and deflazacort both decrease serum potassium. Use Caution/Monitor.

• fleroxacin

  magnesium citrate decreases levels of fleroxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• gemifloxacin

  magnesium citrate decreases levels of gemifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• ifosfamide

  ifosfamide, magnesium citrate.
  Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Monitor electrolytes and renal function.

• levofloxacin

  magnesium citrate decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• moxifloxacin

  magnesium citrate decreases levels of moxifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• ofloxacin

  magnesium citrate decreases levels of ofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• omadacycline

  magnesium citrate will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

• penicillamine

  magnesium citrate decreases levels of penicillamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• sarecycline

  magnesium citrate will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

• sodium phosphates, IV

  magnesium citrate decreases effects of sodium phosphates, IV by cation binding in GI tract. Modify Therapy/Monitor Closely. Magnesium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.

• vitamin D

  vitamin D increases levels of magnesium citrate by Other (see comment). Use Caution/Monitor.
  Comment: Vitamin D can increase serum magnesium concentrations, particularly in the presence of renal impairment. The combined use of vitamin D and magnesium-containing products should be avoided, if possible, in patients with chronic renal failure.

Minor (41)

• amikacin

  amikacin decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• amiloride

  amiloride increases levels of magnesium citrate by decreasing renal clearance. Minor/Significance Unknown.

• amphotericin B deoxycholate

  amphotericin B deoxycholate decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• bazedoxifene/conjugated estrogens

  bazedoxifene/conjugated estrogens decreases levels of magnesium citrate by Other (see comment). Minor/Significance Unknown.
  Comment: Magnesium shifted from blood to tissue storage.

• bendroflumethiazide

  bendroflumethiazide decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• bumetanide

  bumetanide decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• calcitonin salmon

  calcitonin salmon increases levels of magnesium citrate by decreasing renal clearance. Minor/Significance Unknown.

• chlorothiazide

  chlorothiazide decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• chlorthalidone

  chlorthalidone decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• conjugated estrogens

  conjugated estrogens decreases levels of magnesium citrate by Other (see comment). Minor/Significance Unknown.
  Comment: Magnesium shifted from blood to tissue storage.

• conjugated estrogens, vaginal

  conjugated estrogens, vaginal decreases levels of magnesium citrate by Other (see comment). Minor/Significance Unknown.
  Comment: Magnesium shifted from blood to tissue storage.

• cyclopenthiazide

  cyclopenthiazide decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• dextrose

  dextrose decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• dextrose (Antidote)

  dextrose (Antidote) decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• digoxin

  digoxin decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• doxercalciferol

  doxercalciferol increases levels of magnesium citrate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• drospirenone

  drospirenone increases levels of magnesium citrate by decreasing renal clearance. Minor/Significance Unknown.

• estradiol

  estradiol decreases levels of magnesium citrate by Other (see comment). Minor/Significance Unknown.
  Comment: Magnesium shifted from blood to tissue storage.

• estrogens conjugated synthetic

  estrogens conjugated synthetic decreases levels of magnesium citrate by Other (see comment). Minor/Significance Unknown.
  Comment: Magnesium shifted from blood to tissue storage.

• estrogens esterified

  estrogens esterified decreases levels of magnesium citrate by Other (see comment). Minor/Significance Unknown.
  Comment: Magnesium shifted from blood to tissue storage.

• estropipate

  estropipate decreases levels of magnesium citrate by Other (see comment). Minor/Significance Unknown.
  Comment: Magnesium shifted from blood to tissue storage.

• ethacrynic acid

  ethacrynic acid decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• furosemide

  furosemide decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• gentamicin

  gentamicin decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• glucagon intranasal

  glucagon intranasal increases levels of magnesium citrate by decreasing renal clearance. Minor/Significance Unknown.

• hydrochlorothiazide

  hydrochlorothiazide decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• ibandronate

  magnesium citrate decreases levels of ibandronate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• indapamide

  indapamide decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• mannitol

  mannitol decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• mestranol

  mestranol decreases levels of magnesium citrate by Other (see comment). Minor/Significance Unknown.
  Comment: Magnesium shifted from blood to tissue storage.

• methyclothiazide

  methyclothiazide decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• metolazone

  metolazone decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• neomycin PO

  neomycin PO decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• nitrofurantoin

  magnesium citrate decreases levels of nitrofurantoin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• paromomycin

  paromomycin decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• sodium polystyrene sulfonate

  sodium polystyrene sulfonate increases levels of magnesium citrate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

• spironolactone

  spironolactone increases levels of magnesium citrate by decreasing renal clearance. Minor/Significance Unknown.

• streptomycin

  streptomycin decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• tobramycin

  tobramycin decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• torsemide

  torsemide decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• triamterene

  triamterene increases levels of magnesium citrate by decreasing renal clearance. Minor/Significance Unknown.

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Adverse Effects

Frequency Not Defined

Abdominal cramping

Diarrhea

Electrolyte imbalance

Hypermagnesemia

Gas formation

Nausea/vomiting

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Warnings

Contraindications

Low sodium diet

Cautions

For occasional use only in treatment of constipation; prolonged use for constipation may cause serious adverse effects

To be used under the supervision of a physician when administered to patients with sodium or manesium restricted diet, kidney dysfunction, nausea/vomiting/abdominal pain with sudden change in bowel habits persisting over 2 weeks

Use with caution in patients with myasthenia gravis or other neuromuscular disease

Avoid use in renal failure, existing electrolyte imbalance, appendicitis or acute surgical abdomen, myocardial damage or heart block, fecal impaction or rectal fissures, intestinal obstruction or perforation, dehydration

Discontinue use and consult healthcare provider if bowel movement does not occur or rectal bleeding develops

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Pregnancy & Lactation

Pregnancy category: A

Lactation: Use in nursing mothers appears to be safe

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.

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Pharmacology

Mechanism of Action

Increases peristaltic activity of the colon; promotes bowel evacuation by causing osmotic retention of fluid

Absorption

15-30% absorbed

Onset: 0.5-6 hr or less

Elimination

Excretion: Urine (mainly)

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Images

No images available for this drug.

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Patient Handout

A Patient Handout is not currently available for this monograph.

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Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

Magnesium Citrate for Constipation | Simply Supplements

Constipation can be a thoroughly uncomfortable experience, yet is surprisingly common. Scientific studies suggest that up to 20% of the population may suffer from constipation at one time or another.

Generally speaking the evidence suggests that the chance of suffering from constipation increases with age, and is far more common in women than men. It’s little wonder, then, that so many people are searching for effective constipation remedies like magnesium citrate.

What is Constipation?

Doctors have long noted that many people define constipation differently. At its most basic, constipation is defined as a difficulty in passing stools effectively. However, there are a range of elements that may indicate a case of constipation including:

• Hard or lumpy stools
• Difficulties with passing stools
• Excessive straining or discomfort while on the toilet
• A feeling of being unable to pass all material in one go

If you are suffering from any of these symptoms then you may well be experiencing constipation. Fortunately, there are a number of different solutions that can help with the problem, and magnesium is one of the best-known of these.

What Causes Constipation?

A range of different factors can impact our digestive system. While the following list is not exhaustive, some common causes of constipation can include:

• Stress
• Unbalanced diet (for example one deficient in fibrous material)
• Lack of exercise
• Dehydration

In many cases the root cause of constipation remains a mystery, and many people find the symptoms are transient and disappear naturally after a period of time.

If you find yourself suffering regularly then it is advisable to seek guidance from your doctor, who will be able to check that your constipation is not an indication of more serious health issues.

What is Magnesium Citrate?

Magnesium is a tremendously common element. It is considered to be the ninth most abundant element in the universe, and the fourth most abundant mineral in the body.

It has been used for years as a remedy for constipation and is now available in a range of different forms. Some of the most common forms of magnesium used for medicinal purposes include magnesium hydroxide (better known as “milk of magnesia”) and magnesium sulphate (also known as Epsom salt). This article, however, focuses on magnesium citrate.

As the name suggests, magnesium citrate comprises of magnesium molecules bound to citric acid. The reason for magnesium citrate’s popularity in recent years has been its high bioavailability. The combination of magnesium and citric acid seems to make it more easily absorbed by the body, and so can boost the benefit of taking this supplement.

How Does Magnesium Help With Constipation?

Magnesium has a long history of use when it comes to digestive problems. Two of the most common therapeutic uses relate to the treatment of constipation and colonic cleansing, particularly before surgical procedures. Generally speaking any product designed to treat the condition we know as constipation is known as a laxative.

There are a host of different laxatives, which are often grouped by their specific mode of action. Magnesium in general, and magnesium citrate in particular, belong in a category known as “osmotic laxatives”. In essence, magnesium citrate functions by drawing water into the gut from the rest of the body. When this happens stools not only travel more easily but can absorb this water itself, making for easier and more comfortable passing.

Indeed, studies have found that the consumption of just 3.5g of magnesium reduced urinary volume in volunteers by almost a third, as this moisture is redirected into the intestine and lost through the stool. It is important to understand this mode of action because dehydration can result in constipation, as well as a range of other potential health issues.

Therefore if you opt to use magnesium citrate for constipation you should also be certain to drink suitable volumes of water to prevent the risk of dehydration and to allow the supplement to do its job effectively.

What Foods Contain Magnesium?

Magnesium is so common that it may be found in a wide range of different foods. In reality, the levels can be quite low and so you may wish to instead consider the use of a supplement to ease symptoms of constipation. As an ongoing treatment for digestive health the following foods may come in handy…

• Halibut
• Almonds
• Cashews
• Spinach
• Shredded Wheat
• Oatmeal
• Potato
• Peanuts
• Wheat Bran
• Yogurt
• Bran Flakes
• Brown Rice
• Avocado
• Kidney Beans
• Banana
• Whole Wheat Bread
• Raisins
• Whole Milk

Alternatively, or additionally, ensure that you’re getting enough fibre in your diet.

How Much Magnesium Citrate Should I Take for Constipation?

Numerous studies have aimed to assess the “optimal” dosage for magnesium citrate. One study provided a range of different permutations to volunteers and found that “faecal weight is proportional to faecal soluble magnesium output”. In other words, the more you take, the greater the impact.

Magnesium citrate, like many other osmotic laxatives, is considered a relatively fast-acting constipation remedy. The scientists in question found that most adults that consume between 2.4 and 4.8 g experience “an evacuation within 6 hours”.

Another study of magnesium’s effect on constipation, this time in children, recommended similar doses and claimed that these should be taken for two or three days, or until the issue is resolved.

Reports on the use of magnesium in Japan suggest rather lower doses are common in the East, with the average treatment dose coming in at 600mg per day, but that under these circumstances treatment is often continued for some weeks with no obvious negative side effects.

One final study suggested that a daily intake of 25ml of magnesium can be beneficial, but that doses of up to 8.7g are commonly used as a “bulk laxative”.

Generally speaking it would seem that starting off with smaller doses makes sense, which can be subsequently increased over time if required.

Our magnesium citrate supplement contains 200mg per tablet. It therefore seems likely that three of these tablets would be a good starting point for constipation treatment. This could be increased subsequently if the issue does not resolve itself. It has been suggested by experts that consuming magnesium citrate with a glass of water or juice will help it to be absorbed more effectively.

What are the Side Effects of Magnesium Citrate?

Magnesium citrate is considered to be quite a safe remedy for constipation because it works within the intestine rather than in the body at large. Side effects therefore tend to be minimal, especially when taken in moderation and for short periods of time.

Most side effects are minor and soon pass once supplementation ceases. Possibly the most common potential side effect of supplementing with magnesium citrate is that the volume of moisture drawn into the intestines can actually moisten stools too much, leading to short-term diarrhoea.

Used excessively, some experts have also raised concerns about the potential for electrolyte imbalances thanks to the osmotic properties of magnesium. Some experts claim that long term use has the potential to result in magnesium toxicity.

It is therefore recommended that you closely follow the dosing instructions on your chosen supplement, and if side effects arise you should discontinue use and seek advice from your doctor.

What Other Remedies Could I Try for Constipation?

Magnesium citrate is just one potential treatment for constipation. A range of other options may also offer benefits, and some individuals opt to experiment with different alternatives to find the combination that works best for them.

Three of the most popular supplements for recurring constipation are:

Psyllium Fibre – A rich source of fibre, ideal for encouraging more regular toilet visits. Learn about psyllium fibre here.

Glucomannan – Also known as konjac fibre, glucomannan is a popular source of soluble fibre. Take this supplement with a large glass of water, which it will absorb in the gut, turning into a thick gel that eases stools along their journey. Learn about glucomannan here.

Probiotics – Some experts believe that an imbalance in the bacteria that line the gut wall can lead to digestive problems like diarrhoea and constipation. Indeed, some IBS sufferers regularly use probiotics to help rebalance their microflora.

Try to bulk up the “friendly bacteria” in your digestive tract and you may find that constipation becomes a thing of the past. Learn about probiotics here.

Conclusion

Magnesium has a long pedigree of use for resolving cases of constipation, and magnesium citrate is considered one of the most easily-absorbed forms. It tends to be fast acting, so keeping a tub in your cupboard at home can represent an excellent “on demand” solution for constipation sufferers.

Shop for magnesium citrate here.

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Sources:

http://europepmc.org/abstract/med/3126699
https://www.newsmaker.com.au/releaseFile/view/id/162667/Clinical%20Study%20-%20Magnesium.pdf
http://ods.od.nih.gov/factsheets/magnesium.asp
http://www.sciencedirect.com/science/article/pii/S0889855310000439
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042657/
http://www.nccpeds.com/ContinuityModules-Spring/Spring%20Faculty%20Modules/Constipation-Faculty.pdf
http://go.galegroup.com/ps/anonymous?id=GALE%7CA87914478&sid=googleScholar&v=2.1&it=r&linkaccess=fulltext&issn=00943509&p=AONE&sw=w&authCount=1&isAnonymousEntry=true
http://www.metabolics.com/blog/the-definitive-guide-to-magnesium-and-magnesium-supplements/
http://onlinelibrary.wiley.com/doi/10.1046/j. 1365-2036.2001.00982.x/full
https://www.nature.com/articles/1601907

The use of magnesium citrate allows the prevention of preterm birth in pregnant women with a high risk of miscarriage | Tetruashvili N.K., Gromova O.A., Serov V.N.

Introduction
Recurrent miscarriage is a complex polyetiological problem. The process of interaction of the blastocyst with the maternal endometrium plays a central role in this pathology. Factors that disrupt the normal course of implantation and placentation include hormonal, autoimmune, alloimmune, and anatomical factors [1].

Recurrent miscarriage is a complex polyetiological problem. The process of interaction of the blastocyst with the maternal endometrium plays a central role in this pathology. Factors that disrupt the normal course of implantation and placentation include hormonal, autoimmune, alloimmune, and anatomical factors [1].
Pathogenetic mechanisms of early pregnancy termination are often implemented through endothelial dysfunction, microthrombosis, spasm of the spiral arteries, which leads to growth restriction and invasion of the trophoblast, impaired gas exchange, and a decrease in the hormone-producing function of the placenta. The emergence of endothelial dysfunction and microthrombosis largely contribute to infectious and inflammatory gynecological diseases [1,2].
Numerous early predictors of miscarriage are known from clinical practice: infectious diseases of the genitourinary tract, hemocoagulation factors (elevated levels of homocysteine, a tendency to thrombophilia), including acquired and genetic ones (antiphospholipid syndrome, mutations of factor V Leiden, prothrombin, PAI-1, GP IIIA, FGB, FXI, MTHFR / MTRR, thrombogenic DNA polymorphisms of genes, etc.), spasmophilia (increased tone of the uterus, also accompanied by cramps in the calf muscles, spasms of the esophagus (the so-called “lump in the throat”), intestinal spasms, etc.) [2,3]. An increase in the tone of the uterus disrupts the uteroplacental blood flow and creates additional obstacles to the full development of the fetal egg. Increased uterine tone is often accompanied by significant discomfort in the pelvis and lower abdomen, up to pain [1,2].
It should be noted that spasm, hypertonicity of the myometrium and hypercoagulability are largely the result of an imbalance in the sympathetic and parasympathetic autonomic nervous system. Like hormones, potassium, magnesium, calcium and sodium ions are classified as systemic substances: for example, Na + and Ca2 + ions cause vasoconstriction, and K + and Mg2 + ions have an expanding effect. Ignoring the correction of autonomic disorders and deformed mineral balance in the complex therapy of habitual miscarriage reduces the effectiveness of treatment, and in some cases makes it completely unsuccessful [4].
The balance of potassium, sodium, magnesium, calcium is often considered in a simplified way, only in terms of the regulation of water-salt metabolism. We should not forget about the critical role of electrolytes in maintaining the balance of the autonomic nervous system. In particular, magnesium deficiency, like potassium deficiency, corresponds to hypersympathiconia, which is manifested by the aforementioned increase in uterine tone, convulsions, spasms of the esophagus and intestines [5]. Magnesium deficiency also contributes to a significant increase in the risk of thrombophilia [6] and a decrease in the activity of magnesium-dependent placental proteins [7]. Therefore, effective and safe compensation of magnesium deficiency in early pregnancy is a promising direction in the prevention of miscarriage.
The use of preparations of organic magnesium salts for oral administration (magnesium citrate), which have high bioavailability and practically no side effects, is a promising direction for effective and safe compensation of magnesium deficiency during pregnancy. A meta-analysis (7 studies, 2689 patients) presented in the Cochrane Evidence-Based Research Database (Cochrane Database) showed the effectiveness of oral administration of organic magnesium salts in the prevention of pregnancy complications [8]. It was found that the intake of organic magnesium salts up to 25 weeks. pregnancy significantly (compared with placebo) reduces the risk of preterm birth by 27% (OR 0. 73; 95% CI 0.57-0.94), threatened miscarriage by 62% (RR 0.38; 95% CI 0.16-0.90)
and the risk of having children with low body weight – by 33%
(OR 0.67; 95% CI 0.46–0.96) [8].
Therefore, in recent obstetric practice, oral use of preparations of organic magnesium salts in order to prevent placental insufficiency and early termination of pregnancy has received special attention. This article offers readers a brief overview of the fundamental molecular mechanisms of the impact of magnesium deficiency on the pathophysiology of miscarriage (thrombophilia, spasmophilia, fetoplacental insufficiency). To illustrate the clinical effects of the inclusion of preparations of organic magnesium salts in a set of measures for the prevention of miscarriage, two typical cases from practice are given.
Magnesium deficiency and thrombophilia
According to world data, up to 55–62% of cases of recurrent miscarriage are associated with defects in coagulation proteins or platelets [3]. One of the negative consequences of magnesium deficiency, leading to pregnancy complications (miscarriage, preeclampsia, etc.), is an increased tendency of blood to thrombosis [9,10]. And vice versa – magnesium preparations reduce the formation of blood clots [11,12], improving the overall and uteroplacental blood flow.
The main process of thrombus formation is a complex physiological process through which blood passes from a fluid state to a thrombotic state and vice versa. Although coagulation is the main process of hemostasis, the state of the coagulation system is far from the only factor influencing the formation of a thrombus. For example, in the second half of pregnancy, many women experience proatherogenic processes that narrow the lumen of the vessel and initiate platelet aggregation. Systematic analysis of the biological roles of magnesium [9] showed that it contributes to a decrease in thromboxane synthesis, weakening of hypercoagulability and vasoconstriction, and a decrease in inflammation of the vascular endothelium (Fig. 1).
In particular, fundamental research conducted for more than 30 years has repeatedly confirmed that magnesium is an effective antiplatelet agent [12], contributes to a significant decrease in thromboxane A2 levels [13], and inhibits its biological effects [14]. With magnesium deficiency in the blood, the levels of thromboxane A2 in blood plasma and urine increase [15].
Magnesium deficiency
and placental insufficiency
More than 700 Mg-dependent proteins have been found in the human body, of which at least 100 have been found in the placenta. Due to the fact that the placenta, first, contains many Mg-dependent proteins and, secondly, is one of the centers of energy metabolism (which also depends on magnesium), magnesium is fundamental for the functioning of the placenta and, therefore, for the development of the fetus. In a systematic analysis, the molecular functions of almost all known Mg-dependent placental proteins were considered and a generalized picture of the effect of magnesium and Mg deficiency on the functioning of the placenta was formulated [7] .
The mother-placenta-fetus system is formed and functions from the earliest stages of pregnancy until the birth of a child. Among the tissues of the human body, the placenta is characterized by one of the highest levels of magnesium. Placental Mg-dependent proteins control: 1) energy metabolism and metabolism in the placenta, 2) the state of the muscular, immune, connective tissue systems, 3) proliferation (division) and apoptosis of cells (Fig. 2).
energy metabolism. The less intense the transfer of energy and nutrients to the growing fetus through the placenta, the more likely will be malnutrition and immaturity of the fetus. Magnesium deficiency negatively affects the functioning of Mg-dependent carbohydrate metabolism proteins (in particular, glycolysis proteins) and fatty acids. For example, the glycolytic enzymes enolase (ENO1, ENO2), phosphoglucomutase (PGM1, PGM2, PGM3), and 6-phosphofructokinase (PFKP) have been found in significant amounts in placental tissues. All three of these key glycolytic enzymes require magnesium as a cofactor (Figure 3).
Magnesium and proteins of the immune system. Magnesium levels influence the specific and non-specific immune response [16]. At least 20 Mg-dependent placental proteins are directly involved in the functioning of signaling pathways in the immune system – in particular, through signaling from the cytokine TNF (“tumor necrosis factor”) and the regulation of adenosine levels. Magnesium deficiency will interfere with signal transmission, thereby weakening the intensity of the immune response.
Placental proteins and apoptosis. Normal tissue growth in the placenta and fetus is the result of a delicate balancing act between cell proliferation (division) and cell apoptosis (programmed cell death). Violation of this balance will lead to pathology of the placenta, low birth weight and developmental defects of the embryo. As a key cofactor for more than 25 Mg-dependent apoptosis/cellular survival proteins (such as activin receptors, serine-threonine kinases, mitogen-activated protein kinases, etc. ), magnesium helps maintain a balance between these two fundamental cellular processes.
Thus, magnesium is absolutely essential for maintaining the biological functions of the placenta. Magnesium deficiency leads to a decrease in its total amount in the placenta in complexes with both ATP and proteins. A decrease in the activity of Mg-dependent placental proteins causes defective functioning of the placenta. Replenishment of magnesium deficiency through preparations based on highly assimilable forms of organic magnesium will help maintain fetoplacental function.
Magnesium deficiency and spasmophilia
Magnesium supports the rapid recovery of the resting potential of the membranes of muscle cells (cells of the myometrium, smooth muscles of blood vessels and the heart, skeletal muscles, etc.). With magnesium deficiency, the duration of the resting phase is reduced, which leads to an increase in muscle tone, defective (shortened) diastole, and skeletal muscle cramps [17,18].
However, shortening the resting phase is far from the only way magnesium deficiency affects the functioning of muscle cells. It should be remembered that the tone of the myometrium and other muscle cells is regulated by the action of a number of neurotransmitters on their receptors. The biological effects of neurotransmitters are realized through a number of Mg-dependent proteins. First of all, it should be noted the most important role of magnesium in the regulation of the biological effects of catecholamines (adrenaline and noradrenaline), known stress hormones.
Under stress, the levels of catecholamines in the blood of pregnant women increase. The signal from catecholamines enters the b-2adrenergic receptors of muscle cells (myometrium, cardiomyocytes, etc.) and is transmitted into the cell through the signaling molecule of cyclic adenosine monophosphate (cAMP). The amplitude of this signal is limited by the activity of Mg-dependent adenylate cyclases (genes ADCY1, ADCY2, etc. , only 10 genes) and the rate of decay of excess cAMP by Mg-dependent cAMP-phosphodiesterases. Therefore, magnesium deficiency will contribute to a more enhanced muscle response to catecholamine stimulation, which will lead to hyperconstriction of smooth muscles, including the uterus and blood vessels of the placenta [19].
In addition, the Mg-dependent enzyme catechol-O-methyltransferase (COMT) (Fig. 4) is responsible for the inactivation of excess catecholamines in the blood. Obviously, COMT activity decreases with magnesium deficiency, which contributes to the maintenance of excess smooth muscle tone even at low stress levels. Increased vascular tone of the placenta leads to a decrease in the intensity of the blood circulation of the fetus and, consequently, to limit the intensity of development of its tissues and malnutrition. It is well known that stress is an important etiological factor in miscarriage [1–4].
Case studies
To illustrate the actual participation of organic magnesium salts in achieving the best results in the prevention and treatment of miscarriage, we present two typical cases from clinical practice. In both cases, the patients had a pronounced magnesium deficiency (ICD-10 code E61.2).
Clinical case No. 1
Patient I.V.V., 36 years old.
Complaints of scanty bloody discharge from the genital tract, nagging pain in the lower abdomen and lower back, constipation, general weakness, irritability, insomnia.
Pregnancy occurred spontaneously, menstruation was delayed by 2 weeks, pregnancy test was positive.
Anamnesis data: allergic anamnesis is not burdened; previous diseases: rubella, chicken pox, appendicitis and appendectomy in 1995
Gynecological diseases: in 1996, chlamydial and papillomavirus infection, cervicitis, cervical ectopia were detected. The patient and her husband were treated with macrolide preparations and metronidazole, smears were taken for oncocytology – stage I-II dysplasia, a second course of antibiotic therapy was carried out, control smears for oncocytology – no pathology was detected.
Menstrual function: menarche at 12 years old, regular menstrual cycle, menstruation every 28–30 days, 5–6 days each, moderate, painless.
Reproductive history:
• 1st pregnancy (2005) proceeded with the threat of interruption since the first trimester, was treated with antispasmodics in a hospital setting. The pregnancy ended in preterm labor at 35 weeks. – premature detachment of a normally located placenta, caesarean section, a child weighing 2030 g, 42 cm tall, girl, alive. Blood loss – 1800 ml, blood transfusion.
• 2nd pregnancy (2007) ended in spontaneous miscarriage for a period of 5-6 weeks. Conducted curettage of the walls of the uterine cavity.
• 3rd pregnancy (2009) ended in spontaneous miscarriage at 19 weeks, the miscarriage began with bleeding, curettage was performed, the size of the fetus corresponded to a period of 16 weeks.
• 4th pregnancy (2010) ended in early spontaneous miscarriage at a period of 7-8 weeks, a non-developing pregnancy was diagnosed (according to ultrasound, the size of the embryo corresponded to 5-6 weeks).
• 5th pregnancy, real, occurred spontaneously, without prior preparation, the patient applied for a period of 5 weeks. with signs of threatened miscarriage.
Objectively: on examination – a woman of the correct physique (height – 165 cm, weight – 60 kg). Hair on the female type.
Previous results of the examination: hormones are within normal limits, rectal temperature is biphasic, infection outside of pregnancy was not detected.
Inspection of the cervix in the mirrors and vaginal examination: the cervix is ​​tilted backwards, ectopia and cervicitis are determined, moderate bleeding from the cervical canal. On palpation, the cervix is ​​dense, formed, 3 cm long, the external os is closed. The body of the uterus is enlarged up to 6 weeks. pregnancy, in high tone. Discharge from the genital tract moderate, bloody. After a detailed examination according to the accepted algorithms, the patients with recurrent miscarriage were diagnosed with a pregnancy of 6 weeks. Threatened miscarriage. antiphospholipid syndrome. Habitual miscarriage.
Anticoagulant (enoxaparin), hormonal (dydrogesterone), antispasmodic (drotaverine) therapy, magnesium citrate with pyridoxine (Magne B6 forte) was prescribed. Against the background of the treatment for 5 days, a pronounced positive effect was achieved, the pains in the lower abdomen and lower back were stopped, the tone of the uterus returned to normal, the stool became regular, the patient’s psycho-emotional state improved, sleep normalized.
Therapy with Magne B6 forte was continued throughout pregnancy, which made it possible to avoid the appointment of tocolytic therapy.
The appointment of magnesium citrate with pyridoxine (Magne B6 forte, 1 tablet 2 times a day) made it possible to eliminate the adverse symptoms of magnesium deficiency – spastic constipation, insomnia, and normalize uterine tone. The daily dose of elemental magnesium as part of therapy was 200 mg (100 mg per 1 tablet), and pyridoxine – 20 mg (10 mg per 1 tablet). In a double-blind, placebo-controlled study in pregnant women, it was shown that the dose of pyridoxine is 30 mg / day. is a safe and effective therapy for nausea and vomiting, including in women at risk of miscarriage [20]. In this patient, under the influence of ongoing therapy, there were no signs of placental insufficiency, which, in particular, is explained by the complex effect of therapeutic measures with the inclusion of magnesium citrate and pyridoxine. A full-term girl was born weighing 3520 g, height 52 cm, Apgar score – 8–9points. Blood loss – 600 ml.
The course of pregnancy and drug therapy of the patient I.V.V. are shown in Figure 5.

Case #2
Patient V.E.G., 29 years old.
Came in at 20 weeks gestation. She complained of pain in the lower abdomen and lower back, increased tone of the uterus, cramps in the muscles of the legs, anxiety, sleep disturbances.
Anamnesis data: heredity is not burdened.
Past diseases: rubella, chickenpox, mumps, tonsillectomy in childhood, chronic cholecystitis.
Menstrual function: menarche at the age of 13, menstrual cycle regular, menstruation after 26–28 days, 5–6 days each, moderate, painless.
Gynecological diseases: chronic salpingo-oophoritis (antibacterial therapy was carried out together with the patient and her husband in 2008).
Reproductive history: first marriage. 1st pregnancy is real.
Objectively: on examination, she is a woman of the correct physique, reduced nutrition (height – 170 cm, weight – 58 kg).
Examination of the cervix in the mirrors and vaginal examination: the cervix is ​​tilted backwards, clean, 2 cm long, moderate transparent mucous discharge from the cervical canal. On palpation, the cervix is ​​2 cm long, of a dense consistency, the external os is closed. The uterus is not enlarged, limited mobility, painless. Discharges are light, mucous.
According to the functional study of the state of the fetus, no violations were noted, the length of the cervix according to cervicometry with a vaginal sensor was 3.5 cm.
The patient has clinical signs of magnesium deficiency: cramps in the muscles of the legs, anxiety, sleep disturbances. In addition, complaints of pain in the lower abdomen and in the lower back indicate a periodically occurring increased tone of the uterus.
As the first line of therapy in this case, preparations of organic magnesium salts are prescribed orally – Magne B6 in a daily dose of 6 tablets or Magne B6 forte in a daily dose of 3 tablets. At the same time, in women of childbearing age, Magne B6 forte is preferable to magnesium preparations in the form of lactate dihydrate or orotate dihydrate. If in the diet of pregnant women there is an excess of animal proteins (red meat) and / or simple carbohydrates (sweets, confectionery), then there is often a deficiency of citrate anions, which leads to acidotic changes in the body, therefore, in such patients, it is important to supplement not only magnesium, but also citrates. For the same reason (citrate deficiency and the formation of an acidotic shift), Magne B6 forte is indicated for women who have had acute respiratory and other infectious diseases during the convalescence period. Against the background of treatment with Magne B6 forte, a faster regression of the clinical symptoms of magnesium and pyridoxine deficiency (normalization of uterine tone, night sleep, disappearance of cramps in the calf muscles and muscle twitches) was noted than with the use of magnesium in the form of lactate dihydrate or orotate dihydrate. The patient on the background of the use of Magne B6 forte noted a rapid improvement in well-being.
Such a fairly rapid normalization of the patient’s condition is probably due to the replenishment of magnesium deficiency, which occurs both as a result of an increased need for magnesium during pregnancy (especially in the second trimester), and due to its insufficient intake with food.
Therapy with Magne B6 forte tablets during pregnancy contributed to its prolongation in this patient and the birth of a full-term viable baby at term 39weeks pregnancy weighing 3456 g, height 50 cm, Apgar score – 8-9 points.
Conclusion
The normal content of magnesium and balanced metal ligand homeostasis is a prerequisite for the harmonious functioning of the female genital area, including the regularity of the menstrual cycle, the ability to ovulate, conceive, normal pregnancy and lactation. The daily requirement for magnesium for healthy women is 300 mg, during pregnancy this figure increases by an additional 150 mg [21,22].
Magnesium deficiency during pregnancy can occur for several reasons. One of the factors is its insufficient intake with food due to an unbalanced diet (refined food, carbonated drinks, easily digestible carbohydrates, soft water). In addition, magnesium absorption disorders are possible in diseases of the gastrointestinal tract. Increased excretion of magnesium ions from the body, which also leads to magnesium deficiency, occurs with the systematic use of laxatives, diuretics, and in renal pathology. The risk group is also made up of women with extragenital pathology – diabetes, hyperthyroidism, hypoparathyroidism, heart disease, hypertension. For women with similar diseases, it is advisable to prescribe magnesium supplements prophylactically to prevent magnesium deficiency.
The available data from fundamental and clinical studies suggest that the treatment regimens for pregnant women must necessarily include preparations containing organic magnesium salts that are approved for use in this contingent. With an unbalanced diet in terms of proteins and simple carbohydrates, which is common for most women of childbearing age, it is preferable to use magnesium citrate, because. this form allows you to eliminate the deficiency of citrate anions (drug Magne B6 forte). Therapy with modern oral preparations of organic magnesium salts is of particular importance during pregnancy and in the prenatal period due to the high bioavailability of magnesium in these preparations, their high proven efficacy, considerable experience in their use and high safety.
RU.MGP.12.04.17.

Literature
1. Sidelnikova V.M., Sukhikh G.T. Miscarriage: A guide for practitioners. 2010, MIA. 986 p.
2. Tetruashvili N.K. Early pregnancy loss (immunological aspects, ways of prevention and therapy): Abstract of the thesis. dis. … doc. honey. Sciences .. 2010.
3. Makatsaria A.D. Metabolic syndrome and thrombophilia in obstetrics and gynecology, Moscow: MIA, 2006. 460 p.
4. Kosheleva N.G., Arzhanova O.N., Pluzhnikova T.A. Miscarriage: etiopathogenesis, diagnosis, clinic and treatment // Consilium Medicum. Gynecology. 2008. No. 7(6). pp. 1–8.
5. Fundamental and clinical physiology. / Ed. A.G. Kamkina, A.A. Kamensky. Moscow: Academia. 2004. 1072 p.
6. Tetruashvili N.K., Torshin I.Yu., Gromova O.A. Magnesium and thrombophilia in pregnancy: molecular mechanisms and evidence-based medicine // Russian Bulletin of the Obstetrician-Gynecologist. 2009. V. 9. No. 6. S. 75–80.
7. Sukhikh G.T., Torshin I.Yu., Gromova O.A., Rudakov K.V. Molecular mechanisms of regulation of placental proteins by magnesium // Russian Bulletin of the Obstetrician-Gynecologist 2008. No. 6. P. 9-16.
8. Makrides M., Crowther C.A. Magnesium supplementation in pregnancy // Cochrane Database Syst Rev. 2001 Vol. 4. CD000937.
9. Vormann J., Gunther T., Hollriegl V., Schumann K. Pathobiochemical effects of graded magnesium deficiency in rats // Z Ernahrungswiss. 1998 Vol. 37. Suppl 1, pp. 92–97.
10. Sheu J.R., Hsiao G., Shen M.Y., Fong T.H., Chen Y.W., Lin C.H., Chou D.S. Mechanisms involved in the antiplatelet activity of magnesium in human platelets // Br J Haematol. 2002 Vol. 119(4). R. 1033–1041.
11. Sheu J.R., Hsiao G., Shen M.Y., Lee Y.M., Yen M.H. Antithrombotic effects of magnesium sulfate in vivo experiments // Int J Hematol. 2003 Vol. 77(4). R. 414–419.
12. Herrmann R.G., Lacefield W.B., Crowe V.G. Effect of ionic calcium and magnesium on human platelet aggregation // Proc Soc Exp Biol Med. 1970 Vol. 135(1). R. 100–103.
13. Ravn H.B., Vissinger H., Kristensen S.D., Husted S.E. Magnesium inhibits platelet activity–an in vitro study // Thromb Haemost. 1996 Vol. 76(1). R. 88–93.
14. Shechter M. The role of magnesium as antithrombotic therapy // Wien Med Wochenschr. 2000 Vol. 150 (15–16). R. 343–347.
15. Nadler J.L., Buchanan T., Natarajan R., Antonipillai I., Bergman R., Rude R. Magnesium deficiency produces insulin resistance and increased thromboxane synthesis // Hypertension. 1993 Vol. 21 (6 Pt 2). R. 1024–1029.
16. Gonzalez C., Cruz M.A., Gallardo V., Varela J. Magnesium and potassium ions on tone and reactivity of human placental chorionic veins // Gen. Pharmacol. 1991 Vol. 22(6). R. 1121–1125.
17. Gonzalez C., Cruz M.A., Gallardo V., Varela J. Magnesium and potassium ions on tone and reactivity of human placental chorionic veins // Gen Pharmacol. 1991 Vol. 22(6). R.1121.
18. Torshin I.Y., Gromova O.A. Magnesium and pyridoxine: fundamental studies and clinical practice // Nova Science. 2009.
19. Vutyavanich T., Wongtra-ngan S., Ruangsri R. Pyridoxine for nausea and vomiting of pregnancy: a randomized, double-blind, placebo-controlled trial // Am J Obstet Gynecol. 1995 Oct. Vol. 173 (3 Pt 1). R. 881–884.
20. Tkacheva O.N., Gromova O.A., Mishina I.E., Klemenov A.V. Macro- and microelement status during pregnancy. M.: Medpraktika-M, 2007. 129 p.
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Magnesium citrate – help with constipation. : evgenia2108 – LiveJournal

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Hello everyone.

My very first Instagram post was about this Natural Vitality magnesium. But I like him so much that I want to write another post about him, but in a slightly different way.

In the photo, in addition to magnesium, Donat Mg water is a natural medicinal water containing many minerals, in particular magnesium. It is prescribed for diseases of the gastrointestinal tract. My son Makar was prescribed it by a gastroenterologist for chronic constipation against the background of dolichosigmoid.

It works really well, tastes salty and has a visible mineral flavor. But to a child who is not even 2 years old, you cannot explain that you need to drink it to go to the toilet. He doesn’t like it, he doesn’t drink.

So I ordered magnesium citrate, which also has a laxative effect. He is sweet, with a lemon taste, his son drinks much easier than Donut. Dilute in water at room temperature, drink in the evening.

The principle of action is as follows – magnesium retains fluid in the stool, preventing its absorption into the intestinal wall. Thus, the stool remains more voluminous and soft, which allows it to move faster and easier through the rectum. Magnesium also relaxes the muscles in the intestines, which also helps to eliminate constipation.

With magnesium citrate, organic lemon filling and stevia as a sweetener.

I also drink it, it relaxes me no worse than magnesium glycinate. Of the flavors that I have tried (cherry, without fillers), this one is the most delicious. Neither I nor my son have any allergic reactions. Drink in the evening, stool in the morning. Everything is fast 🙂

Discount code ARY5723.

Tags: iherb, iherb, magnesium, magnesium citrate

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