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Jerkovic D, Tadin A, Gavic L, Vladislavic NZ, Grgic N, Macan D. Effect of orally administered magnesium on postoperative pain level and trismus after surgical removal of the lower third molars: a randomized, double-blind, placebo-controlled trial. Clin Oral Investig 2020; 24:4649-4659. [PMID: 32436160 DOI: 10.1007/s00784-020-03335-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Pain and trismus are the most common postoperative complications following a surgical removal of the lower third molar. This randomized, double-blind, placebo-controlled clinical trial evaluated the effect of orally administrated magnesium on postoperative pain and trismus after surgical removal of the lower third molars. MATERIALS AND METHODS The study was conducted on 80 participants who were divided into two groups. Each group took different oral forms of magnesium citrate. Participants in both groups had their two lower molars surgically removed. For one randomly selected third molar, participants received either magnesium citrate tablets or lozenges. For the surgical removal of the lower third molar of the opposite side, the participants received either placebo tablets or lozenges. The data were analyzed using the Wilcoxon signed-ranked test, the Mann-Whitney U test, and the Spearman rank-order correlation with the level of significance set at p < 0.05. This manuscript was written in accordance with the Consort recommendation. RESULTS The results show a statistically significant lower pain level at all tested times (24 h, 48 h, and 72 h postoperatively) for participants who used magnesium preparations in lozenges (p = 0.012, p = 0.013, and p ≤ 0.001) as well as in tablet form (p ≤ 0.001) compared to placebo. The results also show a statistically significant greater mouth opening ability at all tested times (24 h, 48 h, and 72 h postoperatively) between magnesium preparations and the placebo (p ≤ 0.001). CONCLUSION Orally administered magnesium (either lozenges or tablets) before and after a lower third molar surgical removal significantly reduces pain intensity and the degree of trismus in the postoperative period. CLINICAL RELEVANCE Based on the results of the study, oral magnesium could be used in the oral and maxillofacial surgery to reduce postoperative complications after surgical removal of the lower third molars. TRIAL REGISTRATION This study is registered on http:clinicaltrials.gov under protocol no. NCT03398382.
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Affiliation(s)
- Daniel Jerkovic
- Department of Maxillofacial Surgery, Study of Dental Medicine, School of Medicine, Clinical Hospital Centre, University of Split, Spinciceva 1, 21000, Split, Croatia.
| | - Antonija Tadin
- Department of Restorative Dental Medicine and Endodontics, Study of Dental Medicine, School of Medicine, University of Split, Split, Croatia
| | - Lidia Gavic
- Department for Oral Medicine and Periodontology, Study of Dental Medicine, School of Medicine, University of Split, Split, Croatia
| | | | - Nino Grgic
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Darko Macan
- Department of Maxillofacial and Oral Surgery, School of Dental Medicine, University of Zagreb, University Hospital Dubrava, Zagreb, Croatia
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Circulating Ionized Magnesium as a Measure of Supplement Bioavailability: Results from a Pilot Study for Randomized Clinical Trial. Nutrients 2020; 12:nu12051245. [PMID: 32353962 PMCID: PMC7281967 DOI: 10.3390/nu12051245] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/09/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022] Open
Abstract
Oral supplementation may improve the dietary intake of magnesium, which has been identified as a shortfall nutrient. We conducted a pilot study to evaluate appropriate methods for assessing responses to the ingestion of oral magnesium supplements, including ionized magnesium in whole blood (iMg2+) concentration, serum total magnesium concentration, and total urinary magnesium content. In a single-blinded crossover study, 17 healthy adults were randomly assigned to consume 300 mg of magnesium from MgCl2 (ReMag®, a picosized magnesium formulation) or placebo, while having a low-magnesium breakfast. Blood and urine samples were obtained for the measurement of iMg2+, serum total magnesium, and total urine magnesium, during 24 h following the magnesium supplement or placebo dosing. Bioavailability was assessed using area-under-the-curve (AUC) as well as maximum (Cmax) and time-to-maximum (Tmax) concentration. Depending on normality, data were expressed as the mean ± standard deviation or median (range), and differences between responses to MgCl2 or placebo were measured using the paired t-test or Wilcoxon signed-rank test. Following MgCl2 administration versus placebo administration, we observed significantly greater increases in iMg2+ concentrations (AUC = 1.51 ± 0.96 vs. 0.84 ± 0.82 mg/dL•24h; Cmax = 1.38 ± 0.13 vs. 1.32 ± 0.07 mg/dL, respectively; both p < 0.05) but not in serum total magnesium (AUC = 27.00 [0, 172.93] vs. 14.55 [0, 91.18] mg/dL•24h; Cmax = 2.38 [1.97, 4.01] vs. 2.24 [1.98, 4.31] mg/dL) or in urinary magnesium (AUC = 201.74 ± 161.63 vs. 139.30 ± 92.84 mg•24h; Cmax = 26.12 [12.91, 88.63] vs. 24.38 [13.51, 81.51] mg/dL; p > 0.05). Whole blood iMg2+ may be a more sensitive measure of acute oral intake of magnesium compared to serum and urinary magnesium and may be preferred for assessing supplement bioavailability.
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Blancquaert L, Vervaet C, Derave W. Predicting and Testing Bioavailability of Magnesium Supplements. Nutrients 2019; 11:nu11071663. [PMID: 31330811 PMCID: PMC6683096 DOI: 10.3390/nu11071663] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 11/20/2022] Open
Abstract
Despite the presumption of the beneficial effects of magnesium supplementation, little is known about the pharmacokinetics of different magnesium formulations. We aimed to investigate the value of two in vitro approaches to predict bioavailability of magnesium and to validate this in subsequent in vivo testing. In vitro assessment of 15 commercially available magnesium formulations was performed by means of a Simulator of the Human Intestinal Microbial Ecosystem (SHIME®) and by dissolution tests. Two magnesium formulations with contrasting bioavailability prediction from both in vitro tests (best vs. worst) were selected for in vivo testing in 30 subjects. In vivo bioavailability was compared following one acute ingestion by monitoring blood magnesium concentrations up to 6 h following intake. The in vitro tests showed a very wide variation in absorption and dissolution of the 15 magnesium products. In the in vivo testing, a significant different serum magnesium absorption profile was found up to 4 h following supplement ingestion for the two supplements with opposing in vitro test results. Moreover, maximal serum magnesium increase and total area under the curve were significantly different for both supplements (+6.2% vs. +4.6% and 6.87 vs. 0.31 mM.min, respectively). Collectively, poor bioaccessibility and bioavailability in the SHIME model clearly translated into poor dissolution and poor bioavailability in vivo. This provides a valid methodology for the prediction of in vivo bioavailability and effectiveness of micronutrients by specific in vitro approaches.
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Affiliation(s)
- Laura Blancquaert
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium
| | - Chris Vervaet
- Laboratory of Pharmaceutical Technology, Ghent University, 9000 Ghent, Belgium
| | - Wim Derave
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium.
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Dualé C, Cardot JM, Joanny F, Trzeciakiewicz A, Martin E, Pickering G, Dubray C. An Advanced Formulation of a Magnesium Dietary Supplement Adapted for a Long-Term Use Supplementation Improves Magnesium Bioavailability: In Vitro and Clinical Comparative Studies. Biol Trace Elem Res 2018. [PMID: 29524192 DOI: 10.1007/s12011-018-1277-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
While general recommendations are for 300-mg magnesium intake a day, an advanced low-dose formulation of magnesium chloride, ChronoMag®, was designed to provide 100 mg of magnesium element, thus decreasing the risk of gastrointestinal side effects and allowing long-term supplementation in health conditions related to low magnesium levels. The present study aimed to compare magnesium release profile and bioavailability between this patented low-dose continuous-release magnesium chloride tablet (100 mg magnesium element) and a reference tablet at the usually prescribed dose (300 mg magnesium element). Magnesium release profile was determined by dissolving the tablets in solutions simulating the gastrointestinal tract environment. A randomized double-blind crossover controlled trial of ChronoMag® versus reference tablet (3 × 100 mg magnesium element tablets) in 12 normo-magnesemic healthy volunteers was conducted to evaluate the bioavailability of the patented magnesium chloride tablets (two 50 mg magnesium tablets, once-a-day intake). While the reference tablet released 100% of its magnesium within 1 h of dissolution, release from the magnesium chloride formulation was continuous for 6 h. Cumulative urinary magnesium levels compared to those with the reference tablet were 76% (0-5 h), 89% (0-10 h), and 87% (0-24 h). Elimination after 24 h was fairly similar with both supplements. Our results suggest that the new magnesium chloride formulation, providing continuous low-dose magnesium release throughout the gastrointestinal tract, improves absorption and bioavailability. This formulation conforms to the physiological mechanism of magnesium absorption throughout the digestive tract, allowing high absorption, and may improve gastrointestinal tolerance in long-term use.
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Affiliation(s)
- Christian Dualé
- Pharmacologie Fondamentale et Clinique de la Douleur, Neuro-Dol, Université Clermont Auvergne, Inserm 1107, F-63000, Clermont-Ferrand, France
- Centre de Pharmacologie Clinique / Centre d'Investigation Clinique Inserm 1405, CHU Clermont-Ferrand, Rue Montalembert, BP 69, 63003, Clermont-Ferrand Cedex 1, France
| | - Jean-Michel Cardot
- Centre de Pharmacologie Clinique / Centre d'Investigation Clinique Inserm 1405, CHU Clermont-Ferrand, Rue Montalembert, BP 69, 63003, Clermont-Ferrand Cedex 1, France
| | - Fabienne Joanny
- FJ RECHERCHE & DEVELOPPEMENT, Research Organization, 230 Rue du Faubourg Saint-Honoré, F-75008, Paris, France
| | - Anna Trzeciakiewicz
- FJ RECHERCHE & DEVELOPPEMENT, Research Organization, 230 Rue du Faubourg Saint-Honoré, F-75008, Paris, France
| | - Elodie Martin
- FJ RECHERCHE & DEVELOPPEMENT, Research Organization, 230 Rue du Faubourg Saint-Honoré, F-75008, Paris, France
| | - Gisèle Pickering
- Pharmacologie Fondamentale et Clinique de la Douleur, Neuro-Dol, Université Clermont Auvergne, Inserm 1107, F-63000, Clermont-Ferrand, France
- Centre de Pharmacologie Clinique / Centre d'Investigation Clinique Inserm 1405, CHU Clermont-Ferrand, Rue Montalembert, BP 69, 63003, Clermont-Ferrand Cedex 1, France
| | - Claude Dubray
- Pharmacologie Fondamentale et Clinique de la Douleur, Neuro-Dol, Université Clermont Auvergne, Inserm 1107, F-63000, Clermont-Ferrand, France.
- Centre de Pharmacologie Clinique / Centre d'Investigation Clinique Inserm 1405, CHU Clermont-Ferrand, Rue Montalembert, BP 69, 63003, Clermont-Ferrand Cedex 1, France.
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Dolberg MKB, Nielsen LP, Dahl R. Pharmacokinetic Profile of Oral Magnesium Hydroxide. Basic Clin Pharmacol Toxicol 2017; 120:264-269. [PMID: 27412366 DOI: 10.1111/bcpt.12642] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/11/2016] [Indexed: 11/30/2022]
Abstract
Despite the presumption of a beneficial effect of magnesium (Mg) supplementation on various diseases, little is known concerning the pharmacokinetics of Mg hydroxide. This study was designed to provide a pharmacokinetic profile of Mg hydroxide after a single oral dose. Ten healthy male adults participated in this cross-over study with three 24-hr study days. Interventions were (i) none (baseline), (ii) oral intake of three (3 × 360 mg) tablets of Mg hydroxide (Mablet® ) and (iii) IV bolus infusion of 2 g Mg sulphate (index drug). Blood samples were collected before the single dose, after (i.e. after treatment administration) 15, 30, 60, 90 and 120 min. and after 3, 4, 6, 8, 12 and 24 hr. Urine was collected in four 6-hr periods per study day. Blood (N = 10) and urine (N = 6) Mg were analysed by descriptive statistics. Bioavailability was 14.9% (CI: 8.3; 26.8), blood clearance was 5.1 L/hr (CI: 2.1; 17.0), apparent volume of distribution was 60.2 L (CI: 35.6; 102.0), elimination constant was 0.08 per hour (CI: 0.05; 0.14), half-life was 8.3 hr (CI: 4.8; 14.1), Cmax was 0.11 mmol/L (CI: 0.07; 0.14), and AUC[0-24] was 92.3 mmol/L × min. (CI: 45.5; 139.1). Urine Mg excretion augmented by 17.7% (CI: 8.9; 35.0) from baseline. No severe side effects were observed. The bioavailability of Mg hydroxide was 15%, and it constitutes a clinically relevant option for oral Mg supplementation. No severe side effects were seen.
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Affiliation(s)
- Mette Konow Bøgebjerg Dolberg
- Department of Respiratory Diseases and Allergy & Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Peter Nielsen
- Department of Respiratory Diseases and Allergy & Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Ronald Dahl
- Department of Respiratory Diseases and Allergy & Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
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Abstract
The essential mineral magnesium is involved in numerous physiological processes. Recommended dietary intake is often not met and a low magnesium status increases the risk for various diseases. Magnesium status is regulated by several magnesium transport systems either in cellular or paracellular pathways. Numerous drugs either interfere with magnesium absorption in the intestines or the reabsorption from primary urine in the kidney. Low magnesium status has been identified as a significant risk factor for several diseases, including type-2 diabetes, cardiovascular diseases, arrhythmias, as well as general muscular and neurological problems. Therefore, an adequate magnesium supply would be of special benefit to our overall health.
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Affiliation(s)
- Jürgen Vormann
- Institute for Prevention and Nutrition, Ismaning/Munich, Germany
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Topp H, Hochfeld O, Bark S, Grossmann M, Joukhadar C, Westphal M, Straatsma H, Rothenburger M. Glycerophosphate is interchangeable with inorganic phosphate in terms of safety and serum pharmacokinetics. Pharmacology 2011; 88:193-200. [PMID: 21986180 DOI: 10.1159/000331341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 07/14/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The primary aim of the present investigation was to determine and compare the pharmacokinetic (PK) profiles of inorganic phosphate in serum and urine after intravenous administration of sodium glycerophosphate and inorganic sodium phosphate. Additionally, study product safety profiles were evaluated. SUBJECTS AND METHODS In total, 27 healthy, white volunteers (17 male/10 female) were enrolled in this double-blinded, randomized, 2-sequence, crossover study and were assigned to receive an organic test drug (sodium glycerophosphate) and an inorganic reference preparation (sodium phosphate) on 2 occasions. Validated analytical methods were used, and concentrations of total inorganic phosphate in serum and urine were determined over 24 h following a single 4-hour continuous intravenous infusion of test and reference drugs at a dose of 80 mmol. Study days were separated by washout periods of 7 days. An analysis of variance, based on population means and 90% confidence intervals (CIs), was used for testing bioequivalence (BE; range 0.8-1.25) between investigational products. RESULTS The geometric means of the ratio of the point estimates and corresponding 90% CIs for the area under the concentration-versus-time curve of inorganic serum phosphate from 0 to 24 h (AUC(0-24)), the phosphate's maximum concentration in serum (C(max)) and the total amount of inorganic phosphate excreted in urine over 24 h corrected for individual baseline values (Ae(0-24 bc)) were estimated. The test/reference ratios for inorganic phosphate were 1.04 (CI 1.00-1.07), 0.85 (CI 0.84-0.87) and 0.84 (CI 0.77-0.92) for AUC(0-24), C(max) in serum and Ae(0-24 bc) in urine, respectively. Hence, standard BE criteria were met for AUC(0-24) and C(max) in serum, while Ae(0-24 bc) marginally failed to demonstrate BE. After drug administration, a total of 15 subjects reported the occurrence of at least 1 treatment emergent adverse event (AE). All AEs were classified as mild to moderate in severity, and the two treatment groups were equally affected. No serious AEs occurred. CONCLUSION The serum PK profiles of inorganic phosphate were almost superimposable following intravenous administration of equimolar doses of test and reference drugs. Thus, we conclude that the two study drugs are essentially similar in terms of serum PK profiles, safety and tolerability.
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Newhouse IJ, Johnson KP, Montelpare WJ, McAuliffe JE. Variability within individuals of plasma ionic magnesium concentrations. BMC PHYSIOLOGY 2002; 2:6. [PMID: 11978186 PMCID: PMC113254 DOI: 10.1186/1472-6793-2-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2002] [Accepted: 04/26/2002] [Indexed: 02/05/2023]
Abstract
BACKGROUND With the invention of the ion-selective electrode (ISE), ionic magnesium (iMg) is a common blood assay. This could be advantageous, as iMg is the biologically active form of Mg. There is some evidence that iMg has considerable within subject variability. RESULTS Individual ranges averaged.08 mmol/L (range.05 to.14). Coefficients of variation (CV) ranged from 3% to 7% (mean 4%) while analytical variation was determined to be 2.3%. Biological variability thus accounts for almost half of the variability, which is clinically significant, as 9 of the 13 subjects recorded at least one value below a reference range of.46 -.60 mmol/L. A significant within-day variation (p <.001) was noted, with differences between 7:00 and 10:00 as well as 10:00 and 22:00. Between day variations were not significant (p =.56). CONCLUSIONS A plausible explanation of this data is that iMg has a circadian rhythm. Thus, cautious interpretation of single iMg values is warranted until future research determines the nature of iMg variability.
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Affiliation(s)
- Ian J Newhouse
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Kris P Johnson
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
| | | | - Jim E McAuliffe
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
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Ranade VV, Somberg JC. Bioavailability and pharmacokinetics of magnesium after administration of magnesium salts to humans. Am J Ther 2001; 8:345-57. [PMID: 11550076 DOI: 10.1097/00045391-200109000-00008] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Therapeutically, magnesium salts represent an important class of compounds and exhibit various pharmacologic actions. Examples of magnesium salts are ionic magnesium and magnesium citrate in nephrolithiasis, magnesium salicylate in rheumatoid arthritis, magnesium hydroxide as an antacid as well as a cathartic, and magnesium mandelate as urinary antiseptic. Various anions attached to the cation magnesium, such as oxide, chloride, gluconate, and lactate, affect the delivery of the amounts of elemental magnesium to the target site and thereby produce different pharmacodynamic effects. This review examines the bioavailability and pharmacokinetics of various magnesium salts and correlates pharmacodynamic action with the structure-activity relationship.
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Affiliation(s)
- V V Ranade
- Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612-3515, USA
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Vierling W. [Comments on the kinetics and extracellular effects of potassium and magnesium]. Herz 1997; 22 Suppl 1:3-10. [PMID: 9333589 DOI: 10.1007/bf03042649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Potassium and magnesium are important electrolytes which have to be ingested in sufficient amounts. They differ in the necessary daily intake (about 100 mmol potassium, about 12 mmol magnesium), the degree of intestinal absorption (potassium almost 100%, magnesium about 30%) and the distribution between the extracellular and intracellular space. If there is a deficiency in potassium or magnesium, it is necessary to substitute these materials. Deficiency of potassium is not rarely combined with deficiency of magnesium. The concentration gradient between intra- and extracellular potassium mainly determines the resting membrane potential of the cell. Lower extracellular potassium may lead to an instable membrane potential because of a decrease in potassium conductance. An increase in extracellular potassium concentration leads to the depolarization of the cell. Extracellular potassium activates the sodium potassium pump and thereby prevents an increased intracellular accumulation of sodium and calcium. Important effects of extracellular magnesium are: calcium antagonism, increase of excitation threshold and inhibition of transmitter release. By increasing the plasma concentration of magnesium, it is possible to exert pharmacodynamic effects. An increase above the normal range usually is only possible by parenteral application. However, a slight elevation can already be achieved by oral application. This increase may lead to limited pharmacodynamic effects. By elevation of the extracellular magnesium concentration, adverse, depolarisation-dependent effects of an increase in extracellular potassium concentration (for example slowing of conduction of excitation) can be compensated. This effect can be explained by a magnesium-dependent decrease of the membrane surface potential.
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Affiliation(s)
- W Vierling
- Institut für Pharmakologie und Toxikologie, Technischen Universität München
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Peikert A, Wilimzig C, Köhne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia 1996; 16:257-63. [PMID: 8792038 DOI: 10.1046/j.1468-2982.1996.1604257.x] [Citation(s) in RCA: 182] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In order to evaluate the prophylactic effect of oral magnesium, 81 patients aged 18-65 years with migraine according to the International Headache Society (IHS) criteria (mean attack frequency 3.6 per month) were examined. After a prospective baseline period of 4 weeks they received oral 600 mg (24 mmol) magnesium (trimagnesium dicitrate) daily for 12 weeks or placebo. In weeks 9-12 the attack frequency was reduced by 41.6% in the magnesium group and by 15.8% in the placebo group compared to the baseline (p < 0.05). The number of days with migraine and the drug consumption for symptomatic treatment per patient also decreased significantly in the magnesium group. Duration and intensity of the attacks and the drug consumption per attack also tended to decrease compared to placebo but failed to be significant. Adverse events were diarrhea (18.6%) and gastric irritation (4.7%). High-dose oral magnesium appears to be effective in migraine prophylaxis.
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Affiliation(s)
- A Peikert
- Department of Neurology and Clinical Neurophysiology, Munich-Harlaching Clinic, Germany
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