title: Clinical pharmacokinetic properties of magnesium sulphate in women with pre-eclampsia and eclampsia.
abstract: BACKGROUND
  The pharmacokinetic basis of magnesium sulphate (MgSO4 ) dosing regimens for eclampsia prophylaxis and treatment is not clearly established.
  
  
  OBJECTIVE
  To review available data on clinical pharmacokinetic properties of MgSO4 when used for women with pre-eclampsia and/or eclampsia.
  
  
  METHODS
  MEDLINE, EMBASE, CINAHL, POPLINE, Global Health Library and reference lists of eligible studies.
  
  
  METHODS
  All study types investigating pharmacokinetic properties of MgSO4 in women with pre-eclampsia and/or eclampsia.
  
  
  METHODS
  Two authors extracted data on basic pharmacokinetic parameters reflecting the different aspects of absorption, bioavailability, distribution and excretion of MgSO4 according to identified dosing regimens.
  
  
  RESULTS
  Twenty-eight studies investigating pharmacokinetic properties of 17 MgSO4 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.
  
  
  CONCLUSIONS
  The 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.
  
  
  CONCLUSIONS
  Minimum effective serum magnesium concentration for eclampsia prophylaxis is lower than the generally accepted therapeutic level.
authors.affiliation: Experimental and Maternal Medicine (EMM) Unit, Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
authors.forename: B O
authors.initials: BO
authors.lastname: Okusanya
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: O T
authors.initials: OT
authors.lastname: Oladapo
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Q
authors.initials: Q
authors.lastname: Long
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: P
authors.initials: P
authors.lastname: Lumbiganon
authors.affiliation: Centro Rosarino de Estudios Perinatales, Rosario, Argentina.
authors.forename: G
authors.initials: G
authors.lastname: Carroli
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
authors.forename: Z
authors.initials: Z
authors.lastname: Qureshi
authors.affiliation: Nottingham Clinical Trials Unit, Queens Medical Centre, Nottingham, UK.
authors.forename: L
authors.initials: L
authors.lastname: Duley
authors.affiliation: Department of Social Medicine, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, São Paulo, Brazil.
authors.forename: J P
authors.initials: JP
authors.lastname: Souza
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: A M
authors.initials: AM
authors.lastname: Gülmezoglu
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D004461:Eclampsia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008278:Magnesium Sulfate / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D011225:Pre-Eclampsia / Q000188:drug therapy*; D011247:Pregnancy
chemical_list: D000927:Anticonvulsants; D008278:Magnesium Sulfate
keywords: Eclampsia; magnesium sulphate; pharmacokinetics; pre-eclampsia; serum magnesium