Magnesium
Specifically for Asthma
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Why it works for Asthma:
Bronchodilation via calcium antagonism: Magnesium relaxes airway smooth muscle by opposing calcium entry and modulating intracellular calcium handling; it may also enhance adenyl cyclase/cAMP signaling that complements β₂-agonists. It likely inhibits acetylcholine release and stabilizes mast cells, reducing bronchoconstriction and mediator release. BJA Anaesthesia
Clinical niche: Because of that physiology, IV magnesium sulfate is used as an adjunct for moderate–severe acute exacerbations that don’t respond to first-line therapy (oxygen, repeated inhaled SABA, systemic corticosteroids ± ipratropium). Current global guidelines reflect this positioning. Global Initiative for Asthma - GINA
How to use for Asthma:
Adults (acute severe exacerbation, after first-line therapy):
- Magnesium sulfate 1.2–2 g IV (typically 2 g) infused over ~20 minutes. Considered when peak flow/FEV₁ <50% predicted and response to initial bronchodilators is poor. RCEM Learning
Children/adolescents (ED setting):
- 25–50 mg/kg IV once (max 2 g) over ~20 minutes; some pathways specify ~40 mg/kg. Used for moderate–severe attacks refractory to initial therapy, often with senior consultation. IWK Drug Information Resource
Nebulised magnesium (with SABA):
- Evidence is mixed; some older trials suggested short-term score improvements, but more recent high-quality data show no reduction in 24-h hospitalisation in children, and GINA 2024 no longer recommends nebulised MgSO₄ routinely. If used, it’s typically as an ED adjunct under protocol. JAMA Network
Oral magnesium for chronic/stable asthma:
- Not standard of care. Systematic reviews find inconclusive/insufficient benefit for lung function or symptoms; it’s not in major guideline step therapy. Nature
Scientific Evidence for Asthma:
Intravenous magnesium sulfate (ED use):
- Adults: Cochrane review (14 RCTs) – IV MgSO₄ reduces hospital admissions and improves some lung function measures when added after first-line therapy; number needed to treat ≈7 in pooled analyses. openaccess.sgul.ac.uk
- Children: Cochrane and subsequent meta-analyses suggest possible benefit (reduced admissions/severity) in moderate–severe exacerbations unresponsive to initial therapy, but data are fewer and heterogenous; practice varies. Cochrane Library
Nebulised magnesium:
- MAGNETIC and related trials showed small, short-term clinical score improvements in some subgroups, but the large JAMA RCT (n=816) found no significant reduction in 24-h hospitalisation vs placebo when added to albuterol after standardised initial therapy. Guidelines have de-emphasised its use. The Lancet
Guidelines (latest):
- GINA 2024: supports IV MgSO₄ as an adjunct in moderate–severe exacerbations not responding to initial treatment; nebulised MgSO₄ not recommended as routine care. Global Initiative for Asthma - GINA+
Specific Warnings for Asthma:
Monitor and avoid in high-risk settings; toxicity can be serious.
- Adverse effects (dose/infusion related): flushing, hypotension, nausea/vomiting; at high serum levels—loss of deep-tendon reflexes, respiratory depression, bradycardia/heart block, coma. Treat severe toxicity with IV calcium (e.g., calcium gluconate) and supportive care. DailyMed
- Renal impairment: Magnesium is renally excreted—use with caution or avoid in significant renal dysfunction due to risk of hypermagnesaemia; monitor urine output and levels if prolonged/continuous infusions are used. Gloucestershire Hospitals NHS Trust
- Myasthenia gravis: Contraindicated/strong caution—magnesium can worsen neuromuscular transmission and precipitate myasthenic crisis. Drugs.com
- Cardiac conduction disease: Avoid parenteral magnesium in heart block/myocardial damage without specialist oversight; continuous ECG/BP monitoring may be required in severe cases or high infusion rates. Gloucestershire Hospitals NHS Trust
- Drug interactions: Caution with neuromuscular blockers (excessive block) and in digitalised patients (if calcium is needed for toxicity, conduction issues may arise). CNS depressants may have additive sedative/respiratory effects. MedLibrary.org
- Administration warnings: Give slow IV infusion (not IV push), with resuscitation drugs available. Loss of reflexes and RR <12/min are red flags to stop/slow and reassess. NDC List
- Pregnancy/neonates: Most asthma MgSO₄ use is single-dose ED therapy; prolonged infusions (e.g., obstetric indications) carry separate maternal/neonatal toxicity risks—not relevant to single ED dosing, but underscores why monitoring matters. FDA Access Data
General Information (All Ailments)
What It Is
Magnesium is a mineral that is essential for numerous physiological functions in the human body. It is the fourth most abundant mineral in the body and is required for the proper functioning of muscles, nerves, enzymes, and the cardiovascular system. Magnesium is found both inside cells and in bone tissue, where about 60% of the body’s total magnesium is stored. The remainder is distributed in muscles, soft tissues, and fluids such as blood.
Dietary sources of magnesium include leafy green vegetables (like spinach and kale), nuts and seeds (such as almonds, pumpkin seeds, and cashews), whole grains, legumes, and dark chocolate. Magnesium is also available as a dietary supplement, often in forms such as magnesium citrate, oxide, glycinate, or malate, each with different absorption rates and gastrointestinal effects.
How It Works
Magnesium acts as a cofactor in over 300 enzymatic reactions that regulate vital biochemical processes. These include:
- Energy production: It is necessary for the synthesis of ATP (adenosine triphosphate), the main energy currency of cells.
- Protein synthesis and DNA/RNA repair: Magnesium stabilizes nucleic acids and assists in genetic replication and protein construction.
- Muscle and nerve function: It helps regulate neuromuscular signaling by controlling calcium and potassium flow across cell membranes, thus influencing muscle contraction and nerve impulse transmission.
- Blood glucose and pressure regulation: Magnesium helps maintain insulin sensitivity and modulates vascular tone, supporting stable blood sugar and healthy blood pressure.
- Electrolyte balance: It contributes to maintaining equilibrium between other electrolytes, such as sodium, potassium, and calcium.
In simple terms, magnesium acts as a biological stabilizer, ensuring that chemical reactions in the body proceed smoothly and that cells maintain proper electrical and metabolic function.
Why It’s Important
Magnesium is vital for overall health and longevity. Its benefits span multiple systems:
- Cardiovascular health: Adequate magnesium helps prevent arrhythmias, hypertension, and atherosclerosis by promoting vascular relaxation and reducing inflammation.
- Bone strength: Magnesium supports bone mineralization and influences parathyroid hormone (PTH) and vitamin D metabolism, which are key in calcium regulation.
- Mental health and mood: It contributes to neurotransmitter balance, reducing symptoms of anxiety, depression, and stress by modulating the brain’s HPA (hypothalamic–pituitary–adrenal) axis.
- Metabolic function: Low magnesium levels are linked to insulin resistance, type 2 diabetes, and metabolic syndrome.
- Muscle recovery and performance: Magnesium aids in preventing cramps, spasms, and fatigue by supporting muscle relaxation and energy metabolism.
Chronic deficiency can lead to symptoms such as muscle weakness, fatigue, tremors, irregular heartbeat, mood changes, and sleep disturbances. Severe deficiency is rare but can occur due to malnutrition, alcoholism, certain medications (like diuretics or proton pump inhibitors), or health conditions affecting absorption (such as Crohn’s disease).
Considerations
While magnesium is generally safe, there are important factors to keep in mind:
- Dosage and supplementation: The Recommended Dietary Allowance (RDA) for adults typically ranges from 310–420 mg per day, depending on age and sex. Excessive supplementation can cause diarrhea, nausea, and abdominal cramping, especially from poorly absorbed forms like magnesium oxide.
- Kidney function: Individuals with impaired kidney function should be cautious, as they may not be able to excrete excess magnesium efficiently, leading to hypermagnesemia, which can cause low blood pressure, slow heart rate, and even cardiac arrest in extreme cases.
- Medication interactions: Magnesium supplements may interfere with the absorption of certain medications, including antibiotics (e.g., tetracyclines, fluoroquinolones) and bisphosphonates used for osteoporosis. Spacing doses by a few hours is recommended.
- Bioavailability: The form of magnesium affects how well it’s absorbed. Chelated forms like magnesium glycinate or citrate tend to be better tolerated and absorbed compared to oxide or sulfate.
- Lifestyle factors: Chronic stress, high alcohol intake, excessive caffeine, and diets low in whole foods can all deplete magnesium levels.
Helps with these conditions
Magnesium is most effective for general wellness support with emerging research . The effectiveness varies by condition based on clinical evidence and user experiences.
Detailed Information by Condition
Constipation
Osmotic effect: Magnesium salts (e.g., magnesium citrate, magnesium hydroxide [“milk of magnesia”], magnesium oxide) are osmotic laxatives. They are p...
Anxiety
Neurotransmitter modulation (GABA & NMDA): Magnesium acts as a natural regulator of excitatory NMDA glutamate receptors and supports inhibitory GA...
Insomnia
Magnesium helps regulate neurotransmitters and hormones that control sleep (it modulates GABA and NMDA signaling, and appears to influence melatonin a...
Sleep Apnea
There is biological plausibility and observational evidence that low magnesium is associated with obstructive sleep apnea (OSA), and magnesium can imp...
Migraine
Magnesium is involved in many brain and vascular processes that are implicated in migraine: it modulates neuronal excitability (including NMDA/glutama...
High Blood Pressure
Magnesium helps blood vessels relax (vasodilation) by acting as a mild, natural calcium-channel antagonist, supporting nitric-oxide and prostacyclin p...
Asthma
Bronchodilation via calcium antagonism: Magnesium relaxes airway smooth muscle by opposing calcium entry and modulating intracellular calcium handling...
PMS
Neurotransmitters & neuromodulation. Magnesium is a cofactor in >300 enzyme systems and is important for nerve transmission and muscle function...
Osteoporosis
Bone matrix + mineralization: Magnesium is incorporated into bone mineral and affects crystal size and quality; deficiency impairs mineralization and...
Kidney Stones
Biochemical mechanisms (mainly for calcium-oxalate stones):Binds oxalate in the gut, lowering oxalate absorption.Competes with calcium for oxalate in...
Tinnitus
Neuroexcitation control (NMDA block). Magnesium (Mg²⁺) sits in and blocks NMDA-type glutamate receptors in a voltage-dependent way; this dampens excit...
Endometriosis
Smooth-muscle relaxation & prostaglandins: Magnesium can reduce uterine smooth-muscle excitability and may lower prostaglandin synthesis—both rele...
Restless Legs Syndrome
Cellular / physiological rationale: magnesium is a cofactor for hundreds of enzymes, is involved in nerve impulse conduction and muscle relaxation, an...
Epilepsy
Physiology/mechanism. Magnesium blocks the NMDA-type glutamate receptor channel and helps stabilize neuronal membranes; low magnesium (hypomagnesemia)...
Meniere’s Disease
Mechanistic plausibility (indirect): Magnesium modulates calcium channels and NMDA receptors, influences vascular tone, and has antioxidant/anti-excit...
Celiac Disease
Magnesium does not treat or cure celiac disease — the only disease-directed therapy is a strict gluten-free diet. However, magnesium supplementation i...
Temporomandibular Joint Disorder
Reduces central sensitisation / pain signalling. Magnesium blocks NMDA receptors, which are key in pain amplification. Multiple reviews in anaesthesia...
Arrhythmia
Electrophysiology 101. Magnesium modulates movement of calcium and potassium across cardiac cell membranes, stabilizing the action potential and AV-no...
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Helps With These Conditions
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