Usage
Alginic acid + potassium hydrogen carbonate is prescribed for the symptomatic relief of gastroesophageal reflux disease (GERD) and its associated symptoms, such as heartburn, acid regurgitation, and indigestion (dyspepsia). It’s also used to alleviate symptoms related to acid reflux after meals, during pregnancy, or due to a hiatal hernia. It is pharmacologically classified as a reflux suppressant and antacid.
The medication works by creating a physical barrier and neutralizing stomach acid. Alginic acid reacts with saliva and gastric acid to form a viscous gel, a “raft,” that floats on the stomach contents, preventing acid reflux into the esophagus. Potassium hydrogen carbonate neutralizes excess stomach acid, further reducing irritation.
Alternate Names
Alginate/Potassium Bicarbonate; Sodium Alginate/Potassium Hydrogen Carbonate. Some popular brand names include Gaviscon, Gaviscon Advance, and others.
How It Works
Pharmacodynamics: Alginic acid reacts with gastric acid to form a viscous gel, creating a physical barrier that prevents reflux. Potassium bicarbonate neutralizes gastric acid, raising the pH and decreasing irritation in the esophagus. This raft is buoyant due to the entrapped carbon dioxide gas produced by the reaction between the carbonate and stomach acid. The protective layer remains localized in the stomach, without significant systemic absorption.
Pharmacokinetics: Alginic acid isn’t absorbed systemically. It forms a raft in the stomach and is later broken down in the digestive system and expelled in the feces. Potassium hydrogen carbonate is absorbed, but given the low dose, significant systemic effects are unlikely in patients with normal renal function. Any absorbed potassium is excreted renally. The medication’s effect is primarily topical and mechanical within the gastrointestinal tract, and therefore systemic absorption is minimal. It is not metabolized by CYP enzymes.
Mode of Action: Upon contact with gastric acid, alginic acid forms a gel raft due to the presence of calcium ions in the formulation. Carbon dioxide is released through the reaction of potassium hydrogen carbonate with gastric acid. This gas gets entrapped within the gel raft, providing buoyancy and allowing it to float on top of the stomach’s contents. The raft acts as a physical barrier, impeding gastro-oesophageal reflux for up to 4 hours, and protecting the oesophagus from the harmful effects of acid, pepsin, and bile.
Elimination: Primarily via fecal excretion.
Dosage
Standard Dosage
Special Cases:
- Elderly Patients: No dose modification is usually needed unless there is renal impairment.
- Patients with Renal Impairment: Caution is needed, especially for those on restricted sodium diets. Potassium levels should be monitored.
- Patients with Hepatic Dysfunction: No dose adjustments are typically needed.
- Patients with Comorbid Conditions: Those with heart failure or on a controlled potassium diet should be cautious due to the sodium and potassium content.
Clinical Use Cases
Dosage recommendations for specific clinical scenarios, such as intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations, are not explicitly defined for alginic acid + potassium hydrogen carbonate. Its primary use is for the symptomatic relief of GERD.
Dosage Adjustments
Dose adjustments are not generally needed for specific clinical use cases. However, consider renal function and electrolyte balance in patients with heart failure or renal impairment, particularly regarding sodium and potassium levels.
Side Effects
Common Side Effects:
Diarrhea, nausea, vomiting, bloating, and flatulence. These side effects are typically mild and transient.
Rare but Serious Side Effects:
Allergic reactions, including difficulty breathing, hives, skin rash, and facial swelling, though rare, necessitate immediate discontinuation of the medication and urgent medical intervention.
Long-Term Effects:
No specific long-term side effects have been identified. However, chronic kidney disease patients or individuals with a high sodium intake should be cautious about the medication’s sodium content.
Adverse Drug Reactions (ADR):
While uncommon, hypersensitivity reactions and allergic manifestations constitute potential ADRs necessitating urgent intervention. Monitor patient closely and discontinue the medication if such reactions occur.
Contraindications
Hypersensitivity to any components of the formulation. Caution is advised in patients with renal insufficiency and those on restricted sodium or potassium diets.
Drug Interactions
Alginic acid may reduce the absorption of certain drugs, including tetracyclines, fluoroquinolones, iron salts, thyroid hormones, chloroquine, bisphosphonates, and estramustine. Maintain a 2-hour interval between alginic acid + potassium hydrogen carbonate administration and these medications. Inform the doctor about all current medications, including OTC drugs and supplements.
Pregnancy and Breastfeeding
Available data indicates no malformative or feto/neonatal toxicity with alginic acid and potassium hydrogen carbonate use. Considered generally safe during pregnancy and breastfeeding if clinically needed.
Drug Profile Summary
- Mechanism of Action: Forms a physical barrier (raft) in the stomach and neutralizes gastric acid.
- Side Effects: Diarrhea, nausea, vomiting, bloating, flatulence, and rarely allergic reactions.
- Contraindications: Hypersensitivity. Caution in renal impairment and sodium/potassium restricted diets.
- Drug Interactions: Tetracyclines, fluoroquinolones, iron salts, thyroid hormones, chloroquine, bisphosphonates, and estramustine.
- Pregnancy & Breastfeeding: Generally considered safe.
- Dosage: Adults: 5-10 ml/1-2 tablets after meals and at bedtime. Pediatric dosage requires physician guidance.
- Monitoring Parameters: Renal function and electrolyte balance in specific patient populations.
Popular Combinations
Often combined with other antacids like calcium carbonate and magnesium carbonate for enhanced neutralizing capacity.
Precautions
- General Precautions: Screen for allergies and assess renal function, especially for patients with renal/heart failure, edema, and cirrhosis. Those with hypercalcemia, nephrocalcinosis, recurrent calcium-containing renal calculi, or on a restricted sodium or potassium diet require careful consideration.
- Specific Populations: Refer to Dosage section.
- Lifestyle Considerations: Interaction with alcohol is unknown. Advise patients to consult their doctor regarding alcohol consumption while taking this medicine.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Alginic Acid + Potassium Hydrogen Carbonate?
A: Adults: 5-10 ml or 1-2 tablets after meals and at bedtime, up to four times a day. Pediatric dosage needs physician guidance.
Q2: How quickly does Alginic Acid + Potassium Hydrogen Carbonate work?
A: The raft forms almost immediately upon contact with stomach acid, providing rapid relief from heartburn and acid reflux.
Q3: Can I take this medication during pregnancy?
A: Generally considered safe for use during pregnancy and breastfeeding, but consult your doctor.
Q4: What are the major contraindications for this drug?
A: Known hypersensitivity to any components. Use with caution in patients with renal impairment, heart failure, or on restricted sodium/potassium diets.
Q5: Are there any specific drug interactions I should be aware of?
A: Yes. Avoid co-administration with certain antibiotics, iron salts, thyroid hormones, and other medications. Maintain a 2-hour interval between this medication and other interacting drugs.
Q6: Can this be used long-term for GERD management?
A: While effective for symptom relief, it’s not a primary treatment for GERD. Consult a physician for ongoing management and consider alternative options for long-term GERD control.
A: Common side effects are mild and include diarrhea, nausea, vomiting, bloating, and flatulence. Although rare, severe allergic reactions might occur.
A: The liquid generally acts more quickly than the tablets, but both forms are effective. Patient preference can guide selection.
Q9: Can I take this medicine along with proton pump inhibitors (PPIs)?
A: Combining these with PPIs can be beneficial, especially for those with refractory GERD. The combination is primarily for symptomatic relief, whereas PPIs are for long-term management and healing of the esophagus.
A: Calcium carbonate provides additional antacid activity. However, consider the potential for increased calcium levels in susceptible individuals.
