Effect of intravenous magnesium sulphate in reducing irritability and restlessness in pure and polysubstance opiate detoxification

• Published in: Psychiatry research 2005-05, Vol.135 (1), p.53-63
• Main Authors: Naderi-Heiden, Angela, Frey, Richard, Presslich, Otto, Frottier, Patrick, Willinger, Ulrike, Blasbichler, Thomas, Smetana, Ronald, Schmid, Daniela, Kasper, Siegfried
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Akathisia, Drug-Induced - drug therapy; Biological and medical sciences; Calcium; Chlormethiazole (Clomethiazol); Chlormethiazole - administration & dosage; Chlormethiazole - therapeutic use; Diagnostic and Statistical Manual of Mental Disorders; Double-Blind Method; Drug Administration Schedule; Female; Humans; Inactivation, Metabolic; Injections, Intravenous; Irritable Mood; Magnesium; Magnesium Sulfate - administration & dosage; Magnesium Sulfate - therapeutic use; Male; Medical sciences; Miscellaneous; Mood Disorders - diagnosis; Mood Disorders - drug therapy; Morphine; Morphine - administration & dosage; Morphine - therapeutic use; Narcotics - administration & dosage; Narcotics - adverse effects; Narcotics - pharmacokinetics; Narcotics - therapeutic use; Neuroprotective Agents - administration & dosage; Neuroprotective Agents - therapeutic use; Opiate detoxification; Opioid-Related Disorders - diagnosis; Opioid-Related Disorders - therapy; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Severity of Illness Index; Substance Withdrawal Syndrome - diagnosis; Substance Withdrawal Syndrome - etiology; Treatments
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2004.07.012

The aim of this double-blind, placebo-controlled study was to evaluate the efficacy of intravenous magnesium sulphate (MgSO 4) on the need for chlormethiazole in pure or polysubstance opiate detoxification. Forty-one inpatients suffering from pure and polysubstance opiate dependence were treated with morphine sulphate pentahydrate in a gradual detoxification program. Morphine reduction took about 11 days. Additionally, 5% MgSO 4 was administered intravenously to the intervention group (Mg group, n = 22) over 24 h by perfusor (150–200 mg MgSO 4/h; plasma level of 2.36 ± 0.29 mmol/l), whereas NaCl 0.9% was intravenously administered in the placebo group ( n = 19). In case of withdrawal symptoms (irritability, restlessness, and insomnia), patients received chlormethiazole p.o. Our hypothesis that the need for chlormethiazole would be decreased by adjunctive administration of Mg was not confirmed in our study population (2180 mg/day in the Mg group vs. 2360 mg/day in the placebo group). There was neither a difference in the quantity of chlormethiazole required nor a difference in the severity of withdrawal symptoms measured with the Wang scale between the two comparison groups. We observed that calcium plasma levels decreased and phosphate plasma levels increased significantly during intravenous therapy with Mg. Despite promising pilot studies, the administration of Mg did not enable a dose reduction of tranquilizing medication (chlormethiazole) in pure and polysubstance opiate detoxification