Book Notes: Pain Free 1-2-3

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Appendix F: Myers Cocktail

The following are instructions for making up and administering the slow IV Myers Push (MP).

Items 1 through 3 and 6 through 12 can be ordered (among other sources) from Harvard Drug Company (Phone: 800-783-7103). Item 4 can be obtained from compounding pharmacies, including Pathways and Wellness and Health Pharmaceuticals. Item 5 can be purchased from G.Y. and N. Most of the above items are also available from McGuff (Phone: 800-854-7220) or Cape Apothecary (Phone: 800–248–5978 or 410–757–3522 or 410–974–1788).

To make the Myers Push (MP), draw up each ingredient using a separate syringe/needle and squirt it into the mouth of a 20-cc to 25-cc syringe. Attach the 25-gauge butterfly to the large syringe, pushing fluid through the butterfly tubing until the entire tubing and needle are filled. Now the mixture is ready for venipuncture and a slow IV push. The glutathione should be kept in the initial syringe (not mixed with other nutrients) and pushed in over 1 to 10 minutes (1 cc every one to two minutes).

The dose of MgSO₄ typically begins at 2 cc. If the patient feels comfortable, without dizziness, nausea, or hypotension (warmth in the neck, face, chest, abdomen, groin, and/or extremities is normal, and is a sign of physiological action of the magnesium as a vasodilator), I usually increase the MgSO₄ to 4 cc and give it over 10 to 40 minutes. Alternately, all these nutrients can be added in an IV bag and allowed to drip in over 30 to 60 minutes.

The desired result is to inject at a rate at which the patient feels comfortable warmth without excessive flushing or feeling ill—that is, dizziness, nausea, and headache- symptoms that are rare.

Prior to the injection, it is important for the patient to be instructed to give frequent feedback about any developing warm feeling early on, so that the injection may be slowed down, or even temporarily stopped, before excessive, uncomfortable flushing occurs. Likewise, feedback by the patient needs to be given when the warm feeling has mostly subsided so that the injection may be resumed at a reduced rate. Eventually, the infusion will find the “happy medium” rate of injection, which maintains the “comfortable warmth” (see above).

Also, prior to the first few MP injections, explain that a taste of B vitamins usually appears during the infusion, often early in the push.

The physician needs to consider one major option, which has become routine in many quarters—the possible addition of calcium gluconate, 10 percent injectable. Some of the major reasons for deciding to include calcium are:

• If the patient feels consistently unwell for any reason after the MP (weakness, fatigue, sleepiness, palpitations—all rare and mild, if present).

• If the patient has a history, or laboratory evidence, of calcium deficit.

• If the physician’s clinical judgment dictates it for any reason.

The dose of calcium gluconate 10 percent injectable varies from 4 cc to 10 cc, depending on the clinician’s judgment. The key is to maintain balance without diluting the magnesium’s positive effects.

A final caveat is that one needs to keep in mind the third of the troika—potassium. Over a period of time, IV magnesium may deplete potassium; the danger is that one may be tempted to increase the dose of magnesium, only to aggravate the low potassium picture. Always keep in mind that a potassium deficit may prevent magnesium repletion and vice-versa.

It is also, of course, possible to create a calcium deficit by the MP. However, potassium depletion, in my experience, is clinically more frequent and more symptom-provoking, and at times alarming. (If needed, give the potassium by mouth—not IV. IV push potassium is fataL. I use Micro K Extendtabs, 10 MEQ, 1 to 2 times a day if potassium levels are under 4.0.)