title: Magnesium enhances opioid-induced analgesia - What we have learnt in the past decades?
abstract: Opioids are increasingly used in alleviating pain, including cancer-related pain and postoperative pain. Unfortunately, the development of tolerance, the resistance of neuropathic pain on opioid analgesia or other undesirable effects may limit their utility. In order to reduce opioid doses, and thereby to avoid the risk of side effects and sudden deaths due to overdosing, attempts have been made to introduce co-analgesics. Due to an increasing amount of data concerning a potential enhance of opioid analgesia by the physiological antagonist of N-methyl-d-aspartate receptors, magnesium ions (Mg2+), a concomitant use of such a combination seems to be interesting from a clinical point of view. Therefore, the aim of this review is to provide an analysis of existing preclinical and clinical studies in the context of the benefits of using this combination in clinical practice. A potential mechanism of magnesium - opioid interaction is also suggested. The potential influence of Mg on opioid adverse/side effects as well as conclusions on the safety of combined administration of magnesium and opioid drugs were also summarized. Data from animal studies indicate that magnesium increases opioid analgesia in chronic (e.g., neuropathic, inflammatory) as well as acute pain. In clinical trials, most authors confirmed that magnesium reduces opioid consumption and alleviates postoperative pain scores while not increasing the risk of side effects after opioids. However, more clinical studies are needed concerning an influence of Mg on opioid activity in other difficult to treat types of pain, especially neuropathic and inflammatory.
authors.affiliation: Department of Pharmacodynamics, Centre for Preclinical Research and Technology (CEPT) Laboratory, Medical University of Warsaw, Stefana Banacha 1B street, 02-097 Warsaw, Poland. Electronic address: magdalena.bujalska@wum.edu.pl.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Bujalska-Zadrożny
authors.affiliation: Department of Pharmacodynamics, Centre for Preclinical Research and Technology (CEPT) Laboratory, Medical University of Warsaw, Stefana Banacha 1B street, 02-097 Warsaw, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Tatarkiewicz
authors.affiliation: Department of Pharmacodynamics, Centre for Preclinical Research and Technology (CEPT) Laboratory, Medical University of Warsaw, Stefana Banacha 1B street, 02-097 Warsaw, Poland.
authors.forename: Kamila
authors.initials: K
authors.lastname: Kulik
authors.affiliation: Laboratory of Drug Addiction Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, Smętna 12 street, 31-343 Kraków, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Filip
authors.affiliation: Department of Pharmacognosy and Molecular Basis of Phytotherapy, Faculty of Pharmacy, Medical University of Warsaw, Stefana Banacha 1 street, 02-097 Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Naruszewicz
mesh_terms: D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000494:pharmacology*; D000701:Analgesics, Opioid / Q000494:pharmacology*; D000818:Animals; D004361:Drug Tolerance; D006801:Humans; D008274:Magnesium / Q000494:pharmacology*; D009437:Neuralgia / Q000188:drug therapy*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D016194:Receptors, N-Methyl-D-Aspartate; D008274:Magnesium
keywords: Analgesics; Animal studies; Clinical studies; Magnesium; N-methyl-d-aspartate receptors; Opioids