Magnesium

Magnesium is a natural essential mineral belonging to the supplement category electrolyte class.

Magnesium is also known as magnesia.

Magnesium is essential for maintaining healthy bones, muscles, and nerves as well as for generating energy and controlling blood pressure. Additionally, it helps with protein synthesis, enzyme function, and heart rhythm.

A deficiency of magnesium leads to hypomagnesaemia. Mild tremors and generalized weakness to cardiac ischemia and death characterize hypomagnesaemia.

Natural sources of magnesium include beans, nuts, seeds, whole grains, spinach, green leafy vegetables, milk, yoghurt, and other dairy products. Additionally, fortified meals like morning cereals and other fortified foods contain it.

Magnesium is absorbed predominantly by the small intestine, distributed in tissues and bones as a cofactor, and excreted primarily through the kidneys.

The common side effects of magnesium include gastrointestinal effects like abdominal cramps, diarrhoea and nausea.

Magnesium is available in caplets.

Biochemical action of magnesium

Magnesium belonging to the supplement class helps in the growth and development of the body.

Magnesium acts via numerous pathways as a cofactor for multiple enzyme processes. One of the most prominent pathways is its involvement in the NMDA receptor pathway in the neurological system. Magnesium works as a natural antagonist at the NMDA receptor, a form of glutamate receptor important in synaptic development and learning. Furthermore, magnesium is important in regulating ion channels, particularly calcium channels, in excitable cells such as neurons and muscle cells. It contributes to the right balance of calcium and potassium ions, which is required for good nerve and muscle function.

Magnesium is also necessary for several energy-producing activities, including glycolysis, the citric acid cycle, and oxidative phosphorylation. It supports the conversion of nutrients into functional energy molecules like ATP by acting as a cofactor for the enzymes involved in these processes.

Magnesium is available in caplet.

Caplet: To be swallowed whole with water/liquid, as applicable.

Magnesium can be used as a supplement when the amount of magnesium taken in from the diet is insufficient.

Magnesium supplement orally is used for preventing and treating magnesium.

Adequate oral intake of magnesium supplements might is used as a laxative for constipation.

Magnesium supplement supports bone health by contributing to the structural integrity of bones and teeth.

Vitamins and natural supplements should not replace a balanced diet.

This product is not intended to diagnose, treat or prevent any disease(s).

Magnesium may be useful as a supplement for the following health benefits:

• Treatment and prevention of deficiency: Supplementation with magnesium is used to prevent and treat magnesium insufficiency. This is accomplished through either oral or parenteral form. Magnesium forms that are more unlikely to cause diarrhoea are preferred for long-term use.
• Constipation: Magnesium has a laxative effect at high doses, which is used regularly for the short-term treatment of constipation and for washing the colon for surgical or diagnostic procedures. It is commonly found in magnesium hydroxide (milk of magnesia) or magnesium sulfate (Epsom salts).
• Dyspepsia: Oral magnesium reduces symptoms of dyspepsia and gastric acidity and acts as an antacid by forming magnesium chloride in the stomach.
• Cardiovascular disease (CVD): Magnesium is a cofactor of the Na-K-ATP pump and a natural calcium channel blocker. Magnesium helps in the modulation of atrioventricular node conduction. As a result, hypomagnesemia can produce myocardial excitability, leading to arrhythmias, including ventricular tachycardia and torsades de pointes.
• Prevention of migraine headaches: Individuals suffering from migraine headaches frequently have low magnesium levels. According to limited research, magnesium supplementation may reduce migraine frequency. More study is needed to determine its efficacy in preventing or treating migraines.
• Osteoporosis: Adequate magnesium consumption promotes bone health by increasing bone mineral density and possibly lowering fracture and osteoporosis incidence. Magnesium benefits osteoporosis prevention and therapy, but further research is required to confirm these benefits.
• Neurological System: Magnesium reduces the central nervous system (CNS) and acts as an anticonvulsant. It blocks the release of acetylcholine at neuromuscular junctions, preventing peripheral neuromuscular transmission.
• Reproductive System: During pre-term labour, magnesium is used as a tocolytic. Magnesium increases muscular relaxation and vasodilation by stimulating calcium reuptake by the sarcoplasmic reticulum. Magnesium reduces calcium levels in the uterine muscle, which helps in pre-term labour.

Magnesium supplementation may be administered orally.

Magnesium supplements are available as caplets can be taken orally. It is best absorbed when taken with meals to reduce stomach upset.

The dosage and duration of treatment should be as per the clinical judgment of the treating healthcare professional).

Vitamins and natural supplements should not replace a balanced diet

This product is not intended to diagnose, treat or prevent any disease(s).

Caplet: 84mg

Magnesium is available in caplets.

Magnesium should be used as supplement support for maintaining strong bones along with appropriate dietary restrictions.

• Limit the consumption of drinks that include caffeine, such as coffee, chocolate, and alcoholic beverages, as this substance could hinder magnesium absorption.
• Foods containing oxalic acid or phytic acid, like beans, nuts, beets, whole grains, seeds, legumes and nuts, can bind to magnesium and reduce its absorption.
• Stay within your daily calorie needs.

The dietary restriction should be individualized as per patient requirements.

Recommended Daily Allowance (RDA)

The adult RDA is 400–420 mg for men and 310–320 mg for women.

Upper Tolerable Intake (UTL):

The UTL is set for magnesium is 350 mg.

Magnesium supplementation may be contraindicated in the following conditions:

• Hypersensitivity; sensitive to magnesium element.
• Myasthenia gravis
• Chronic Kidney Failure(CKD)
• Having a history of heart block or myocardial damage
• Alcoholism
• Diabetic coma
• Hypermagnesemia
• Hypercalcemia

• Magnesium supplementation should be cautiously in people with bleeding disorders as it might increase the risk of bleeding or bruising.
• Caution should be exercised when using magnesium supplements for the long term as it may lead to fetal skeletal demineralization, hypocalcemia, and hypermagnesemia abnormalities.
• For individuals on hemodialysis, magnesium supplements might not be absorbed well.
• Patients with myasthenia gravis or any neuromuscular disease should use extreme caution while using magnesium supplements.

Safe to use during breastfeeding.

Safe to use during pregnancy.

Limit the consumption of foods and beverages that include caffeine, such as coffee, tea, chocolate, and alcoholic beverages, as this substance could hinder magnesium absorption.

Magnesium is generally well-tolerated.

The adverse reactions related to magnesium can be categorized as-

• Common: Diarrhea, nausea, and gastric irritation.
• Less Common: Dizziness, muscle weakness, or irregular heartbeat
• Rare: Low blood pressure, difficulty breathing, or even coma.

The clinically relevant drug interactions of magnesium are briefly summarized here:

• Alcohol: Due to the increased urine losses of magnesium associated with alcohol use, additional magnesium supplementation may be required with higher chronic ingestion.
• Aminoglycosides (e.g. gentamicin): Drugs may decrease magnesium absorption; thus, monitoring for any signs and symptoms of magnesium deficiency is essential. Long-term therapy may require higher magnesium intake.
• Calcium: Magnesium regulates PTH and vitamin D; thus, calcium and magnesium deficits frequently come together. Excessive magnesium intake lowers calcium levels by suppressing PTH and increasing excretion. To affect calcium's redistribution, magnesium works similarly to calcium.
• Calcium-channel blockers: Magnesium may increase the hypotensive effects of calcium-channel blockers. Clinicians must monitor patients' medical conditions and possibly positive drug interactions.
• Fluoroquinolone: Since magnesium may reduce their absorption-separate doses of fluoroquinolone antibiotics by at least 2 hours before or 4 hours after oral magnesium
• Loop diuretics and thiazide diuretics: Increased magnesium intake may be required with long-term therapy because of increased urinary excretion — monitor magnesium efficacy and status with long-term drug use.
• Potassium: Hypomagnesaemia results in hypokalaemia due to increased potassium efflux from cells and renal excretion.
• Potassium-sparing diuretics: Observe patients taking this combination since it could increase the effects of supplementary magnesium.
• Tetracycline antibiotics: Tetracyclines and magnesium combine to generate insoluble complexes, which delay the absorption of both — separate dosages — by at least two hours.
• Dasatinib: May increase magnesium blood levels — observe
• Neuromuscular blockers: May potentiate effects of neuro blockers — observe.
• L-thyroxine: Studies suggest reduced effectiveness of levo- thyroxine with magnesium-containing antacids and laxatives— observed.

The common side of magnesium includes the following:

• Constipation
• Nausea
• Upset stomach
• Diarrhoea
• Stomach cramps
• Vomiting

The use of magnesium should be prudent in the following group of special populations.

• Pregnancy: Magnesium is crucial for the treatment of pregnancy-related disorders as well as the prevention of premature delivery, low birth weight, and preeclampsia.

The RDA for Magnesium in pregnant women is 350-400 mg/day.

• Paediatrics:

Magnesium plays an essential role in the paediatric population's brain development, fighting infections and growth.

Magnesium supplements are the best way to help children get enough magnesium daily.

The RDA for Magnesium in paediatrics ranges from 30-360 mg/day.

Dosage Adjustment for Paediatric Patients

There are no specific dosage adjustments provided.

• Geriatrics: There is no sufficient scientific evidence traceable regarding the use and safety of magnesium for use in special populations
• Lactating mothers: Magnesium is present in breast milk; supplementation is generally considered compatible with breastfeeding. Magnesium intake during breastfeeding is usually acceptable, and clinical studies have shown no evidence of fetal risk.

The RDA for Magnesium in lactating mothers is 310-360 mg/day.

Dosage Adjustment in Kidney Impairment

There are no specific dosage adjustments provided.

Dosage Adjustment in Hepatic Impairment

There are no specific dosage adjustments provided.

Dosage Adjustment for Adult Patients

Magnesium Deficiency

168-336 mg PO divided BID

Renal Insufficiency

CrCl<30 mL/min: Use caution; monitor for hypermagnesemia

CrCl≥30 mL/min: Dose adjustment not necessary.

The physician should be vigilant about the knowledge pertaining to identifying and treating overdosage of magnesium. Overdosing on magnesium supplements may lead to hypermagnesaemia, which is rare. Mild hypermagnesaemia may include signs and symptoms like light-headedness, headache, nausea, flushing and warmth.

There is no specific antidote or treatment for excessive intake of supplemental magnesium. If an overdose is suspected, immediately stop the magnesium supplement and promptly remove any unabsorbed magnesium. If necessary, supportive and physical therapy can be added.

Biochemistry profile of magnesium

Magnesium is an essential element for numerous metabolic functions throughout the human body. It exists mainly as a divalent cation (Mg2+), necessary for biological processes. It's vital for energy metabolism, playing a role in ATP production through its involvement in various reactions within the citric acid cycle. Additionally, magnesium participates in DNA and RNA synthesis, aiding in genetic information transfer. Magnesium is also required for about 300 critical enzymatic reactions in the body, contributing to essential biological functions. It is crucial in reactions involving nucleotide cofactors or substrates, and it is vital in cellular energy metabolism and other critical metabolic pathways. This mineral is necessary for overall cell function and is engaged in various critical biological activities.

Kinetic profile:

• Absorption: Magnesium is absorbed primarily in the small intestine, specifically in the ileum and jejunum, due to active transport and passive diffusion mechanisms.
• Magnesium absorption is facilitated by adequate stomach acid and certain hormones such as parathyroid hormone (PTH) and vitamin D.
• Distribution: Magnesium is found throughout the body's soft tissues and bones. About 60% of magnesium is stored in bones, while the remaining 40% is found in various tissues and organs. synthesis.
• Metabolism: Magnesium is not extensively processed in the body. Magnesium metabolism involves complex interactions with other minerals.
• Elimination: Magnesium is removed mainly by the kidneys, with only a small amount excreted in the faeces. The kidneys' filtration and reabsorption processes influence excretion rates.

1. Braun L, Cohen M. October 1, 2014.Herbs and Natural Supplements; 4th Edition Vol-2. Australia. Elsevier.
2. https://ods.od.nih.gov/pdf/factsheets/Magnesium-Consumer.pdf
3. https://www.ncbi.nlm.nih.gov/books/NBK554545/
4. https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
5. https://www.ncbi.nlm.nih.gov/books/NBK500003/
6. https://www.ncbi.nlm.nih.gov/books/NBK109816/