• Sarah C Campbell, Chris Stockmann, Alfred Balch, Erin A S Clark, Manijeh Kamyar, Michael Varner, E Kent Korgenski, Joshua L Bonkowsky, Michael G Spigarelli, and Catherine M T Sherwin.
• *Division of Clinical Pharmacology, Department of Pediatrics, University of Utah; †Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine; ‡Intermountain Healthcare, Women and Newborns Clinical Program; §Intermountain Healthcare, Pediatric Clinical Program; and ¶Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
• Ther Drug Monit. 2014 Aug 1;36(4):544-8.

BackgroundThis study sought to determine the frequency of possible cardiopulmonary drug-drug interactions among pregnant women who received intrapartum magnesium sulfate (MgSO4).MethodsPregnant women admitted to an Intermountain Healthcare facility between January 2009 and October 2011 were studied, if they received 1 or more doses of MgSO4. Concomitant medications were electronically queried from an electronic health records system. Adverse events were identified using administrative discharge codes. The frequency of cardiopulmonary drug-drug interactions was compared among women who did, and did not, receive aminoglycoside antibiotics, antacids/laxatives, calcium channel blockers, corticosteroids, diuretics, neuromuscular blocking agents, and vitamin D analogs, all of which were contraindicated for patients receiving MgSO4.ResultsOverall, 683 women received intrapartum MgSO4 during the study period. A total of 219 MgSO4 potentially interacting drugs were identified among 155 (23%) unique patients. The most commonly identified potentially interacting agents included calcium channel blockers (26%), diuretics (25%), and antacids/laxatives (19%). Longer hospital stays were significantly associated with increasing numbers of MgSO4 interacting drugs (P < 0.001). Three of 53 (6%) women who received furosemide experienced a cardiac arrest, compared with 0 of 618 (0%) women who did not receive furosemide (Fisher exact test, P < 0.001).ConclusionsIntrapartum administration of drugs that interact with MgSO4 is common and associated with prolonged hospital stays and potentially cardiopulmonary drug-drug interactions. Caution is warranted when prescribing MgSO4 in combination with known interacting medications.

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