eng Oriental Scientific Publishing Company Biomedical and Pharmacology Journal 0974-6242 2026-07-28 19 3 72888 article Jyoti Mahadev Benni 1 Varsha Mahesh Shindhe 2 Reshma Nadaf 3 Savita Hiremath 4 Fareedabanu Balikai 5 Department of Pharmacology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (KAHER), Deemed-to-be-University, Belagavi, Karnataka, India. Department of Physiology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (KAHER), Deemed-to-be-University, Belagavi, Karnataka, India. Department of Pharmacology, Karnataka Medical College and Research Institute, Hubballi, Karnataka, India. Department of Physiology, SSPM Medical College and Lifetime Hospital, Padve, Shindudurga, Maharashtra, India. Department of Physiology, Universiti Sains Malaysia- KLE, International Medical Programme, Belagavi, Karnataka, India. Magnesium is a vital divalent cation involved in more than 300 enzymatic reactions crucial for cellular metabolism, neuromuscular transmission, and cardiovascular (CV) stability. Traditionally regarded as an electrolyte required for physiological homeostasis, magnesium is now increasingly recognized as a multifunctional modulator influencing diverse biochemical and pharmacological pathways. This narrative review examines the evolving pharmacological significance of magnesium supplementation beyond electrolyte balance, with emphasis on its mechanisms of action, therapeutic roles, and clinical implications. A targeted literature search was performed in PubMed, Scopus, and Google Scholar to retrieve relevant experimental and clinical studies published in English up to the year 2025. Articles addressing magnesium’s physiological actions, deficiency states, and therapeutic interventions were critically reviewed and synthesized. Evidence indicates that magnesium exerts pleiotropic effects on cellular signalling, vascular tone, immune modulation, and neuronal excitability. Therapeutically, magnesium supplementation has been explored in CV disorders, metabolic syndrome, neurological conditions, inflammatory diseases, and oncology. Experimental studies further demonstrate its role in reducing oxidative stress, regulating apoptosis, and maintaining genomic stability. Overall, magnesium’s pharmacological potential extends well beyond its classical role in electrolyte homeostasis. A deeper understanding of its diverse mechanisms may inform therapeutic innovation. However, further translational and clinical studies are desirable to find the optimal dosing strategies, formulations, and disease-specific applications. https://biomedpharmajournal.org/vol19no3/magnesium-a-multifunctional-therapeutic-agent-recent-updates-on-mechanisms-and-clinical-implications-beyond-electrolyte-homeostasis/ Cardioprotection Magnesium Metabolic syndrome Neuroprotection Oxidative stress Pharmacological mechanisms Pleiotropic effects