More details on the Myers Cocktail:
Intravenous micronutrient therapy (IVMT), and specifically the Myers' Cocktail, is a popular approach for treating fibromyalgia syndrome (FMS) among complementary and alternative medicine practitioners, but its efficacy is uncertain. This trial ...
www.ncbi.nlm.nih.gov
- 5 mL of magnesium chloride hexahydrate (20%)
- 3 mL of calcium gluconate (10%)
- 1 mL of hydroxocobalamin (1,000 μ/mL)
- 1 mL of pyridoxine hydrochloride (100 mg/mL)
- 1 mL of dexpanthenol (250 mg/mL)
- 1 mL of B-complex 100 containing:
- 100 mg of thiamine HCl, 2 mg of riboflavin, 2 mg of pyridoxine HCl, and 2 mg of panthenol
- 100 mg of niacinamide, 2% benxyl alcoholr.
- 5 mL of vitamin C (500 mg/mL)
- 20 mL of sterile water.
The 37ml are given in a slow-push infusion delivered over approximately 10 minutes using a 25-gauge butterfly needle.
Intravenous nutrient therapy: the "Myers' cocktail". - PubMed - NCBI [Click on "Full text links" for more info. Very interesting cases available!]
Choice of Ingredients and Administration
At the time of this writing [2002], cyanocobalamin
is a widely available form of injectable vitamin B12,
whereas hydroxocobalamin can be obtained only
through a compounding pharmacist. While both
forms of the vitamin are effective,
hydroxocobalamin
is preferred because it produces more prolonged
increases in serum vitamin B12 levels.48
It has been the author’s impression (and
that of other clinicians) that some patients who respond
to IM vitamin B12 injections do not experience
the same benefit when vitamin B12 is given
as part of the Myers’. It is possible that vitamin C
or another component of the Myers’ destroys some
of the vitamin B12, or that IV vitamin B12 is lost
more rapidly in the urine than IM vitamin B12.
Therefore, for some patients receiving IV nutrient
therapy, the vitamin B12 is given IM in a separate
syringe.
Injectable magnesium can be obtained
either as magnesium chloride hexahydrate (20%
solution), commonly called magnesium chloride,
or magnesium sulfate heptahydrate (50% solution),
commonly called magnesium sulfate. Although
most clinical research has been done with
magnesium sulfate,
some experts prefer magnesium
chloride for IV use because of its greater retention
in the body.50 The author has used magnesium
chloride almost exclusively for IV therapy, while
reserving the more concentrated magnesium sulfate
for IM administration.
For those using magnesium
sulfate, it should be noted that 1 g (2 mL of a 50-
percent solution) is equivalent to 0.8 g (4 mL of a
20-percent solution) of magnesium chloride (each
contains 4 mMol of magnesium). In addition, if 50-
percent magnesium sulfate is given IV instead of
20-percent magnesium chloride, it should be diluted
appropriately with sterile water.
Injectable vitamin C is currently available
in concentrations of 222 and 500 mg per mL. The
author typically uses the lower concentration for
IV therapy. If the higher concentration is used, it
should be diluted appropriately with sterile water.
Occasionally, trace minerals were included
as part of a nutrient infusion. The usual dose was
0.2-0.5 mL of MTE-5, which contains (per mL):
zinc 1 mg, copper 0.4 mg, chromium 4 mcg, selenium
20 mcg, and manganese 0.1 mg. The preparation
was diluted six-fold and administered over a
period of 1-2 minutes in a separate syringe at the
end of the Myers’ push. Two adverse reactions have
been noted with 10 mg of zinc given by slow IV
push; consequently, when giving trace minerals by
IV push, very small doses are used.
Trace minerals
should not be mixed in the same syringe with the
components of the Myers’, as doing so often causes
formation of a precipitate.
Side Effects and Precautions
The Myers’ often produces a sensation of
heat, particularly with large doses or rapid administration.
This effect appears to be due primarily
to the magnesium, although rapid injections of
calcium have been reported to produce a similar
effect.22
The sensation typically begins in the chest
and migrates to the vaginal area in women and to
the rectal area in men. For most patients the heat
does not cause excessive discomfort; indeed, some
patients enjoy it. However, if the infusion is given
too rapidly, the warmth can be overbearing. Some
women experience a sensation of sexual pleasure
in association with the vaginal warmth; on rare
occasions, an orgasm may occur during an IV infusion.
Other patients have remarked their visual
acuity and color perception become sharper immediately
after an injection, as if someone had
turned the lights on. In some cases, this effect lasts
as long as one or two days.
Too rapid administration of magnesium
can cause hypotension, which can lead to
lightheadedness or even syncope. Patients receiving
a Myers’ should be advised to report the onset
of excessive heat (which can be a harbinger of
hypotension) or lightheadedness. If either of these
symptoms occurs, the infusion should be stopped
temporarily and not resumed until the symptoms
have resolved (usually after 10-30 seconds). Patients
with low blood pressure tend to tolerate less
magnesium than do patients with normal blood
pressure or hypertension.
In a small proportion of
patients, even a low-dose regimen given very
slowly causes persistent hypotension; in those
cases, the treatment is usually discontinued and
may or may not be attempted at a later date.
Although too rapid administration can
have adverse consequences, some patients appear
to experience more pronounced benefits from
rapid infusions than from slower ones, presumably
because of higher peak serum concentrations
of nutrients. While both the risks and benefits
should be taken into account in determining an
infusion rate, when in doubt one should err on the
side of safety. When administering the Myers’ to
a patient for the first time, it is best to give 0.5-1.0
mL and then wait 30 seconds or so before proceeding
with the rest of the infusion.
Doing so may
help one distinguish between a vasovagal reaction
and a hypotensive response to the injected
compounds. Patients who experience a vasovagal
reaction at the beginning of an infusion can usually
tolerate the remainder of the treatment after
the reaction has worn off.
For elderly or frail individuals, it may be
advisable to start with lower doses than those listed
in Table 1, or to consider IM administration of
magnesium and B vitamins as an alternative to IV
therapy. However, many elderly patients have tolerated,
and benefited from, IV therapy.
Patients who are deficient in both magnesium
and potassium may have an influx of potassium
into the cells after receiving IV magnesium.
51 This occurs because magnesium activates
the membrane pump that promotes the intracellular
uptake of potassium. The shift of potassium
from the serum to the intracellular space can trigger
hypokalemia.
The author has seen two patients
develop severe muscle cramps several hours after
receiving a Myers’; both patients had been taking
medications known to deplete potassium. Hypokalemia
also increases the risk of digoxin-induced
cardiac arrhythmias. As a first-year resident,
unaware of this potential problem, the author administered
IV magnesium in the hospital to an elderly
woman who was taking digoxin and a potassium-
depleting diuretic. She quickly developed an
arrhythmia, which required short-term treatment in
the intensive care unit.
Patients considered to be at risk of potassium
deficiency include those taking potassiumdepleting
diuretics, beta-agonists, or glucocorticoids;
those with diarrhea or vomiting; and those
who are generally malnourished. If a patient is hypokalemic,
the hypokalemia should be corrected
before IV magnesium therapy is considered. However,
a normal serum potassium concentration is
not a guarantee against intracellular potassium
depletion. For patients considered to be at risk of
potassium deficiency, administration of 10-20 mEq
of potassium orally just prior to the infusion, and
again 4-6 hours later is recommended. After this
practice was instituted, no further problems with
magnesium-induced muscle cramps were encountered.
The addition of even small amounts of
potassium to an IV push is strongly discouraged,
because of the theoretical risk of triggering an arrhythmia
during the first pass when the bolus
reaches the cardiac conducting system.
Intravenous calcium is contraindicated in
patients taking digoxin. In addition,
hypercalcemia
can cause cardiac arrhythmias. For that reason, the
author has tended to leave calcium out of the Myers’
when treating patients with cardiac disease, although
there is no strong evidence it is dangerous
for such patients.
Anaphylactic reactions to IV thiamine have
been reported on rare occasions. Only three such
reactions have been identified in the U.S. literature
since 1946. However, in the world literature, a
total of nine deaths attributed to thiamine administration
were reported between 1965 and 1985.52
These reactions have occurred after oral, IV, IM,
or subcutaneous administration, and are believed
to be due in part to a nonspecific release of histamine.
Anaphylactic reactions have been seen most
often
after multiple administrations of thiamine. In
the United Kingdom, between 1970 and 1988, there
were approximately four reports of anaphylactoid
reactions for every million ampules of IV B vitamins
sold, and one report for every 5 million IM
ampules sold.53
It is possible the risk of anaphylaxis from
the Myers’ is even lower than the low risk associated
with the use of IV thiamine. Many patients
who receive parenteral thiamine are alcoholics, and
alcoholism frequently causes magnesium deficiency.
A
nimal studies suggest thiamine supplementation
in the presence of magnesium deficiency
increases the severity of the magnesium deficiency.
54
A deficiency of magnesium can lead to
spontaneous release of histamine,55 and has been
reported to increase the incidence of experimentally
induced anaphylaxis in animals.56 The presence
of magnesium in the Myers’ might, therefore,
reduce the risk of an anaphylactic reaction to thiamine.
Moreover, as the Myers’ has been used successfully
to treat asthma and urticaria, it is likely
the formula as a whole provides prophylaxis against
anaphylaxis. Nevertheless, practitioners who administer
IV nutrients should be prepared to deal
with the rare anaphylactic reaction.
A small number of patients (approximately
one percent) felt “out of sorts” for up to a day after
receiving an injection and, in two cases, this reaction
lasted one and two weeks, respectively. It is
not clear whether these reactions were due to the
preservatives in some of the injectable preparations
(e.g., benzyl alcohol, methylparabens, or others)
or to the nutrients themselves. In most cases (including
a few patients with asthma) preservativecontaining
products were used because the use of
multi-dose vials reduced the cost of treatment to
the patient. However, for some individuals with
known chemical sensitivities or other significant
allergy-related problems, preservative-free preparations
were used.
Although the Myers’ is extremely hypertonic,
it rarely seemed to cause problems related to
its hypertonicity. Two or three patients developed
phlebitis at the injection site; for those patients, later
treatments were diluted with sterile water to a total
of 60 mL. Some patients experienced a burning
sensation at the injection site during the infusion;
this was often corrected by re-positioning the needle
or by further diluting the nutrients.
When administered with caution and respect,
the Myers’ has been generally well tolerated,
and no serious adverse reactions have been encountered
with approximately 15,000 treatments.
Cost Considerations
In 1995, the author’s last year in private
practice, the cost of the materials for a Myers’ was
approximately $5.00. The use of preservative-free
nutrients at least doubled the cost of materials.
Nursing time and administrative factors represented
the majority of the cost of IV nutrient
therapy. In 1995, the author’s fee for a Myers’ was
$38.00. Other doctors have charged as little as
$15.00 or as much as $100.00 or more.
Since 1995,
the cost of most of the injectable preparations has
increased by 50-100 percent.
Insurance companies do not generally pay
for this treatment. However, in a few instances,
showing them that IV nutrient therapy had greatly
reduced the overall cost of the patient’s health care
persuaded them to pay.