Alternative Medicine Review ◆ Volume 7, Number 5 ◆ 2002 Pa ge 389
R e v i e w “M ye r s ’ C o c k t a il”
AbstractBuilding on the work of the late John Myers,MD, the author has used an intravenousvitamin-and-mineral formula for the treatmentof a wide range of clinical conditions. Themodified “Myers’ cocktail,” which consists of magnesium, calcium, B vitamins, and vitaminC, has been found to be effective against acuteasthma attacks, migraines, fatigue (includingchronic fatigue syndrome), fibromyalgia, acutemuscle spasm, upper respiratory tractinfections, chronic sinusitis, seasonal allergicrhinitis, cardiovascular disease, and otherdisorders. This paper presents a rationale forthe therapeutic use of intravenous nutrients,reviews the relevant published clinicalresearch, describes the author’s clinicalexperiences, and discusses potential side
effects and precautions.(A l t e r n M e d R e v 2002;7(5):389-403)
IntroductionJohn Myers, MD, a physician from Balti-
more, Maryland, pioneered the use of intravenous(IV) vitamins and minerals as part of the overalltreatment of various medical problems. The au-thor never met Dr. Myers, despite living in Balti-more, but had heard of his work, and had occa-sionally used IV nutrients to treat fatigue or acute
infections.After Dr. Myers died in 1984, a numberof his patients sought nutrient injections from theauthor. Some of them had been receiving injec-tions monthly, weekly, or twice weekly for manyyears – 25 years or more in a few cases. Chronicproblems such as fatigue, depression, chest pain,or palpitations were well controlled by these treat-ments; however, the problems would recur if thepatients went too long without an injection.
Alan R. Ga by, MD – Pa st p res ident o f the America n HolisticMedical Ass ociation; author of Preventing and Reversing Osteoporosis , and co-author of The Patient’s Book of Natural Healing .Correspondence address: 301 Dorwood Drive, Carlisle,PA 17013.
It was not clear exactly what the “Myers’cocktail” consisted of, as the information providedby patients was incomplete and no published orwritten material on the treatment was available. Itappeared that Myers used a 10-mL syringe andadministered by slow IV push a combination of magnesium chloride, calcium gluconate, thiamine,vitamin B6, vitamin B12, calcium pantothenate,vitamin B complex, vitamin C, and dilute hydro-chloric acid. The exact doses of individual com-ponents were unknown, but Myers apparently useda two-percent solution of magnesium chloride,rather than the more widely available preparationscontaining 20-percent magnesium chloride or 50-percent magnesium sulfate.
The author took over the care of Myers’patients, using a modified version of his IV regi-men. Most notably, the magnesium dose was in-
creased by approximately 10-fold by using 20-percent magnesium chloride, in order to approxi-mate the doses reported to be safe and effectivefor the treatment of cardiovascular disease. 1, 2 Inaddition, the hydrochloric acid was eliminated andthe vitamin C was increased, particularly for prob-lems related to allergy or infection. Folic acid wasnot included, as it tends to form a precipitate whenmixed with other nutrients.
This treatment was suggested for otherpatients, and it soon became apparent that themodified Myers’ cocktail (hereafter referred to as“the Myers’”) was helpful for a wide range of clini-cal conditions, often producing dramatic results.Over an 11-year period, approximately 15,000
injections were administered in an outpatient set-ting to an estimated 800-1,000 different patients.Conditions that frequently responded includedasthma attacks, acute migraines, fatigue (includ-ing chronic fatigue syndrome), fibromyalgia, acutemuscle spasm, upper respiratory tract infections,chronic sinusitis, and seasonal allergic rhinitis. Asmall number of patients with congestive heartfailure, angina, chronic urticaria, hyperthyroidism,dysmenorrhea, or other conditions were alsotreated with the Myers’ and most showed markedimprovement. Many relatively healthy patientschose to receive periodic injections because it en-hanced their overall well being for periods of aweek to several months.
During the past 16 years these clinicalresults have been presented at more than 20 medi-cal conferences to several thousand physicians.Today, many doctors (probably more than 1,000in the United States) use the Myers’. Some havemade further modifications according to their ownpreferences. In querying audiences from the lec-tern and from informal discussions with colleaguesat conferences, the author has yet to encounter apractitioner whose experience with this treatmenthas differed significantly from his own.
Despite the many positive anecdotal re-ports, there is only a small amount of publishedresearch supporting the use of this treatment. Thereis one uncontrolled trial in which the Myers’ wasbeneficial in the treatment of musculoskeletal painsyndromes, including fibromyalgia. Intravenousmagnesium alone has been reported, mainly inopen trials, to be effective against angina, acutemigraines, cluster headaches, depression, andchronic pain. In recent years, double-blind trialshave shown IV magnesium can rapidly abort acuteasthma attacks. There are also several published
case reports in which IV calcium provided rapidrelief from asthma or anaphylactic reactions.This paper presents a rationale for the use
of IV nutrient therapy, reviews the relevant pub-lished clinical research, describes personal clini-cal experiences using the Myers’, and discussespotential side effects and precautions.
Theoretical Basis for IV NutrientTherapy
Intravenous administration of nutrients
can achieve serum concentrations not obtainablewith oral, or even intramuscular (IM), adminis-tration. For example, as the oral dose of vitaminC is increased progressively, the serum concen-tration of ascorbate tends to approach an upperlimit, as a result of both saturation of gastrointes-tinal absorption and a sharp increase in renal clear-ance of the vitamin. 3 When the daily intake of vi-tamin C is increased 12-fold, from 200 mg/day to2,500 mg/day, the plasma concentration increasesby only 25 percent, from 1.2 to 1.5 mg/dL. Thehighest serum vitamin C level reported after oraladministration of pharmacological doses of thevitamin is 9.3 mg/dL. In contrast, IV administra-tion of 50 g/day of vitamin C resulted in a meanpeak plasma level of 80 mg/dL. 4 Similarly, oralsupplementation with magnesium results in littleor no change in serum magnesium concentrations,whereas IV administration can double or triple theserum levels, 5,6 at least for a short period of time.
Various nutrients have been shown to ex-ert pharmacological effects, which are in manycases dependent on the concentration of the nutri-
ent. For example, an antiviral effect of vitamin Chas been demonstrated at a concentration of 10-15 mg/dL, 4 a level achievable with IV but not oraltherapy. At a concentration of 88 mg/dL in vitro ,vitamin C destroyed 72 percent of the histaminepresent in the medium. 7 Lower concentrationswere not tested, but it is possible the serum levelsof vitamin C attainable by giving several gramsin an IV push would produce an antihistamine ef-fect in vivo . Such an effect would have implica-tions for the treatment of various allergic condi-tions. Magnesium ions promote relaxation of bothvascular 8 and bronchial 9 smooth muscle – effectsthat might be useful in the acute treatment of va-sospastic angina and bronchial asthma, respec-tively. It is likely these and other nutrients exertadditional, as yet unidentified, pharmacologicaleffects when present in high concentrations.
In addition to having direct pharmacologi-cal effects, IV nutrient therapy may be more ef-fective than oral or IM treatment for correctingintracellular nutrient deficits. Some nutrients arepresent at much higher concentrations in the cellsthan in the serum. For example, the average mag-nesium concentration in myocardial cells is 10times higher than the extracellular concentration.This ratio is maintained in healthy cells by an ac-tive-transport system that continually pumps mag-nesium ions into cells against the concentrationgradient. In certain disease states, the capacity of membrane pumps to maintain normal concentra-tion gradients may be compromised. In one study,the mean myocardial magnesium concentration
was 65-percent lower in patients with cardiomy-opathy than in healthy controls, 10 implying a re-duction in the intracellular-to-extracellular ratioto less than 4-to-1. As magnesium plays a key rolein mitochondrial energy production, intracellularmagnesium deficiency may exacerbate heart fail-ure and lead to a vicious cycle of further intracel-lular magnesium loss and more severe heart fail-ure.
Intravenous administration of magnesium,by producing a marked,though transient, increasein the serum concen-tration, provides awindow of opportunity forailing cells to take upmagnesium against asmaller concentrationgradient. Nutrients takenup by cells after an IVinfusion may eventuallyleak out again, but perhapssome healing takes place
before they do. If cells arerepeatedly “flooded” withnutrients, the improve-ment may be cumulative.It has been the author’sobservation that somepatients who receive aseries of IV injectionsbecome progressivelyhealthier. In these patients,
the interval between treatments can be graduallyincreased, and eventually the injections are nolonger necessary.
Other patients require regular injectionsfor an indefinite period of time in order to controltheir medical problems. This dependence on IVinjections could conceivably result from any of the following: (1) a genetically determined impair-ment in the capacity to maintain normal intracel-lular nutrient concentrations; 11 (2) an inborn errorof metabolism that can be controlled only by main-taining a higher than normal concentration of aparticular nutrient; or (3) a renal leak of a nutri-ent. 12 In some cases, continued IV therapy may benecessary because a disease state is too advanced
to be reversible.
The Modified Myers’ CocktailSee Table 1 for the nutrients that make up
the modified Myers’ cocktail.Dexpanthenol is the commercially avail-
able injectable form of pantothenic acid (vitaminB5). One milliliter of B complex 100 contains 100mg each of thiamine and niacinamide, and 2 mgeach of riboflavin, dexpanthenol, and pyridoxine.
All ingredients are drawn into one syringe,and 8-20 mL of sterile water (occasionally more)is added to reduce the hypertonicity of the solu-tion. After gently mixing by turning the syringe afew times, the solution is administered slowly,usually over a period of 5-15 minutes (dependingon the doses of minerals used and on individualtolerance), through a 25G butterfly needle. Occa-sionally, smaller or larger doses than those listedin Table 1 have been used. Low doses are oftengiven to elderly or frail patients, and to those withhypotension. Doses for children are lower thanthose listed, and are reduced roughly in propor-tion to body weight. The most commonly usedregimen has been 4 mL magnesium, 2 mL cal-
cium, 1 mL each of B12, B6, B5, and B complex,6 mL vitamin C, and 8 mL sterile water.
The following is a review of conditionssuccessfully treated with the Myers’. The num-bers of patients treated and proportion that re-sponded are, for the most part, estimates.
AsthmaCase #1: A five-year-old boy presented
with a two-year history of asthma. During the pre-vious 12 months he had suffered 20 asthma at-
tacks severe enough to require a visit to the hospi-tal emergency department. His symptoms ap-peared to be exacerbated by several foods, andskin tests had been positive for 23 of 26 inhalantstested. His initial treatment consisted of identifi-cation and avoidance of allergenic foods, as wellas daily oral supplementation with pyridoxine (50mg), vitamin C (1,000 mg), calcium (200 mg),magnesium (100 mg), and pantothenic acid (100mg), in two divided doses with meals. On this regi-men, he experienced marked improvement, andhad no asthma attacks requiring medical care un-
til nearly 11 months after his initial visit.At that time the child, now six years old,
presented for an emergency visit with mild butpersistent wheezing and difficulty breathing. Hewas given a slow IV infusion containing 6 mLvitamin C, 1.4 mL magnesium, and 0.5 mL eachof calcium, B12, B6, B5, and B complex. Thesymptoms resolved within two minutes and didnot recur.
Over the ensuing eight years and threemonths, he received a total of 63 IV treatmentsfor acute exacerbations of asthma. In most in-stances, a single injection resulted in marked im-provement or complete relief within two minutes,and the acute symptoms did not recur. Occasion-ally, a second injection was needed after a periodof 12 hours to two days, and during one episodethree treatments were required over a four-dayperiod. As the patient grew, the nutrient doses weregradually increased; by age 10 he was receiving10 mL vitamin C, 3 mL magnesium, 1.5 mL cal-cium, and 1 mL each of B12, B6, B5, and B com-plex.
The treatment was unsuccessful only
once; on that occasion the patient presented withgeneralized urticaria, angioedema, and unusuallysevere asthma, after the inadvertent ingestion of an artificial food coloring (FD&C red #40) andother potential allergens. Three separate injectionsgiven over a 60-minute period produced transientimprovement each time. However, the symptomsreturned, and he was taken to the emergency roomand hospitalized.
Despite that single treatment failure, thepatient and his parents reported that IV nutrienttherapy worked faster, produced a more sustainedimprovement, and caused considerably fewer sideeffects than the conventional therapies he had re-ceived previously in the emergency room.
The author has treated approximately adozen asthmatics (mainly adults) with the Myers’for acute asthma attacks; in most instances, markedimprovement or complete relief occurred withinminutes. A few patients received maintenance in-
jections once weekly or every other week duringdifficult times and reported the treatments kepttheir asthma under better control.
Intravenous magnesium is now well docu-mented as an effective treatment for acute asthma.In one study, 38 patients with an acute exacerba-tion of moderate-to-severe asthma that had failedto respond to conventional beta-agonist therapywere randomly assigned to receive, in double-blindfashion, IV infusions of either magnesium sulfate(1.2 g over a 20-minute period) or placebo (sa-line). 13 Peak expiratory flow rate improved to a
significantly greater extent in the magnesiumgroup (225 to 297 L/min) than the placebo group(208 to 216 L/min). In addition, the hospitaliza-tion rate was significantly lower in the magnesiumgroup than in the placebo group (37% vs. 79%; p< 0.01). No patient had a significant drop in bloodpressure or change in heart rate after receivingmagnesium.
In a second double-blind study, 149 pa-tients with acute asthma who were being treatedwith inhaled beta-agonists and IV steroids wererandomly assigned to receive an IV infusion of magnesium sulfate (2 g over 20 minutes) or sa-line placebo, beginning 30 minutes after presen-tation. 14 Among patients with severe asthma (de-
fined as forced expiratory volume in 1 second[FEV 1] less than 25 percent of predicted value)compared with placebo, magnesium significantlyreduced the hospitalization rate (33.3% vs. 78.6%;p < 0.01) and significantly improved FEV 1. How-ever, magnesium treatment was of no benefit topatients with moderate asthma (defined as baselineFEV 1 between 25 and 75 percent of predictedvalue).
In two placebo-controlled studies of asth-matic children, IV magnesium sulfate significantlyimproved pulmonary function and significantlyreduced hospitalization rates during acute exacer-bations that had failed to respond to conventionaltherapy. 15,16 A dose of 40 mg per kg body weight(maximum dose, 2 g) given over a 20-minute pe-riod appeared to be more effective than 25 mg perkg. Higher doses of IV magnesium sulfate (10-20g over 1 hour, followed by 0.4 g per hour for 24hours) have been used successfully in the treat-ment of life-threatening status asthmaticus. 6 In afew studies, IV magnesium failed to improve pul-monary function or to reduce the need for hospi-
talization.17,18
However, a meta-analysis of sevenrandomized trials concluded that IV magnesiumreduced the need for hospitalization by 90 per-cent among patients with severe asthma, althoughthe treatment was not beneficial for patients withmoderate asthma. 19
Calcium is the only other component of the Myers’ that has been studied as a treatmentfor acute exacerbations of asthma. In an early re-port, a series of IV infusions of calcium chloriderelieved asthma symptoms in three consecutivepatients, with relief occurring almost immediatelyafter some injections. 20 Intravenous and IM ad-ministration of an unspecified calcium salt tem-porarily inhibited severe anaphylactic reactions intwo other patients. 21
Nutrients other than magnesium and cal-cium may have contributed to the beneficial ef-fect observed in asthma patients. Oral vitaminsC22 and B6 23,24 and IM vitamin B12 25 have eachbeen used with some success against asthma, al-
though none of these nutrients has been tested asa treatment for acute attacks. Intramuscular ad-ministration of niacinamide has been shown toreduce the severity of experimentally inducedasthma in guinea pigs, 26 and pantothenic acid ap-pears to have an anti-allergy effect in humans. 27
On one occasion, a patient’s asthma at-tack was treated with IV magnesium alone. Al-though the symptoms resolved rapidly, they re-turned within 10-15 minutes. The remaining con-stituents of the Myers’ (without additional mag-nesium) were then administered, and the symp-toms disappeared almost immediately and did notreturn. Thus, it seems the Myers’ is more effec-tive than magnesium alone in the treatment of asthma attacks.
MigraineCase #2: A 44-year-old female suffered
from frequent migraines, which appeared to betriggered in many instances by exposure toenvironmental chemicals or, occasionally, toingestion of foods to which she was allergic.
Allergy desensitization therapy had provided littlebenefit. Over a six-year period, the patient wasgiven IV therapy on approximately 70 occasionsfor migraines. Nearly all of these injectionsresulted in considerable improvement or completerelief within several minutes, although a fewtreatments were ineffective. Through trial anderror, it was determined her most effective regimen
was 16 mL vitamin C, 5 mL magnesium, 4 mLcalcium, 2 mL B6, and 1 mL each of B12, B5, andB complex. The 4-mL dose of calcium was foundto provide better relief than lower calcium doses.
Over the years, a half dozen other patientshave presented one or more times with an acutemigraine. In almost every instance, the Myers’produced a gratifying response within a few min-utes.
The beneficial effect of IV magnesium asa treatment for migraine has been demonstratedin recent clinical trials. In one study, 40 patientswith an acute migraine received 1 g magnesiumsulfate over a five-minute period. 28 Fifteen min-utes after the infusion, 35 patients (87.5%) re-
ported at least a 50-percent reduction of pain, andnine patients (22.5%) experienced complete re-lief. In 21 of 35 patients who benefited, the im-provement persisted for 24 hours or more. Patientswith an initially low serum ionized magnesiumconcentration (less than 0.54 mMol/L) were sig-nificantly more likely to experience long-lastingimprovement than were patients with initiallyhigher serum ionized magnesium levels. In asingle-blind trial that included 30 patients with anacute migraine, IV administration of magnesiumsulfate (1 g over 15 minutes) completely and per-manently relieved pain in 13 of 15 patients(86.6%), whereas no patients in the placebo groupbecame pain free (p < 0.001 for difference betweengroups). 29 In addition, magnesium treatment re-sulted in rapid disappearance of nausea, vomit-ing, and photophobia in all 14 patients who hadexperienced those symptoms.
A single 1-g dose of magnesium sulfatehas also been reported to abort an episode of clus-ter headaches in seven of 22 patients (32%), and aseries of three to five injections provided sustained
relief in an additional two patients (9%).30
It is not clear whether the Myers’ is moreeffective than magnesium alone for migraines;however, one patient did experience noticeablebenefit from IV calcium.
FatigueMany patients with unexplained fatigue
have responded to the Myers’, with results lasting
only a few days or as long as several months. Pa-tients who benefited often returned at their owndiscretion for another treatment when the effecthad worn off. One patient with fatigue associatedwith chronic hepatitis B experienced marked andprogressive improvement in energy levels withweekly or twice-monthly injections.
Approximately 10 patients with chronicfatigue syndrome (CFS) received a minimum of four treatments (usually once weekly for fourweeks), with more than half showing clear im-provement. One patient experienced dramatic ben-efit after the first injection, whereas in other casesthree or four injections were given before improve-ment was evident. A few patients became progres-sively healthier with continued injections and wereeventually able to stop treatment. Several othersdid not overcome their illness, but periodic injec-tions helped them function better.
There is some research support for the useof parenteral magnesium in patients with fatigue.One study found magnesium deficiency, demon-strated by an IV magnesium-load test, in 47 per-
cent of 93 patients with unexplained chronic fa-tigue, including 50 with CFS. 31 In a second study,the mean erythrocyte magnesium concentrationwas significantly lower in 20 patients with CFSthan in healthy controls. 32
As one arm of the second study, 32 pa-tients with CFS were randomly assigned to re-ceive, in double-blind fashion, 1 g magnesiumsulfate IM or placebo, once weekly for six weeks.Twelve (80%) of 15 patients given magnesiumreported improvement (e.g., more energy, a betteremotional state, and less pain) and fatigue was
eliminated completely in seven cases. In contrast,only three (18%) of 17 placebo-treated patientsimproved (p = 0.0015 for difference betweengroups), and in no case was the fatigue completelyeliminated. According to one report, at least half of CFS patients with magnesium deficiency ben-efited from oral magnesium supplementation;however, some patients needed IM injections. 33
Both oral and IM administration of the same nu-trients were tried but found to be ineffective.Weekly injections provided almost complete re-lief from symptoms and allowed him to discon-tinue psychotherapy. The patient noted that rap-idly administered injections provided longer-last-ing relief than did slower injections. The infusionrate was therefore carefully and progressively in-creased, without causing any adverse side effectsor changes in blood pressure or heart rate. Thepatient reported that when the treatment was givenover a one-minute period, the effect would lastapproximately two weeks, whereas a slower in-
jection (such as five minutes) would last only aweek. Approximately four years after initial treat-
ment, he was able to reduce the frequency of in- jections to once monthly or less.
Many other patients with depression and/ or anxiety have shown a positive response to theMyers’. However, this treatment should not beconsidered first-line therapy for major depression.It seems to be helpful only for certain subsets of depressed individuals, such as those who also suf-fer from fibromyalgia, migraines, excessive stress,or alcohol-induced exacerbations. Shealy et alhave observed an antidepressant effect of IV mag-nesium in some patients with chronic pain. 39
Cardiovascular DiseaseCase #5: A 79-year-old man was seen at
home in end-stage heart failure, after having suf-fered four myocardial infarctions. During the pre-vious 12 months, spent mostly in the hospital, hehad become progressively worse; his ejection frac-tion had fallen to 19 percent and his body weighthad declined from 171 pounds to a severelycachectic 113 pounds. He was confined to bed andrequired supplemental oxygen much of the time.
He also had severe peripheral occlusive arterialdisease, which had resulted in the development of gangrene of six toes. A peripheral angiogram re-vealed complete occlusion of both femoral-popliteal arteries, with no detectable blood flowto the distal extremities. Two independent vascu-lar surgeons had recommended bilateral above-the-knee amputations to prevent development of septicemia. However, the cardiologist advised the
patient that his heart would not last more thananother month, so the patient declined the ampu-tations.
He was treated with weekly IM injectionsof magnesium sulfate (1 g) for eight weeks, andprescribed oral supplementation with vitamins Cand E, B complex, folic acid, and zinc. The mag-nesium injections appeared to reduce the pain inhis gangrenous toes considerably, with the ben-efit lasting about five days each time. Six weeksafter the first injection, his ejection fraction hadincreased from 19 percent to 36 percent and he nolonger required supplemental oxygen. After eightweeks, the IM injections were replaced by weeklyIV injections, consisting of 5 mL magnesium, 1
mL each of B12, B6, B5, and B complex, and alow-dose (0.2 mL) trace mineral preparation(MTE-5 containing: zinc, copper, chromium, se-lenium, and manganese). After a total of 18months, his weight had increased from 113 to 147pounds, which was remarkable as cardiac cachexiais generally considered to be irreversible. In addi-tion, the gangrenous areas on his toes had sloughedand been replaced almost entirely by healthy tis-sue. Intravenous therapy was continued and even-tually reduced to every other week. The patientlived for eight years and died at age 87 from mul-tiple organ failure.
Of the handful of other patients with an-gina or heart failure who received IV or IM injec-tions of magnesium (with or without B vitamins),all showed significant improvement. The resultswith angina are consistent with those reported byothers using parenteral magnesium therapy. 40-42
Upper Respiratory Tract InfectionsCase #6: A 40-year-old male presented
with a cold and a one-day history of fatigue, nasal
congestion, and rhinorrhea. He was given an IVinfusion of 16 mL vitamin C, 3 mL magnesium,1.5 mL calcium, and 1 mL each of B12, B6, B5,and B complex. By the end of the 10-minute treat-ment he was symptom free. The cold symptomsdid return the next day but were only 10 percentas severe as before the injection.
One-quarter to one-third of patients whoreceived the Myers’ for an acute respiratory in-fection experienced marked improvement, eitherimmediately or by the next morning. Approxi-mately half of patients given this treatment re-ported that it shortened the duration of their ill-ness. Patients who benefited tended to have a simi-lar response if treated for a subsequent infection,whereas non-responders tended to remain non-re-sponders.
Case #7: A 32-year-old female had a longhistory of chronic sinusitis. Avoidance of aller-genic foods and oral supplementation with vita-min C and other nutrients had provided only mini-mal benefit. She was given an IV infusion of 20
mL vitamin C, 4 mL magnesium, 2 mL calcium,and 1 mL each of B12, B6, B5, and B complex;this protocol was repeated the next day. At the timethese injections were given she had been experi-encing persistent sinus problems for a year. Hersymptoms resolved rapidly after the injections andshe remained relatively symptom free for morethan six months. The same treatment given at alater date was also helpful, although the benefitwas not as pronounced as the first time.
One other patient with chronic sinusitishad a similar response to back-to-back injections,while a few others showed no improvement.
Seasonal Allergic RhinitisCase #8: A 38-year-old man had a long
history of seasonal allergic rhinitis, occurring eachspring and lasting about a month. Symptoms in-cluded nasal congestion, itchy eyes, and fatigue.During a symptomatic period, an IV infusion of 12 mL vitamin C, 3 mL magnesium, and 1 mLeach of B12, B6, B5, and B complex providedrapid relief. This treatment was repeated as needed
during the hay fever season (once weekly or less)and successfully controlled his symptoms. In sub-sequent years he began the IVs shortly before, andrepeated them periodically during, the hay feverseason; this approach prevented the developmentof symptoms.
Narcotic WithdrawalCase #9: A 35-year-old man addicted to
morphine came to the office in the early stages of withdrawal, with diaphoresis and extreme agita-tion. He was given an IV infusion of 16 mL vita-min C, 5 mL magnesium, 2.5 mL calcium, and 1mL each of B12, B6, B5, and B complex. In hisagitated state he was unable to sit still on the examtable, so we walked up and down the hall with abutterfly needle in his arm. Halfway through theinjection, he was able to sit still, and by the end of the injection his withdrawal symptoms were alle-viated. The symptoms returned 36 hours later; hetherefore came for another treatment, which again
relieved the symptoms within minutes. He re-turned the next day, still symptom free, for a thirdinjection, which carried him uneventfully throughthe remainder of the withdrawal period.
Chronic UrticariaCase #10: A 71-year-old woman had
chronic urticaria with hives present somewhereon her body nearly every day for 10 years. An al-lergy-elimination diet and oral supplementationwith vitamin C and other nutrients provided littleor no relief. She was given an IV infusion of 12mL vitamin C, 3 mL magnesium, 1.5 mL calcium,and 1 mL each of B12, B6, B5, and B complex.The same treatment was repeated the followingday. After these injections the hives resolved rap-idly and did not recur for more than a year. Whenthe lesions did recur, the IV treatment was repeatedbut was ineffective.
Athletic PerformanceCase #11: An 18-year-old, 235-pound
high school wrestler developed a flu-like illnessfour days before a major tournament. Two daysbefore the three-day tournament, when it appearedhe might have to miss the event, he was given anIV injection of 16 mL vitamin C, 5 mL magne-sium, 2.5 mL calcium, and 1 mL each of B12, B6,B5, and B complex. The next morning he remarkedthat he had more energy than he had ever had in
his life. This energy boost persisted for the dura-tion of the tournament, at which he took secondplace, a better performance than at any other timein his career.
In this era in which many athletes are us-ing performance-enhancing drugs, it is not theauthor’s intention to encourage athletes to seek another “boost” with IV nutrients. However, thiscase does demonstrate that nutritional factors canplay an important role in athletic performance.
HyperthyroidismTwo patients with hyperthyroidism were
treated with the Myers’ once or twice weekly forseveral weeks. In one case, the treatment con-trolled the symptoms of hyperthyroidism, althoughthere was no reduction in thyroid-hormone lev-els. The injections were discontinued after medi-cal therapy had restored the hormone levels tonormal. In the other case, symptoms improvedmarkedly after the first injection and thyroid-func-tion tests, measured two weeks later, returned tonormal.
The potential value of IV nutrient therapyfor patients with hyperthyroidism is supported byseveral studies. Serum and erythrocyte magnesium
levels have been found to be low in patients withGraves’ disease. 43 In addition, daily IM injectionsof magnesium chloride (20 mL of a 14-percentsolution) for 3-7 weeks reduced the size of thethyroid gland and improved the clinical conditionof three patients with hyperthyroidism. 44 Intrave-nous vitamin B6 (50 mg per day) was reported torelieve muscle weakness in three patients withhyperthyroidism, 45 and animal studies indicatevitamin B12 can counteract some of the adverseeffects of experimentally induced hyperthyroid-ism. 46,47
Other ConditionsThe modified Myers’ cocktail seems to
provide rapid relief for patients with acute musclespasm resulting from sleeping in the wrong posi-tion or from overuse. It also has been observed torelieve tension headaches in many cases. One pa-tient (a 70-year-old female) with chronic torticol-lis experienced moderate pain relief with periodic
treatments. Of three patients with acute dysmen-orrhea treated with the Myers’, two experiencedalmost instant pain relief. One patient with chronicobstructive pulmonary disease intermittently re-ceived weekly IV injections and reported the treat-ments improved his strength and breathing.
Choice of Ingredients andAdministration
At the time of this writing, cyanocobalaminis a widely available form of injectable vitamin B12,whereas hydroxocobalamin can be obtained onlythrough a compounding pharmacist. While bothforms of the vitamin are effective, hydroxocobal-amin is preferred because it produces more pro-longed increases in serum vitamin B12 levels. 48
It has been the author’s impression (andthat of other clinicians) that some patients who re-spond to IM vitamin B12 injections do not experi-ence the same benefit when vitamin B12 is givenas part of the Myers’. It is possible that vitamin Cor another component of the Myers’ destroys someof the vitamin B12, 49 or that IV vitamin B12 is lostmore rapidly in the urine than IM vitamin B12.Therefore, for some patients receiving IV nutrienttherapy, 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. Althoughmost clinical research has been done withmagnesium sulfate, some experts prefer magnesiumchloride for IV use because of its greater retentionin the body. 50 The author has used magnesiumchloride almost exclusively for IV therapy, whilereserving the more concentrated magnesium sulfatefor IM administration. For those using magnesiumsulfate, it should be noted that 1 g (2 mL of a 50-percent solution) is equivalent to 0.8 g (4 mL of a20-percent solution) of magnesium chloride (eachcontains 4 mMol of magnesium). In addition, if 50-percent magnesium sulfate is given IV instead of 20-percent magnesium chloride, it should be dilutedappropriately with sterile water.
Injectable vitamin C is currently availablein concentrations of 222 and 500 mg per mL. Theauthor typically uses the lower concentration forIV therapy. If the higher concentration is used, itshould be diluted appropriately with sterile water.
Occasionally, trace minerals were includedas part of a nutrient infusion. The usual dose was0.2-0.5 mL of MTE-5, which contains (per mL):zinc 1 mg, copper 0.4 mg, chromium 4 mcg, sele-nium 20 mcg, and manganese 0.1 mg. The prepa-ration was diluted six-fold and administered over aperiod of 1-2 minutes in a separate syringe at theend of the Myers’ push. Two adverse reactions havebeen noted with 10 mg of zinc given by slow IVpush; consequently, when giving trace minerals by
IV push, very small doses are used. Trace mineralsshould not be mixed in the same syringe with thecomponents of the Myers’, as doing so often causesformation of a precipitate.
Side Effects and PrecautionsThe Myers’ often produces a sensation of
heat, particularly with large doses or rapid admin-istration. This effect appears to be due primarilyto the magnesium, although rapid injections of calcium have been reported to produce a similar
effect.22
The sensation typically begins in the chestand migrates to the vaginal area in women and tothe rectal area in men. For most patients the heatdoes not cause excessive discomfort; indeed, somepatients enjoy it. However, if the infusion is giventoo rapidly, the warmth can be overbearing. Somewomen experience a sensation of sexual pleasurein association with the vaginal warmth; on rareoccasions, an orgasm may occur during an IV in-fusion. Other patients have remarked their visualacuity and color perception become sharper im-mediately after an injection, as if someone had
turned the lights on. In some cases, this effect lastsas long as one or two days.
Too rapid administration of magnesiumcan cause hypotension, which can lead tolightheadedness or even syncope. Patients receiv-ing a Myers’ should be advised to report the onsetof excessive heat (which can be a harbinger of hypotension) or lightheadedness. If either of thesesymptoms occurs, the infusion should be stopped
temporarily and not resumed until the symptomshave resolved (usually after 10-30 seconds). Pa-tients with low blood pressure tend to tolerate lessmagnesium than do patients with normal bloodpressure or hypertension. In a small proportion of patients, even a low-dose regimen given veryslowly causes persistent hypotension; in thosecases, the treatment is usually discontinued andmay or may not be attempted at a later date.
Although too rapid administration canhave adverse consequences, some patients appearto experience more pronounced benefits fromrapid infusions than from slower ones, presum-ably because of higher peak serum concentrationsof nutrients. While both the risks and benefits
should be taken into account in determining aninfusion rate, when in doubt one should err on theside of safety. When administering the Myers’ toa patient for the first time, it is best to give 0.5-1.0mL and then wait 30 seconds or so before pro-ceeding with the rest of the infusion. Doing so mayhelp one distinguish between a vasovagal reac-tion and a hypotensive response to the injectedcompounds. Patients who experience a vasovagalreaction at the beginning of an infusion can usu-ally tolerate the remainder of the treatment afterthe reaction has worn off.
For elderly or frail individuals, it may beadvisable to start with lower doses than those listedin Table 1, or to consider IM administration of magnesium and B vitamins as an alternative to IVtherapy. However, many elderly patients have tol-erated, and benefited from, IV therapy.
Patients who are deficient in both mag-nesium and potassium may have an influx of po-tassium into the cells after receiving IV magne-sium. 51 This occurs because magnesium activatesthe membrane pump that promotes the intracellu-
lar uptake of potassium. The shift of potassiumfrom the serum to the intracellular space can trig-ger hypokalemia. The author has seen two patientsdevelop severe muscle cramps several hours afterreceiving a Myers’; both patients had been takingmedications known to deplete potassium. Hy-pokalemia also increases the risk of digoxin-in-duced cardiac arrhythmias. As a first-year resident,
unaware of this potential problem, the author ad-ministered IV magnesium in the hospital to an eld-erly woman who was taking digoxin and a potas-sium-depleting diuretic. She quickly developed anarrhythmia, which required short-term treatment inthe intensive care unit.
Patients considered to be at risk of potas-sium deficiency include those taking potassium-depleting diuretics, beta-agonists, or glucocorti-coids; those with diarrhea or vomiting; and thosewho are generally malnourished. If a patient is hy-pokalemic, the hypokalemia should be correctedbefore IV magnesium therapy is considered. How-ever, a normal serum potassium concentration isnot a guarantee against intracellular potassium
depletion. For patients considered to be at risk of potassium deficiency, administration of 10-20 mEqof potassium orally just prior to the infusion, andagain 4-6 hours later is recommended. After thispractice was instituted, no further problems withmagnesium-induced muscle cramps were encoun-tered.
The addition of even small amounts of potassium to an IV push is strongly discouraged,because of the theoretical risk of triggering an ar-rhythmia during the first pass when the bolusreaches the cardiac conducting system.
Intravenous calcium is contraindicated inpatients taking digoxin. In addition, hypercalcemiacan cause cardiac arrhythmias. For that reason, theauthor has tended to leave calcium out of the Myers’when treating patients with cardiac disease, al-though there is no strong evidence it is dangerousfor such patients.
Anaphylactic reactions to IV thiamine havebeen reported on rare occasions. Only three suchreactions have been identified in the U.S. litera-ture since 1946. However, in the world literature, a
total of nine deaths attributed to thiamine adminis-tration were reported between 1965 and 1985. 52
These reactions have occurred after oral, IV, IM,or subcutaneous administration, and are believedto be due in part to a nonspecific release of hista-mine. Anaphylactic reactions have been seen mostoften after multiple administrations of thiamine. Inthe United Kingdom, between 1970 and 1988, therewere approximately four reports of anaphylactoid
reactions for every million ampules of IV B vita-mins sold, and one report for every 5 million IMampules sold. 53
It is possible the risk of anaphylaxis fromthe Myers’ is even lower than the low risk associ-ated with the use of IV thiamine. Many patientswho receive parenteral thiamine are alcoholics, andalcoholism frequently causes magnesium defi-ciency. Animal studies suggest thiamine supple-mentation in the presence of magnesium deficiencyincreases the severity of the magnesium defi-ciency. 54 A deficiency of magnesium can lead tospontaneous release of histamine, 55 and has beenreported to increase the incidence of experimen-tally induced anaphylaxis in animals. 56 The pres-
ence of magnesium in the Myers’ might, therefore,reduce the risk of an anaphylactic reaction to thia-mine. Moreover, as the Myers’ has been used suc-cessfully to treat asthma and urticaria, it is likelythe formula as a whole provides prophylaxis againstanaphylaxis. Nevertheless, practitioners who ad-minister IV nutrients should be prepared to dealwith the rare anaphylactic reaction.
A small number of patients (approximatelyone percent) felt “out of sorts” for up to a day afterreceiving an injection and, in two cases, this reac-tion lasted one and two weeks, respectively. It isnot clear whether these reactions were due to thepreservatives in some of the injectable preparations(e.g., benzyl alcohol, methylparabens, or others)or to the nutrients themselves. In most cases (in-cluding a few patients with asthma) preservative-containing products were used because the use of multi-dose vials reduced the cost of treatment tothe patient. However, for some individuals withknown chemical sensitivities or other significantallergy-related problems, preservative-free prepa-rations were used.
Although the Myers’ is extremely hyper-tonic, it rarely seemed to cause problems related to
its hypertonicity. Two or three patients developedphlebitis at the injection site; for those patients, latertreatments were diluted with sterile water to a totalof 60 mL. Some patients experienced a burningsensation at the injection site during the infusion;this was often corrected by re-positioning the needleor by further diluting the nutrients.
When administered with caution and re-spect, the Myers’ has been generally well tolerated,and no serious adverse reactions have been encoun-tered with approximately 15,000 treatments.
Cost ConsiderationsIn 1995, the author’s last year in private
practice, the cost of the materials for a Myers’ wasapproximately $5.00. The use of preservative-freenutrients at least doubled the cost of materials.Nursing time and administrative factors repre-sented the majority of the cost of IV nutrienttherapy. 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 hasincreased by 50-100 percent.
Insurance companies do not generally payfor this treatment. However, in a few instances,showing them that IV nutrient therapy had greatlyreduced the overall cost of the patient’s health carepersuaded them to pay.
ConclusionThe Myers’ has been found by the author
and hundreds of other practitioners to be a safe
and effective treatment for a wide range of clini-cal conditions. In many instances this treatment ismore effective and better tolerated than conven-tional medical therapies. Although most of theevidence is anecdotal, some published research hasdemonstrated the efficacy of the Myers’ or someof its components. Widespread appropriate use of this treatment would likely reduce the overall costof healthcare, while greatly improving the healthof many individuals. Additional research is ur-gently needed to confirm the effectiveness of thistreatment and to determine optimal doses of thevarious nutrients. Although double-blind trialswould be difficult to perform because of the obvi-ous sensations induced by IV nutrient infusions,trials comparing the Myers’ with established thera-pies would be informative. Practitioners using thistreatment are encouraged to report their findings.
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