title: A double-blind placebo-controlled crossover trial of intravenous magnesium sulfate for foscarnet-induced ionized hypocalcemia and hypomagnesemia in patients with AIDS and cytomegalovirus infection.
abstract: Foscarnet (trisodium phosphonoformate hexahydrate) is an antiviral agent used to treat cytomegalovirus disease in immunocompromised patients. One common side effect is acute ionized hypocalcemia and hypomagnesemia following intravenous administration. Foscarnet-induced ionized hypomagnesemia might contribute to ionized hypocalcemia by impairing excretion of preformed parathyroid hormone (PTH) or by producing target organ resistance. Prevention of ionized hypomagnesemia following foscarnet administration could blunt the development of ionized hypocalcemia. To determine whether intravenous magnesium ameliorates the decline in ionized calcium and/or magnesium following foscarnet infusions, MgSO(4) at doses of 1, 2, and 3 g was administered in a double-blind, placebo-controlled, randomized, crossover trial to 12 patients with AIDS and cytomegalovirus disease. Overall, increasing doses of MgSO(4) reduced or eliminated foscarnet-induced acute ionized hypomagnesemia. Supplementation, however, had no discernible effect on foscarnet-induced ionized hypocalcemia despite significant increases in serum PTH levels. No dose-related, clinically significant adverse events were found, suggesting that intravenous supplementation with up to 3 g of MgSO(4) was safe in this chronically ill population. Since parenteral MgSO(4) did not alter foscarnet-induced ionized hypocalcemia or symptoms associated with foscarnet, routine intravenous supplementation for patients with normal serum magnesium levels is not recommended during treatment with foscarnet.
authors.affiliation: Department of Medicine, University of Oklahoma Health Sciences Center and Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma 73190, USA. mark-huycke@ouhsc.edu
authors.forename: M M
authors.initials: MM
authors.lastname: Huycke
authors.forename: M T
authors.initials: MT
authors.lastname: Naguib
authors.forename: M M
authors.initials: MM
authors.lastname: Stroemmel
authors.forename: K
authors.initials: K
authors.lastname: Blick
authors.forename: K
authors.initials: K
authors.lastname: Monti
authors.forename: S
authors.initials: S
authors.lastname: Martin-Munley
authors.forename: C
authors.initials: C
authors.lastname: Kaufman
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications; D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000150:complications* / Q000378:metabolism; D000328:Adult; D002118:Calcium / Q000097:blood; D018592:Cross-Over Studies; D003586:Cytomegalovirus Infections / Q000209:etiology*; D004311:Double-Blind Method; D017245:Foscarnet / Q000009:adverse effects; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000139:chemically induced / Q000150:complications / Q000188:drug therapy*; D007262:Infusions, Intravenous; D008274:Magnesium / Q000097:blood*; D008278:Magnesium Sulfate / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D010281:Parathyroid Hormone / Q000378:metabolism; D010865:Pilot Projects
chemical_list: D010281:Parathyroid Hormone; D017245:Foscarnet; D008278:Magnesium Sulfate; D008274:Magnesium; D002118:Calcium