Magnesium B6 forte, 30 pcs., 100 mg, film-coated tablets

Magne B6

Magne B6 is a combination drug that includes the macroelement magnesium and pyridoxine (vitamin B6). Without magnesium, the normal functioning of the human body is unthinkable. This macroelement is an active participant in energy and water-salt metabolism, key biosynthetic reactions. Regulates cell growth and is in demand in all phases of the formation of protein molecules. Takes part in phosphorus metabolism, synthesis of high-energy compounds, regulation of glucose breakdown, and bone tissue formation. In addition to the above, magnesium inhibits excitation processes in the central nervous system and increases the body's adaptive abilities to external influences, which allows it to be considered an effective anti-stress factor. The lack of this element is quite common. According to various estimates, it is observed in 25–30% of the population. The main reason is the large amount of refined food in the diet of modern people, as well as the active use of mineral fertilizers, which “wash out” magnesium from the soil. A lack of magnesium can result in cardiovascular, endocrine, and neuropsychiatric pathology. Hidden magnesium deficiency can manifest itself as asthenia, depression, psycho-emotional changes, vertigo, and vegetative-vascular disorders. In this regard, one of the most important tasks of clinical pharmacologists is the creation and implementation of effective and safe tableted magnesium preparations. During their development, the effectiveness of the combination of magnesium with pyridoxine, an important metabolic agent involved in protein metabolism, the synthesis of neurotransmitters, etc., was established. Pyridoxine increases the absorption of magnesium in the gastrointestinal tract, facilitates its transport and promotes accumulation in tissues, enhances the pharmacological effect (shows synergy). Magnesium, for its part, stimulates the activity of pyridoxine in the liver. An example of a combination of magnesium and pyridoxine is Magne B6. The components of the drug complement each other and potentiate each other’s action, effectively preventing magnesium deficiency in the body. About half of the administered dose of the drug is absorbed in the gastrointestinal tract.

Most of the magnesium is accumulated in bone tissue, the rest in smooth and skeletal muscles. Elimination of magnesium from the body is carried out primarily by the kidneys. Taking Magne B6 is advisable for such signs of magnesium deficiency as increased irritability, sleep disorders, spasms of smooth muscles of the gastrointestinal tract, tachycardia, chronic fatigue, tingling in the muscles. Before starting to use the drug, despite its over-the-counter status, you should seek medical advice. The optimal time to take the drug is with meals. Frequency of administration – 2-3 times a day. An indicator of cessation of drug therapy is normalization of plasma magnesium levels. The scope of use of Magne B6 is extremely wide. These are various forms of cardiovascular pathology (hypertension, cardiac failure, cardiac arrhythmias, post-infarction conditions), pathological decrease in bone mineral density, diabetes mellitus, vegetative-vascular dystonia, asthenia, increased fatigue and anxiety, depressive states, headache, somnological disorders, elderly age, pregnancy and increased physical activity. Magne B6 is well tolerated by patients. In extremely rare cases, allergic reactions and dyspepsia are possible. The drug is contraindicated in severe forms of renal failure, individual intolerance, and taking levodopa. In pediatric practice it is used starting from the age of 6 years. Post-marketing studies of the drug in pregnant women demonstrated the absence of undesirable effects on the fetus. However, Magne B6 can be used by pregnant women only in consultation with a doctor. Magnesium is absorbed into breast milk and should be avoided in nursing women. Magne B6 contains the disaccharide sucrose as an auxiliary component, which must be taken into account when prescribing the drug to people suffering from diabetes.

Magnesium B6 forte, 30 pcs., 100 mg, film-coated tablets

Magnesium takes part in more than 300 enzymatic reactions. It is needed for the production of protein, DNA, for the breakdown of glucose, the removal of toxins from the body, for the absorption of vitamin C, thiamine (B1) and pyridoxine (B6). Magnesium contributes to the stability of the cell structure during growth, takes part in the process of regeneration of body cells, has a beneficial effect on the functioning of internal organs, reduces irritability and protects against radiation. Vitamin B2 (riboflavin) helps convert vitamin B6 into its active form. With a lack of Vitamin B2, the absorption of iron decreases and the activity of the thyroid gland worsens. It has antioxidant properties, participates in metabolic processes and has a positive effect on the immune system, the state of the cardiovascular and nervous systems, skin and mucous membranes, liver function, stimulates hematopoiesis, and is responsible for the health of hair and nails. Vitamin B6 (pyridoxine hydrochloride) improves the absorption of magnesium from the gastrointestinal tract and its penetration into body cells, participates in the synthesis of hormones, as well as nucleic acids, which increase immunity and prevent the aging process. Magnesium and the female body Magnesium will help eliminate PMS symptoms. Premenstrual passion for chocolate is explained by a lack of magnesium in the body. "Magnesium B6 FORTE VITAMIR®" will help compensate for the lack of magnesium without adding calories to you.

Effect of Magnesium on the human body:

Magnesium and bones Today it has been proven that consuming the required amount of magnesium significantly increases bone mineral density. Moreover, as it turns out, magnesium is much more important than calcium for the health of our bones. Bone health depends not only on calcium, but it is clear that it depends just as much on magnesium. With the help of magnesium, cartilage and bone tissue grow, calcium and vitamins B, C, E are absorbed.

Magnesium and muscles Magnesium increases endurance. An experiment was conducted for a group of American athletes: before important competitions, they took magnesium. The results exceeded all expectations. In addition, complaints of chest pain that arose during intense training earlier have practically disappeared.

Magnesium and memory, emotions If you have increased anxiety, magnesium will help cope with stress. This trace element increases interest in new things, relieves some types of migraines, and improves memory.

Magnesium and the Heart Most patients with cardiovascular disease are deficient in magnesium. Patients who are being prepared for heart surgery are recommended to be prescribed magnesium to normalize blood pressure and minimize the possibility of heart rhythm disturbances and arrhythmias. Taking magnesium-containing medications as a preventive measure will help reduce the risk of cardiovascular disease.

Magnesium and figure Magnesium improves digestion, helps move food through the intestines, utilize proteins and fats, and stabilizes genes responsible for obesity. If your family has a tendency to be overweight, then in the presence of magnesium these genes will not open up. Magnesium reduces the level of “stress” hormones, saving you from overeating

Magnesium preparations in cardiological practice

Despite the achievements of modern medicine, cardiovascular diseases (CVD) in the Russian Federation, as well as throughout the world, remain one of the most common diseases that practitioners have to deal with. First of all, this is, of course, arterial hypertension (AH), coronary heart disease (CHD) and chronic heart failure (CHF). These diseases are the main cause of death in both developed and developing countries [1]. This makes the problem of optimizing pharmacotherapy in order to reduce cardiovascular risk extremely important, and the search for an individual approach to the management of patients with various CVDs and a differentiated choice of drugs remains an urgent problem for the practicing physician. Today, a doctor has a wide selection of effective pharmacological agents for the treatment of various CVDs, which should be prescribed following the relevant Russian and international recommendations based on a large evidence base.

In recent years, the use of drugs that affect the balance of micro- and macroelements (sodium, potassium, calcium, magnesium, chlorine, phosphorus, sulfur, etc.), which are necessary for the normal functioning and performance of the body and which the human body is not able to synthesize on its own, has become promising. . Maintaining a normal level of these elements is only possible if an adequate amount of them is supplied with food. An optimally balanced diet helps maintain normal levels of macro- and microelements. But these are only ideal conditions, rarely achievable in modern life.

One of the most common types of mineral deficiency in many countries is magnesium deficiency, which occupies one of the leading places in human pathologies caused by disorders of mineral metabolism (manganese, iodine, zinc, copper, calcium), and, according to the International Classification of Diseases, 10th revision , is registered as a separate disease - E 61.2 [2, 3].

Data from a number of observations indicate that from 25% to 40% of the adult population are deficient in this important macronutrient.

Given the prevalence of magnesium deficiency, it is expected that a large number of patients with cardiovascular disease will have magnesium deficiency of varying severity.

Mechanism of action of magnesium

One of the macroelements important for the body is magnesium. From the point of view of biological function, magnesium is a cofactor and activator of a number of enzymes - enolase, alkaline phosphatase, carboxylase, hexokinase. Another role of magnesium ions is stabilizing. Magnesium ions stabilize the substrate molecules - they neutralize the negative charge of the substrate, the active center of the enzyme, help maintain the tertiary and quaternary structures of the enzyme protein molecule, facilitate the attachment of the substrate to the enzyme and thereby facilitate the chemical reaction, the magnesium-ATP complex, stabilizing the ATP molecule, facilitating its attachment and “correct” orientation in the active site of the enzyme, weakening the phosphoester bond and facilitating the transfer of phosphate to glucose. In some cases, magnesium ion can help attach the coenzyme, promoting the activation of metalloenzymes.

Magnesium contributes to the stability of the cell structure during growth and takes part in the process of regeneration of body cells.

Data have been obtained confirming the irreplaceable role of magnesium in the absorption of vitamins B1 (thiamine), B6 ​​(pyridoxine) and vitamin C [4, 5].

The participation of magnesium in phosphorus and carbohydrate metabolism, in protein synthesis, and in the transmission of neuromuscular impulses has been established [4].

Magnesium is involved in maintaining the electrical potential of membranes, promotes the penetration of calcium, sodium, and potassium ions through them, and takes part in the transmission of nerve impulses. It regulates the passage of the inhibition signal from the central parts of the nervous system to the peripheral nervous system. With a lack of magnesium, the nervous system remains in a state of overexcitation and, as a result, chronic stress is observed. Magnesium, in turn, is called an anti-stress element.

Magnesium can affect calcium levels by influencing hormones that control calcium absorption and metabolism. In the regulation of vascular tone, magnesium and calcium ions act as antagonists: calcium plays a leading role in the contraction of smooth muscles of blood vessels, magnesium, on the contrary, in their expansion, promotes the elimination of excess cholesterol, the absorption of calcium and phosphorus.

Magnesium is able to increase insulin secretion and improve its penetration into cells. It is also necessary for the production of brain neuropeptides, stimulates intestinal motility, promotes the secretion of bile, and is involved in the production of catecholamines.

Lack of magnesium in the body

Since magnesium ranks 4th in content in the body, it is natural that with chronic magnesium deficiency, functional disorders occur in many organs and tissues.

Magnesium deficiency can be caused by changes in its distribution between blood serum and cells, decreased dietary intake, or excessive loss. Unlike primary magnesium deficiency, which is associated with a person’s constitutional characteristics, secondary magnesium deficiency is associated with living conditions or diseases.

Living conditions that cause magnesium deficiency:

• insufficient food intake (nutritional deficiency), intravenous therapeutic nutrition;
• hypocaloric diet, unbalanced diet (excessive levels of lipids, calcium, phosphates);
• stress, strenuous physical work;
• physical inactivity;
• exposure to high temperatures;
• increased consumption of magnesium during pregnancy, intensive growth, recovery, with excessive sweating, with excessive physical exertion, with chronic alcoholism;
• hormonal contraception.

Magnesium deficiency associated with diseases and their therapy:

• impaired absorption of macronutrients in the intestine (disease of the small intestine, reduction in the absorptive surface of the intestine after surgery or during radiotherapy, steatorrhea, dysbiosis in the large intestine); impaired insulin production;
• nephrotic syndrome;
• hypercortisolism;
• hypercatecholaminemia;
• hyperaldosteronism;
• hyperthyroidism;
• arterial hypertension;
• myocardial infarction;
• obesity;
• diuretic, cytostatic therapy;
• long-term use of antibiotics (gentamicin), diuretics, antitumor and other medications;
• poisoning with certain substances (aluminum, lead, cobalt, manganese, cadmium, beryllium, nickel).

Physiological effects of magnesium

Due to the combination of such properties inherent in this element, the physiological effects of magnesium are very diverse and are manifested in the fact that it has a beneficial effect on bone growth; helps slow heart rate, reduces high blood pressure; promotes bronchodilation; used as a prophylactic for muscle and joint pain, chronic fatigue syndrome, migraines, etc.

The effects of magnesium on the cardiovascular system are extremely important:

• hypotensive effect - has a hypotensive effect due to negative chrono- and inotropic effects, decreased vascular tone, inhibition of transmission in the autonomic ganglia, inhibition of the vasomotor center;
• anti-ischemic effect - due to the restoration of endothelium-dependent vasodilation, normalization of lipid spectrum indicators, improvement of rheological properties of blood, reduction of platelet aggregation activity, depressor effect on the inotropic function of the heart [6–8];
• antiarrhythmic effect - magnesium has a membrane-stabilizing effect, a depressor effect on the excitability and conductivity of the cell [9]. Depletion of magnesium stores causes significant adverse effects on the myocardium [10]. Violation of the content of potassium and magnesium ions and their ratio is a significant risk factor for the development of arrhythmias. In the Framingham Study, extrasystoles were detected in 5.5% of study participants (n = 3327, mean age 44 years). At the same time, long-term hypomagnesemia correlates with a high incidence of ventricular extrasystoles, tachycardia, and ventricular fibrillation (p = 0.01). This pattern remained significant even after taking into account adjustments for left ventricular mass, including in volunteers without clinically significant disease [11]. The PROMISE Study revealed a higher incidence of ventricular extrasystole and high mortality in the group of patients with hypomagnesemia compared to groups with normo- and hypermagnesemia [12];
• effect on connective tissue - magnesium affects collagen metabolism, reducing the severity of dysplastic changes in connective tissue [13, 14].

In recent years, among the possible pathogenetic mechanisms for the formation of mitral valve prolapse, some researchers point to a chronic deficiency of magnesium ions, which leads to disruption of the formation of connective tissue structures of the supporting trophic framework of the heart, which causes a chaotic arrangement of collagen fibers, disruption of its synthesis and biodegradation [15].

Magnesium ions are of great importance for the normal functioning of connective tissue. In a number of animal experiments, it was shown that magnesium deficiency leads to an increase in the activity of collagenases, in particular matrix metalloproteinases, while the metabolism of the structural components of the extracellular matrix, primarily collagen, was disrupted. Along with an increase in the activity of metalloproteinases, magnesium deficiency reduces the enzymatic activity of transglutaminases and lysyl oxidases involved in the formation of cross-links, resulting in a decrease in the mechanical strength of collagen fibers [15–17].

Symptoms of magnesium deficiency

Signs of magnesium deficiency are nonspecific. Clinically, magnesium deficiency can manifest itself in the form of endocrine-metabolic, mental and neurological disorders, in the form of disorders of various organs and systems, including the cardiovascular and musculoskeletal system.

The main complaints presented by patients: paresthesia in the form of impaired sensitivity, sensations of numbness, tingling, itching, crawling, etc., muscle cramps, increased neuromuscular excitability, fatigue, sudden dizziness accompanied by loss of balance, irritability, insomnia , nightmares, difficult awakening, deterioration in concentration, loss of appetite, constipation, nausea, diarrhea, vomiting, increased blood pressure, arrhythmias, angina pectoris, vasospasms, atrophic skin manifestations in the form of hair loss, increased brittleness of nails.

Examinations may reveal signs of dysfunction of the adrenal glands, the development of diabetes mellitus, urolithiasis and cholelithiasis, and immunodeficiency states. Such patients have an increased likelihood of developing tumor diseases.

Since the metabolism of magnesium and calcium is closely related, with magnesium deficiency the calcium level also decreases and osteoporosis develops. This is also facilitated by dysfunction of the parathyroid gland.

The cardiovascular system also responds to magnesium deficiency: patients experience accelerated progression of atherosclerosis, tachycardia, arrhythmias, mitral valve prolapse, and a decrease in the electrical stability of the myocardium, characterized by an increase in the dispersion and/or duration of the QT interval. In such patients, an increase in mortality from coronary artery disease was observed.

There is an opinion that cases of early myocardial infarction among people aged 30–40 years are associated with reduced magnesium content in the heart muscle.

Clinical experience with the use of magnesium preparations in cardiology

It is obvious that magnesium deficiency in diseases of the cardiovascular system cannot be compensated only by changing the diet; the use of magnesium preparations is necessary.

Inorganic magnesium preparations, such as magnesium sulfate, have extremely low bioavailability of magnesium and have a number of pronounced side effects [4, 18].

To compensate for magnesium deficiency, it is necessary to use magnesium preparations characterized by high bioavailability - organic magnesium preparations [19].

One of these drugs is Magnerot - a salt of magnesium and orotic acid. Orotic acid is one of the products of pyrimidine biosynthesis. In the human body, orotic acid is synthesized in the liver from aspartate and carbamoyl phosphate, subject to the physiological state of hepatocytes. Orotic acid salts are used as a mineral carrier, since orotic acid increases targeted transport into skeletal muscle myocytes and cardiomyocytes, and also has a number of additional advantages compared to inorganic salts.

To date, a large evidence base has been accumulated indicating the high effectiveness of magnesium orotate in various conditions accompanied by magnesium deficiency, including in patients undergoing coronary surgery [3, 7, 20–24].

The greatest experience in the use of magnesium orotate is in patients with mitral valve prolapse (MVP) as pathogenetic therapy. A long-term, over 15 years, observation of patients who took the drug at a dose of 1500 mg/day twice a year for 3 months showed that this leads to an improvement in clinical condition and is accompanied by a decrease in heart rate, number of episodes of tachycardia, duration QTc interval, frequency of paroxysmal supraventricular tachycardia, supraventricular and ventricular extrasystole [25]. The use of magnesium orotate in patients with mitral valve prolapse also improves quality of life and echocardiography indicators (reducing the depth of mitral valve prolapse, reducing the degree of mitral regurgitation) [26]. These effects are realized due to the fact that the drug causes changes in the architectonics of loose fibrous connective tissue, manifested in the orderliness of the relative arrangement of fibers, an increase in the content of amorphous substance of loose fibrous connective tissue involved in the metabolic processes of the myocardium, improved diffusion capacity and architectonics of connective tissue, which determines improved elasticity and extensibility [27].

The anti-ischemic effect of magnesium is manifested due to a positive effect on endothelium-dependent vasodilation [6], as well as normalization of metabolism in ischemic tissues, and a depressor effect on the inotropic function of the heart [8]. These same effects also explain the positive dynamics in patients with severe CHF when magnesium is included in complex therapy [7].

The drug is also effective in the prevention of supraventricular tachyarrhythmias during surgical interventions in patients with combined cardiac and urological pathologies. If the drug is prescribed before surgery, the likelihood of arrhythmia decreases by 16% [9].

An important positive aspect of magnesium preparations in cardiological practice is also that they can be used for the correction and prevention of hyperkalemia associated with long-term courses of potassium-sparing diuretics, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, as well as associated with the presence of metabolic syndrome. With the use of magnesium orotate, the well-being of patients improves and laboratory parameters are normalized [28].

Thus, magnesium deficiency is one of the most common types of mineral deficiency, occurring in 25–40% of the adult population. Literature data and more than 20 years of experience in the clinical use of magnesium preparations indicate their good effectiveness and high safety profile in patients with various cardiac pathologies.

Literature

1. Ezzati M., Lopez A., Rodgers A., Vander Hoorn S., Murray CJL eds. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. Geneva: World Health Organization; 2004.
2. Bourre JM Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients // J. Nutr. Health Aging. 2006; 10 (5): 377–385.
3. Classen HG Magnesium orotate-experimental and clinical evidence // Rom. J. Intern. Med. 2004; 42(3):491–501.
4. Gromova O. A. Magnesium and pyridoxine. Basic knowledge. M.: ProtoTip, 2006. 234 p.
5. Torshin I. Yu., Gromova O. A., Gusev E. I. Mechanisms of anti-stress and antidepressant action of magnesium and pyridoxine // Journal of Neurology and Psychiatry. 2009, No. 11, p. 107–111.
6. Kirichenko A. A., Flegentova O. N., Novichkova Yu. N., Vinogradova I. V., Ryazantsev A. A., Yurchenko K. V. Effect of therapy with Magnerot on cardialgia in postmenopausal women // Attending Physician. 2005. No. 5. P. 76 –77.
7. Stepura OB, Martynow AI Magnesium orotat in severe congestive heart failure (MACH) // Int J Cardiol. 2009, May 1; 134(1):145–147.
8. Ezhov A.V., Pimenov L.T., Zamostyanov M.V. Clinical effectiveness of Magnerot in the treatment of stable angina pectoris in combination with arterial hypertension in the elderly // Ros. honey. lead. 2001. No. 1. P. 71–74.
9. Davydova S., Yarovoy S. Magnesium preparations in the treatment and prevention of supraventricular tachyarrhythmias in urological patients // Doctor. 2011. No. 9. pp. 44–49.
10. Chakraborti S., Chakraborti T., Mandal M. et al. Protective role of magnesium in the cardiovascular diseases: A review // Mol Cell Biochem. 2002; 238:163–179.
11. Tsuji H., Venditti FJ Jr., Evans JC et al. The associations of levels of serum potassium and magnesium with ventricular premature complexes (the Framingham Heart Study) // Am J Cardiol. 1994; 74:232–235.
12. Eichhorn EJ, Tandon PK, Dibianco R. et al. The Study Group Clinical and prognostic significance of serum magnesium concentration in patients with severe chronic congestive heart failure: The Promise Study // J Am Coll Cardiol. 1993; 21(3):634–640.
13. Libova L. T., Dobrynina V. A., Kalenik S. A., Brovkina E. G. Use of the drug MAGNEROT® for mitral valve prolapse and stage I hypertension // New Millennium Medicine. 2011. No. 4. P. 3–4.
14. Martynov A.I., Akatova E.V., Nikolin O.P. Clinical effectiveness of magnesium orotate in patients with rhythm disturbances and arterial hypertension with mitral valve prolapse // Cardiovasc. therapy and prevention. 2009; 8:8–12.
15. Baker P., Bansal G., Boudoulas H. et al. Floppy mitral valve chordae tendineae: histopathologic alterations // Hum Pathology. 1998; 19(5):507–512.
16. Kitlinski M., Konduracka E., Piwowarska. Evaluation of magnesium cation levels in serum of patients with mitrale valve prolapse syndrome // Folia Med Cracov. 2000; 41 (3–4): 17–24.
17. Disse S., Abergei E., Derrebi A. et al. Mapping of the first locus for autosomal dominant myxomatous mitral valve prolapse to chromosome 16 p11.2–p.12.1 // Am J Hum Genet. 1999; 65(5):1242–1251.
18. Lazebnik L. B., Drozdova S. L. Correction of magnesium deficiency in cardiovascular pathology // Cardiology. 1997; 5: 103–104.
19. Tokimasa T., Akasu T. Cyclic AMP regulates an inward rectifying sodiumpotassium current in dissociated bull-frog sympathetic neurons // J Physiol. 1990; 420:409–429.
20. Jellinek H., Takacs E. Morphological aspects of the effects of orotic acid and magnesium orotate on hypercholesterolaemia in rabbits // Arzneimittelforschung. 1995. Vol. 45. No. 8. P. 836–884.
21. Geiss KR, Stergiou N., Neuenfeld HU, Jester HG Effects of magnesium orotate on exercise tolerance in patients with coronary heart disease // Cardiovasc Drugs Ther. 1998; 12: 153–156.
22. Ezhov AV, Pimenov LT Effect of adjuvant magnesium therapy on the quality of life and emotional status of elderly patients with stable angina // Adv Gerontol. 2002; 10: 95–98.
23. Salerno C., Crifo C. Diagnostic value of urinary orotic acid levels: applicable separation methods // J Chromatogr B Analyt Technol Biomed Life Sci. 2002; 781:57–71.
24. Motyl T., Krzeminski J., Podgurniak M. et al. Variability of orotic acid concentration in cow's milk // Endocr Regul. 1991; 25: 79–82.
25. Akatova E.V., Martynov A.I., Nikolin O.P. Results of long-term therapy with magnesium orotate in patients with mitral valve prolapse // Cardiovascular Therapy and Prevention. 2012; 3:30–35.
26. Akatova E.V., Martynov A.I. 15-year experience of using magnesium in patients with MVP // Cardiology. 2011.
27. Avtandilov A. G., Dzeranova K. M., Borovaya T. G., Didenko L. V. Effect of magnesium orotate on the connective tissue framework and inotropic function of the heart in patients with mitral valve prolapse. Clinical and morphological study // Rational pharmacotherapy in cardiology. 2013; 9 (4): 390–397.
28. Limanova O. A., Fedotova L. E., Kalacheva A. G., Torshin I. Yu., Gromova O. A. Management of patients with hyperpotassium conditions (cases from practice) // Zemsky Vrach. 2013; 4 (21), 24–32.

T. E. Morozova1, Doctor of Medical Sciences, Professor O. S. Durnetsova

GBOU VPO First Moscow State Medical University named after. I. M. Sechenova Ministry of Health of the Russian Federation, Moscow

1 Contact information

Discussion, answers to questions. Kuznetsova I.V.

Vladimir Trofimovich Ivashkin , academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences:

– Irina Vsevolodovna, hello. Thank you very much for your very interesting lecture. I have a few questions because your lecture evokes so many associations. Please tell me you are talking about patients with dysmenorrhea. Are these patients with long, heavy periods or not necessarily?

Irina Vsevolodovna Kuznetsova , professor, doctor of medical sciences:

- Thank you very much. We have a mixed audience, so I'll just clarify. The term dysmenorrhea is currently interpreted in gynecology as painful menstruation; this is pathological pain that lasts more than 24 hours in the first days of menstruation. It may, of course, be accompanied by more abundant bleeding, but this is not necessary; it is designated by another term - menorrhagia. But dysmenorrhea itself in its pure form is painful menstruation. It can be primary, that is, it arises precisely as a result of a violation of prostaglandin metabolism, usually in young women, or it can be secondary as a result of endometriosis, as a result of inflammatory processes of the pelvic organs, and so on.

Ivashkin V.T.:

- One more question. You mentioned that the combination of magnesium and vitamin B6 could prevent colon cancer. You see, as a gastroenterologist who is actively interested in this problem, I’m hearing this for the first time. And today, of all possible means of prevention, the only thing that has been proven with certainty is that long-term use of aspirin, and then only in patients in whom there is an increase in type 2 oxygenase in detectable polyps, in this case aspirin has such a preventive effect. As for magnesium and vitamin B6, I wonder what points of application, at what stage they can have a preventive effect?

Kuznetsova I.V.:

– By analogy with aspirin, I can assume that this is also cyclooxygenase, since it is associated with the synthesis of prostaglandins, but this is only an assumption.

Ivashkin V.T.:

– Magnesium is not a cyclooxygenase inhibitor.

Kuznetsova I.V.:

– It is not an inhibitor, I completely agree with you. But also, for example, hormonal drugs, while not inhibitors, are nevertheless capable of increasing or decreasing the expression of type 2 cyclooxygenase.

Ivashkin V.T.:

– You see what’s the matter, colon cancer, colorectal cancer is the first most common cancer among gastrointestinal cancers, and its frequency in Russia is very high. To make a recommendation to take magnesium and vitamin B6 for the purpose of cancer prevention, this still requires data from randomized trials.

Kuznetsova I.V.:

– I do not give such recommendations under any circumstances.

Ivashkin V.T.:

– It seems to me that such assumptions among a wide audience about the possibility of vitamin B6 and magnesium somehow influencing the incidence of colorectal cancer are premature, and it may be inappropriate to discuss this issue among a wide audience.

Kuznetsova I.V.:

– I completely agree with you, and, as you noted, I did not give this either in conclusions or in recommendations. She simply indicated that such a consideration had been put forward. Yes, indeed this is a very controversial issue, as controversial as the reduction in the incidence of colorectal cancer with the use of combined oral contraceptives or hormone replacement therapy, although there are randomized and controlled studies, and large epidemiological studies on this. But nevertheless, these studies cannot in any way serve as a basis for offering this remedy as a prevention of this disease, certainly not.

Oksana Mikhailovna Drapkina , professor, doctor of medical sciences:

– Irina Vsevolodovna, they write to us: “Ulan-Ude is also with you.” The question is: what should be the duration of the Magne B6 course and how often should it be repeated?

Kuznetsova I.V.:

– I believe that the optimal duration of the course is a three-month course, at least in our practice of treating patients with premenstrual syndrome with menopausal syndrome, with dysmenorrhea it is usually a three-month course of treatment. And this, of course, is not monotherapy; it is woven into the complex of therapy for these diseases. As for the need to repeat courses - depending on the situation of the disease. That is, in this case, I do not consider the use of magnesium preparations as a preventive measure that would be aimed at preventing one or another gynecological symptoms. These are the drugs that are introduced into the therapy complex if there are corresponding symptoms.

Drapkina O.M.:

– Our viewers are concerned about the question: is it possible to overdose on vitamin B6? That is, we understand that magnesium is not so scary and dangerous, but what about vitamin B6?

Kuznetsova I.V.:

- No. At the doses in which it is prescribed, an overdose of vitamin B6 has not been described, so there is no concern here.

Drapkina O.M.:

– What courses should I take magnesium supplements, how often should I monitor my blood magnesium levels during treatment?

Kuznetsova I.V.:

– There is no need to monitor blood magnesium levels during treatment. And I said the duration of the course above: for me, a three-month course seems optimal. Perhaps neurologists continue this treatment with longer courses, but from a gynecological point of view, a three-month course is adequate.

Drapkina O.M.:

– What are the objective methods for diagnosing magnesium deficiency? And are there specific indications for prescribing magnesium supplements?

Indeed, clinically, not only in a woman, and not only in a woman of reproductive age, but also in a man, can a deficiency be suspected in any person? The only thing that comes to my mind is heart rhythm disturbances.

Kuznetsova I.V.:

– And convulsive symptoms. You understand, of course, these symptoms are very non-specific. Different completely deficiencies give similar symptoms. As a gynecologist, I can speak about premenstrual syndrome and menopausal syndrome as magnesium deficiency conditions. You yourself saw from the slide show, and you know this from clinical practice, that indeed, the symptoms of magnesium deficiency are very similar to the symptoms of estrogen deficiency, and in some cases to the symptoms of calcium deficiency, such as cramps in the calf muscles. That is, sometimes it is very difficult to separate certain nonspecific symptoms from each other, and it is impossible to talk about magnesium deficiency based on symptoms alone. Therefore, I once again return to the fact that it is in our gynecological practice that we talk about diseases that are more associated with magnesium deficiency. I don’t presume to say how to deal with men, you probably know better.

Drapkina O.M.:

– Vladimir Trofimovich, in our therapeutic clinic?..

Ivashkin V.T.:

– It’s generally difficult for me to imagine how to diagnose isolated magnesium deficiency in clinical practice. Firstly, there are no clinical symptoms to suspect magnesium deficiency. Secondly, there is essentially no instrumental data. Let's take, for example, an ion like potassium. These are practically twin brothers: magnesium-potassium are two intracellular elements, both are essential for the functioning of sodium-potassium ATPase. Magnesium is a cofactor for the sodium-potassium ATPase, and all of these symptoms that have been described can essentially indicate potassium deficiency. And all those drugs that were used before, for example Panangin, were a combination of magnesium and potassium. This combination was aimed at activating the sodium-potassium ATPase. Sodium-potassium ATPase is necessary to maintain the transmembrane potential, therefore the convulsive syndrome that is described is characteristic of calcium deficiency, magnesium deficiency, and potassium deficiency, since in all these cases the transmembrane potential changes, and the excitability threshold decreases, and, Accordingly, depolarization processes are disrupted. Therefore, it is very difficult to say that it is magnesium deficiency that underlies all these manifestations. I think that here the combination of magnesium, potassium and calcium cations, a kind of triad, may to some extent explain the varied symptoms that we encounter.

Drapkina O.M.:

– Olga Vladimirovna will add.

Olga Vladimirovna Kotova , associate professor, candidate of medical sciences:

– I am a neurologist and would like to add something about magnesium deficiency. Quite recently, a dissertation on tension headaches was defended at our university. And there, magnesium deficiency was shown and proven in patients with tension headaches. In complex therapy with the use of Magne B6, accordingly, greater results were obtained than in traditional therapy of just tension headaches. And this was proven by the composition, they looked at hair as the most harmless way to study the deficiency.

Drapkina O.M.:

– Yes, it accumulates in the hair.

And they just echo Vladimir Trofimovich’s assumption about Panangin. The viewer also asks a question: wouldn’t it be more correct to prescribe Panangin to compensate for magnesium deficiency? Thanks for the answer.

Kuznetsova I.V.:

– But Panangin is still a complex drug, it contains magnesium and potassium. You understand, there is no “magnesium deficiency” disease, just as there is no “calcium deficiency” disease. There are no such symptoms, so we are saying that there are some diseases that are largely associated with a deficiency of this microelement. As Olga Vladimirovna wonderfully said, thank you for your support - tension headaches are associated with magnesium deficiency. Also, again, I return to the fact that our diseases, menopausal and premenstrual syndrome, are associated precisely with magnesium, and not with potassium deficiency. Therefore, the administration of potassium - studies were conducted - did not lead to positive changes. And the administration of the drug Magne B6 really gave a good positive effect. Of course, there are probably some nuances in the symptoms, because after all, when such an emotional and mental spectrum of disorders predominates in our patients, plus convulsive, spasmophilic disorders, then we can suspect magnesium deficiency to a greater extent. If there is a tendency, say, to swelling, then we may encounter a deficiency of other microelements.

As for calcium, when we talk about premenopause and postmenopause, there are simply no questions - this is always a calcium-deficient age, and therefore we also add calcium supplements there. And, of course, I completely agree with Vladimir Trofimovich, because of course not only the replenishment of magnesium and vitamin B6, but also other drugs, other microelements, other vitamins are also needed in order to maintain health and solve the problems that come with us a patient.

Drapkina O.M.:

– The question is this: almost all pregnant women are prescribed magnesium. Does it have hepatotoxicity?

Kuznetsova I.V.:

– This question is probably not for me. But I’ll probably say a few words about the fact that indeed all pregnant women are prescribed magnesium supplements. Maybe not for everyone, but it is prescribed very often, probably more often than it should. Polypharmacy during pregnancy is, of course, scary. Absolutely not all pregnant women need magnesium and vitamin B supplements. Moreover, there are vitamins that are much more important for pregnancy, for example, folic acid, which is absolutely necessary for the development of the child and the prevention of some complications associated with hyperhomocysteinemia. But as for Magne B6, its use during pregnancy should, of course, be limited to certain indications, but this has not yet been done. I think that I cannot judge him regarding hepatotoxicity; I have not seen hepatotoxic effects during pregnancy in patients taking magnesium supplements.

Drapkina O.M.:

– From Vladikavkaz, a question: can children with hyperactivity take Magne B6? It's probably good when a child is hyperactive?

Kuznetsova I.V.:

– No, this is not good, but this is not a question for me, this is for neurologists. Thanks a lot.

Kotova O.V.:

– Sorry for interfering, but magnesium for hyperactivity in children is perhaps the safest drug on the entire list that we can offer, from antidepressants to antipsychotics, so we start with more neutral drugs.

Drapkina O.M.:

– What does hyperactivity mean?

Kotova O.V.:

– Attention deficit disorder, ADHD, in short. Excuse me, I am interfering with my neurological topic, or rather, it is semi-psychiatric, because ADHD very often turns into autism, and then not even neurological, but psychiatric problems.

Drapkina O.M.:

- Thanks a lot. Vladimir Trofimovich?

Ivashkin V.T.:

– I think this is a very interesting point of view on the role of magnesium, of course, we should support. I think that it is still necessary to narrow the niche for the use of magnesium, since the extreme expansion of this niche devalues ​​the real significance of this drug. Otherwise, it turns out that you don’t need to control it: you don’t need to control the dosage, you don’t need to control the concentration, and so on - it essentially turns into mineral water, which you can drink in unlimited quantities, without controlling the flow of ions, and so on. Therefore, it seems to me that there should still be a fairly clearly defined niche for those nosological conditions or those syndromes for which this combination of vitamin B6 and magnesium should be used.

Then it’s not entirely clear why exactly this combination? Vitamin B6 is important for protein metabolism, magnesium is a cofactor in maybe a hundred or more different intracellular reactions. Why this combination? In the next lecture, it might be advisable to tell you about this.

Next, of course, it is very important to tell the transport system of magnesium ions: how the magnesium ion enters the cell, the systems for regulating the entry of magnesium into the cell and the exit of magnesium from the cell; is it an active process or a passive one; and how magnesium transport can be controlled at the level of the cell membrane. Here are these three questions: why the combination of vitamin B6 and magnesium, then the transport processes of magnesium, and yet a clearer limitation of nosological conditions and syndromes in which the effect of magnesium was actually obtained using randomized or sequential observations, of course, this would greatly enhance position of this drug.

Drapkina O.M.:

– Thank you very much, Irina Vsevolodovna, for the lecture and for the numerous questions that you had to answer. Thank you and see you next time.

Kuznetsova I.V.:

– Thank you very much, see you later.

All the benefits of magnesium: why take it?

Everyone knows about the benefits of vitamin C, the need for calcium for bones, and fluoride for teeth. But our body also needs Magnesium. Let's find out why it is so important.

The role of magnesium in the body

Magnesium is part of 12 macroelements vital for the normal functioning of the body.

This substance plays a huge role in metabolic processes, including:

• synthesis of enzymes for biochemical processes
• regulation of cell wall function
• interaction with calcium (muscle relaxation and contraction)
• protein synthesis
• excitability of the cardiac conduction system (autonomous functioning of the heart muscle)

Magnesium levels vary depending on age, health status, diet, physical activity, physiological state (pregnancy, lactation), as well as diseases.

Route of entry into the body

Magnesium enters the human body with food. Unfortunately, magnesium does not form in the body. For full functioning of the body, it is necessary to receive 300–700 mg of this substance. When magnesium enters the body, about 70% is stored in the bones, 20% passes into skeletal muscle cells, and another 10% into other tissues.

Magnesium enters the human body with food.

Deficiency Symptoms

First of all, changes appear in the nervous system:

• muscle twitching
• convulsions
• ataxia (motor coordination disorder)
• muscle weakness

Asthenia and mental disorders often appear, which are manifested by anxiety, aggression, anger, and a feeling of fear. With a lack of magnesium, doctors often identify chronic fatigue syndrome.

Among other manifestations are the following:

• spastic constipation
• the appearance of edema
• acceleration of the development of atherosclerosis
• decreased concentration
• cardiac arrhythmias
• migraine type headache

It is important to note that low levels of magnesium are diagnosed in diseases such as acute myocardial infarction, acute disorders of cerebral blood supply, which indicates the influence of magnesium on the development of such situations.

How do you know if you have a magnesium deficiency?

The normal level of magnesium in the blood is 0.66–1.07 mmol/l for ages 20–60 years. A deficiency of this substance can be detected by donating blood for electrolyte analysis.

When the content of this substance in the blood is below 0.5 mmol/l, hypomagnesemia is diagnosed, a life-threatening condition. Experienced physicians diagnose the deficiency using clinical evidence based on careful questioning and the presence of signs of magnesium deficiency.

Are there drugs that reduce magnesium levels?

There is a large list of drugs that can reduce the content of this substance. For example, thiazide diuretics (Hydrochlorothiazide), loop diuretics (Furasemide), some antibiotics, antiprotozoal, antifungal drugs, immunosuppressants.

Are there any known cases of excess magnesium?

In real practice, as well as in both domestic and foreign literature, there is practically no data on excess magnesium in the human body and the consequences of this condition.

Is kidney damage possible?

The kidneys control the excretion of minerals, so the question of kidney damage is quite logical. If a normal level of this substance reduces the risk of cardiovascular events, then with magnesium deficiency an increase in the amount of calcium develops, because, as described earlier, these two substances are in an antagonistic relationship. Due to the increase in calcium, the vascular walls become calcified. For any kidney damage, only a doctor can prescribe magnesium supplements!

Magnesium deficiency can be compensated for.

What drugs are used to compensate for magnesium deficiency?

Pharmaceutical technologies are constantly developing; currently there are already 4 classes of drugs containing magnesium.

Class 1 – Magnesium oxide, magnesium carbonate, magnesium sulfate, magnesium sulfate

Magnesium sulfate is used as a saline laxative, and in obstetric practice as a medicine in the treatment of preeclampsia. It is able to increase blood flow in the uteroplacental tissues.

Class 2 - organic magnesium compounds: citrate, orotate, lactate, asparaginate

A representative of this group is the organic salt of magnesium orotate - Magnerot.

Its cardioprotective effect has been clinically proven, which consists of accelerated healing of the myocardium after a period of ischemia and increased survival of the heart muscle.

Magnesium orotate is used for heart spasms, heart failure, coronary heart disease, and also for spasmophilia. Prescribe 2 tablets 3 times a day for a course of 4 weeks.

Class 3 – complex with biological substances of natural and plant origin: magnesium lactate in combination with pyridoxine, amino acids

Magnesium lactate + Pyridoxine is used for intestinal spasms, muscle spasms and increased fatigue. Contraindicated in pregnant and lactating women, as it penetrates the hematoplacental barrier and through breast milk.

Class 4 - complexes with enzymes, amino acids, lipids, polysaccharides: Magnesium creatine kinase.

Magnesium glycinate has good tissue solubility and does not have a significant laxative effect. Used to treat arterial hypertension and muscle tension.

Magnesium taurate. The interaction of the amino acid taurine and magnesium helps improve heart function, lower blood pressure, increase tissue sensitivity to insulin, reduce neuromuscular excitability, and also have an antithrombotic (reduced platelet aggregation) effect.

Conclusion

Magnesium is a unique substance. With its deficiency, a huge number of diseases are identified, with a wide variety of symptoms. Its intake is necessary to reduce the risk of developing cardiovascular diseases.

Literature:

Trisvetova Evgenia Leonidovna Magnesium in clinical practice // RFK. 2012. No. 4

Magnesium deficiency in children and adolescents involved in various sports and its correction

The high level of modern sports requires an in-depth individual approach based on a comprehensive study of the morpho-functional capabilities of the athlete, the development of which most contributes to the achievement of high sports results.

One of the main areas of solving the problem of maintaining health is appropriate metabolic support. It has been established that the athlete’s body needs adequate replenishment of a whole complex of macro- and micronutrients, which are intensively consumed under conditions of physical and emotional stress. Imbalance of microelements in the human body plays a significant role in the pathogenesis of somatic diseases, manifesting itself in the form of biochemical, clinical and morphological signs.

Biochemical analysis of an athlete's blood serum is an essential part of a comprehensive diagnosis, since this method can be used to judge the functional capabilities of the athletes' body.

332 athletes aged 14-17 years old involved in swimming, hockey, tennis, football, rhythmic gymnastics, and martial arts were examined. Sports experience ranged from 5 to 11 years. Sports qualification – from 1st category and above – 188 teenagers.

Biochemical parameters were determined using an automatic biochemical analyzer DxC800 (Beckman Coulter, USA) on an empty stomach, after training for at least 12 hours. A biochemical study of the blood of our observed athletes revealed a decrease in an important microelement - magnesium - in 32% of cases.

The main reasons for the development of magnesium deficiency in athletes include the following: fluctuations in body weight, high-intensity physical and emotional stress, overexertion, the need for adaptation (urgent and long-term), injuries, and the need for rapid recovery.

In athletes, symptoms of magnesium (Mg) deficiency manifest in a variety of clinical manifestations. All clinical manifestations of magnesium deficiency in the body of athletes are not much different from children and adolescents who do not engage in sports. They can be divided into cardiovascular: vasospasm, arterial hypertension, myocardial dystrophy, tachycardia, arrhythmias, increased QT interval, tendency to thrombosis; neurological: chronic fatigue syndrome, autonomic dysfunction, decreased attention, depression, fear, anxiety, dizziness, migraine, sleep disorders; visceral: bronchospasm, laryngospasm, hyperkinetic diarrhea, spastic constipation, pylorospasm, nausea, vomiting, biliary dyskinesia and cholelithiasis, diffuse abdominal pain, formation of kidney stones; muscular: skeletal muscle cramps (muscle cramps in the back of the head, back, face, parasthesia of the limbs, cramps of the calf muscles, soles, feet).

I would like to emphasize the important point that magnesium ions are part of the main substance of connective tissue and participate in the activation of collagen synthesis. Magnesium deficiency causes a chaotic arrangement of collagen fibers, which is the main morphological sign of connective tissue dysplasia.

One of the signs of DST of the cardiovascular system is heart valve prolapse. We detect grade 1 mitral valve prolapse (MVP) without regurgitation in 15% of cases. Like many authors, we note the connection between magnesium deficiency and polymorphism and severity of clinical symptoms in patients with MVP. In 10-15% of athletes, MVP is usually accompanied by cardiac arrhythmias, primarily in the form of ventricular extrasystoles and impaired myocardial repolarization processes.

For MVP in adolescents, the drug of choice is magnesium orotate (Magnerot). It was shown that after three to six months of regular use of an organic magnesium preparation, not only did the heart rate and blood pressure levels normalize, the number of episodes of rhythm disturbances decreased, but also the tremor and depth of prolapse of the mitral valve leaflets significantly decreased.

The high effectiveness of this drug is confirmed by echocardiographic studies. Thus, in 50% of cases, a complete restoration of the normal rhythm was recorded; in a number of patients, the number of parasystoles and atrial extrasystoles decreased, including the disappearance of blocked extrasystoles and episodes of ventricular rhythm.

The decisive role in the occurrence of magnesium deficiency is played by an imbalance of autonomic regulation - the predominance of sympathoadrenal influences.

It is known that a violation of the autonomic regulation of the cardiovascular system serves as an early sign of a breakdown in the athlete’s body’s adaptation to stress and leads to a decrease in performance. In children with various functional changes in the cardiovascular system, for example, when myocardial repolarization processes are disrupted, sympathicotonic BP up to 60% is detected, which is important to consider when choosing metabolic correction tactics. That is, against the background of magnesium deficiency, electrical instability of the myocardium develops, in the presence of which it is advisable to correct magnesium deficiency, even in the absence of laboratory confirmation.

When correcting deep magnesium deficiency, it is difficult to manage with diet alone and pharmacotherapy is often required. Treatment is more effective if both magnesium and a magnesium fixative (vitamins B6, B1, Glycine) are administered simultaneously. Among the drugs used to correct magnesium deficiency, the drug Magne B6 has approval for use in pediatrics.

The second group of diseases is caused by the participation of magnesium in enzymes that serve energy reactions - carbohydrate and ATP metabolism. Therefore, a lack of magnesium is accompanied by increased fatigue.

The third group of magnesium dysfunctions is associated with its structure-forming role in mediator metabolism. This group of reasons leads to depression, impaired coordination of movements, attention, memory, and mood. We found that with high values ​​of stability and concentration of attention, 44% of athletes have an imbalance of nervous processes with a predominance of excitation strength. Much less often - in 10% of observations, an imbalance of nervous processes with a predominance of braking force is detected. In 10-15% of observations, a destructive relationship with friends and coaches, poorly developed emotional-volitional quality, a high level of anxiety, a high level of rigidity, and a low desire to train are revealed.

If such psychological problems are identified, consultation with a children's sports psychologist, training, and work with coaching staff is necessary. At the same time, to optimize the psychological status, if necessary, we prescribe MagneB6.

Thus, one of the preventive areas for improving the current monitoring of the health of athletes should be monitoring their mineral metabolism and its timely replenishment. To maintain an optimal magnesium balance in the body of children and adolescents involved in sports throughout the training and competition cycles, it is necessary to take metabolic drugs.

Timely correction of magnesium deficiency is the most important means of preventing injuries and cardiac dysfunction in athletes under intense training and competitive loads.