Exact standard formulation
| Ingredient | Typical dose | Mechanism of action | Osmolarity contribution |
|---|---|---|---|
| Magnesium chloride hexahydrate 20% (200 mg/mL) | 2–5 mL (0.4–1 g; ≈ 4–10 mEq Mg²⁺) | Cofactor for ATP-dependent enzymes; calcium-channel and NMDA modulation; relaxes vascular smooth muscle (the source of the warm flush) | ≈ 5.9 mOsm per mL of stock; ≈ 12–30 mOsm per dose |
| Calcium gluconate 10% (100 mg/mL) | 1–3 mL (100–300 mg; ≈ 0.5–1.4 mEq Ca²⁺) | Offsets magnesium’s calcium-channel effect; membrane stability and neuromuscular function | ≈ 0.68 mOsm per mL; ≈ 1–2 mOsm per dose |
| Vitamin B-complex 100 | 1 mL (commonly thiamine 100 mg, niacinamide 100 mg, riboflavin 2 mg, pyridoxine 2 mg, dexpanthenol 2 mg; verify label) | Coenzymes for carbohydrate metabolism, the TCA cycle and NAD/FAD synthesis | ≈ 1.5 mOsm |
| Pyridoxine HCl (B6) 100 mg/mL | 1 mL (100 mg) | Pyridoxal-5-phosphate: transamination and neurotransmitter synthesis | ≈ 1 mOsm |
| Dexpanthenol (B5) 250 mg/mL | 1 mL (250 mg) | Converted to pantothenic acid, the backbone of coenzyme A | ≈ 1.2 mOsm |
| Hydroxocobalamin (B12) 1,000 mcg/mL | 1 mL (1,000 mcg) | Cofactor for methionine synthase and methylmalonyl-CoA mutase | Negligible (< 0.1 mOsm) |
| Ascorbic acid 500 mg/mL (buffered) | 1–5 mL (0.5–2.5 g) | Water-soluble antioxidant; cofactor for collagen hydroxylation; regenerates vitamin E | ≈ 11 mOsm per gram as sodium ascorbate; ≈ 6–28 mOsm |
| Carrier: 0.9% NaCl or Lactated Ringer’s | 250–1,000 mL | Volume vehicle that dilutes the hypertonic additives to a peripheral-friendly osmolarity | NS 308 mOsm/L; LR ≈ 273 mOsm/L |
Clinical background and what the evidence shows
The protocol is named after John Myers, a Baltimore physician who gave an intravenous vitamin and mineral push to patients for decades. It became widely known after a 2002 review in Alternative Medicine Review described a standardized version and the conditions it had been used for, including fatigue, migraine, fibromyalgia and asthma flares.
The original was a slow IV push of roughly 20 mL from a syringe, not a bag. Today almost every lounge and mobile service dilutes the same ingredients in a 250–1,000 mL bag, which is gentler on the vein and adds hydration.
Controlled evidence is thin. The best-known trial, a small placebo-controlled pilot in fibromyalgia published in 2009, found improvement in both the Myers’ and placebo groups without a statistically significant difference between them. Each ingredient is an FDA-approved injectable for deficiency states, but the combination itself has no FDA-approved indication, so wellness use is off-label and should be described as something that may help some people feel better, not as a treatment.
Carrier fluid selection: NS, LR or sterile water
The additives in a Myers’ are strongly hypertonic on their own. The carrier fluid exists to dilute them, and the choice between carriers is mostly about volume, comfort and compatibility.
- 0.9% Sodium Chloride (NS), 308 mOsm/L. The default in most protocols. Compatible with every Myers’ ingredient, including calcium. A 250–500 mL bag is common for a standard Myers’.
- Lactated Ringer’s (LR), about 273 mOsm/L. Slightly hypotonic and closer to plasma electrolytes. Its calcium (2.7 mEq/L) is compatible with the Myers’ additives. Many clinics use a 1,000 mL LR bag when the patient also wants rehydration.
- Sterile Water for Injection. Used only to dilute the classic syringe push or very high-dose vitamin C. Sterile water is never infused on its own because a hypotonic solution causes hemolysis.
See the Normal Saline vs Lactated Ringer’s comparison for electrolyte composition and compatibility warnings.
Osmolarity math for a typical bag
Peripheral veins tolerate solutions well below roughly 900 mOsm/L, a ceiling often cited from parenteral nutrition guidance; most infusion teams aim far lower for comfort. The worked example below uses a 1 g magnesium, 300 mg calcium, 2.5 g ascorbic acid load (about 49 mOsm of additives in about 17 mL).
| Presentation | Total volume | Base mOsm | Additive mOsm | Final osmolarity (approx.) |
|---|---|---|---|---|
| Classic syringe push in sterile water | ≈ 20 mL | 0 | ≈ 49 | ≈ 2,400 mOsm/L (why it is pushed over 5–15 min) |
| 250 mL NS bag | ≈ 267 mL | 77 | ≈ 49 | ≈ 470 mOsm/L |
| 500 mL NS bag | ≈ 517 mL | 154 | ≈ 49 | ≈ 390 mOsm/L |
| 1,000 mL LR bag | ≈ 1,017 mL | 273 | ≈ 49 | ≈ 320 mOsm/L |
Figures ignore manufacturer overfill (commercial bags often contain several percent extra) and assume buffered ascorbate. They are teaching estimates, not a compounding record.
Infusion rate, duration and what patients feel
A Myers’ in a 500 mL bag typically runs over 45–60 minutes through a 22G or 24G peripheral catheter. A 1,000 mL LR bag runs 45–60 minutes in a healthy adult; a 250 mL bag can finish in 20–30 minutes, but faster is not better.
Magnesium is the rate-limiting ingredient. Given quickly it causes warmth, flushing, a metallic taste, lightheadedness and, occasionally, a drop in blood pressure. Most protocols deliver the magnesium dose over at least 15–30 minutes and tell the nurse to slow the drip if flushing becomes uncomfortable.
- Before the start: baseline blood pressure, heart rate, SpO₂ and temperature; confirm the order and the GFE are current.
- During: reassess vital signs at least once mid-infusion and at the end, check the site for infiltration, and keep the patient seated or reclined.
- After: observe for 10–15 minutes after the catheter is removed before the patient drives.
Mixing, sourcing and USP <797> boundaries
A Myers’ bag contains five to seven separate sterile components. Under USP <797> immediate-use rules, a nurse can combine no more than three sterile products outside a cleanroom, and administration must begin within four hours. A full Myers’ mixed at the bedside from single vials therefore exceeds the immediate-use limit in most readings of the chapter.
Compliant practices handle this in one of two ways: they order a pre-mixed Myers’ additive syringe or bag from a 503B outsourcing facility or a 503A pharmacy with a patient-specific prescription, or they reduce the bedside steps to three or fewer components. State Boards of Pharmacy interpret and enforce this differently, so verify your state’s position; the USP <797> guide covers inspections in detail.
Lounge vs mobile pricing context
National self-pay benchmarks put a Myers’ at $165–$225 in a lounge and $225–$295 for mobile concierge at home, a hotel or an office. The mobile premium pays for nurse drive time, a second set of supplies kept in the vehicle and cold-chain storage, not a different formula.
Ask what is included. A fair quote names the carrier volume, the ascorbic acid dose, whether B12 is in the bag or a separate IM shot, and whether the GFE fee ($27–$35 on most telehealth networks) is added. Large metros such as New York, Los Angeles and Miami run above these ranges; much of the Midwest and South runs below.
Model your own visit, including add-ons and group discounts, in the Myers’ Cocktail configurator.
Who it is for and who it is not for
People most often book a Myers’ for general fatigue, recovery after travel or illness, or as a maintenance drip. Those uses rest on patient experience and small studies rather than strong trials. A person with a specific deficiency, such as confirmed low B12 or magnesium, should have it worked up and treated by their own clinician, since a monthly drip is not a substitute.
Patients who want rehydration plus vitamins are better served by a 1,000 mL LR Myers’; those who mainly want hydration can choose plain fluids. For immune-focused visits, compare the zinc and vitamin C protocol.
Lounge vs. mobile price benchmarks
| Setting | Typical price | What is included | Notes |
|---|---|---|---|
| In-clinic lounge | $165–$225 | 250–1,000 mL bag, standard Myers’ additives, nurse monitoring | GFE often separate ($27–$35) for first visit |
| Mobile concierge | $225–$295 | Same formula at home, hotel or office; travel within a service radius | Expect a trip fee outside the radius or after hours |
| Glutathione push add-on | +$35–$60 (lounge) / +$30–$65 (mobile) | 600–2,000 mg slow push after the bag | Given separately, not mixed into the Myers’ bag |
| B12 IM or Vitamin D3 IM add-on | +$30–$50 | Single intramuscular injection | Some menus include B12 in the base price |
| Group event (3–5 people) | ≈ 10% off per person | One RN, shared travel | 6–9 people ≈ 15% off; 10+ ≈ 20% off with multiple RNs |
| Membership / package | Commonly 10–20% below the single-visit price | Typically one drip per month plus discounted add-ons | Terms vary widely; read cancellation rules before signing |
Prices are national self-pay medians; the drip configurator applies your state’s regional index, add-ons and group tiers.
Mandatory screening & contraindications
Required before the infusion
- Good Faith Exam by an MD, DO, NP or PA (synchronous telehealth in most states) before the first infusion and when health history changes
- Medication review, specifically digoxin, ceftriaxone, diuretics and any drug that affects calcium or magnesium
- Kidney and heart history: chronic kidney disease, dialysis, heart failure, arrhythmia or heart block
- Baseline blood pressure, heart rate, SpO₂ and temperature, rechecked during and after the infusion
- Pregnancy and breastfeeding status
- Allergy history, including thiamine, cobalt (hydroxocobalamin) and preservatives such as benzyl alcohol
Contraindications & stop signals
- Absolute: known hypersensitivity to any ingredient
- Absolute: hypercalcemia or hypermagnesemia
- Absolute: severe renal impairment or dialysis (magnesium accumulates)
- Relative: heart block, bradycardia or myasthenia gravis (magnesium)
- Relative: digoxin therapy (IV calcium can provoke toxicity)
- Relative: heart failure or other fluid-restricted states (limit carrier volume)
- Relative: history of oxalate kidney stones or hemochromatosis (ascorbic acid)
- Relative: pregnancy (requires obstetric clearance)
Configure this protocol for your group or event
Choose mobile or lounge, volume, add-ons and participants; the estimate, safety flags and printable brief update instantly and carry into your booking request.
Where this protocol is in demand
Myers’ demand is highest in large lounge markets and resort metros where mobile wellness and hotel recovery bookings concentrate.
For clinics offering this drip: USP <797> Sterile Compounding Compliance and Immediate-Use Rules for IV Hydration Clinics · FDA Section 503A vs 503B Outsourcing Facilities: Sourcing Sterile IV Nutrients Legally · Medical Director Requirements, Responsibilities and Monthly Retainer Benchmarks.
Frequently asked questions
What is in a Myers’ Cocktail?
The standard version contains magnesium chloride, calcium gluconate, a B-complex, extra B6 and B5, vitamin B12 and ascorbic acid, diluted in saline or Lactated Ringer’s. Doses vary by clinic, so ask for the ingredient list and amounts before your visit.
How long does a Myers’ Cocktail take?
Most bag versions take 45–60 minutes, plus a few minutes for setup and observation afterward. The original syringe version was pushed over 5–15 minutes, but most clinics no longer give it that way because a slower bag is more comfortable.
Why do I feel warm during the drip?
Magnesium relaxes blood vessels, which causes a warm or flushed feeling, sometimes with a metallic taste. Tell the nurse; slowing the rate usually resolves it within minutes.
Does a Myers’ Cocktail work?
Evidence is limited. Case reports and patient experience are positive, but the largest placebo-controlled pilot did not show a significant difference from placebo. It is used for general wellness and is not FDA-approved to treat any condition.
How often can I get a Myers’ Cocktail?
Many protocols allow weekly to monthly infusions for healthy adults, with the exact interval set by the medical director. More frequent dosing should prompt a check of kidney function and the reason you feel you need it.
Can I use my HSA or FSA for a Myers’ Cocktail?
Usually only with a Letter of Medical Necessity from a clinician that ties the infusion to a diagnosed condition. General wellness drips are typically not eligible expenses on their own.
Sources & standards reviewed
- Gaby AR. Intravenous nutrient therapy: the “Myers’ cocktail.” Alternative Medicine Review, 2002 Alternative Medicine Review
- Ali A, et al. Intravenous micronutrient therapy (Myers’ Cocktail) for fibromyalgia: a placebo-controlled pilot study. Journal of Alternative and Complementary Medicine, 2009 Mary Ann Liebert
- USP General Chapter <797> Pharmaceutical Compounding—Sterile Preparations USP
- Magnesium: Fact Sheet for Health Professionals NIH Office of Dietary Supplements
- Infusion Therapy Standards of Practice Infusion Nurses Society
- Ceftriaxone and calcium-containing solutions: FDA drug safety information U.S. Food and Drug Administration
Reviewed under the IVConnection clinical and regulatory review policy. Report a correction to clinical@ivconnection.com.