Usage
This combination medication is prescribed for the symptomatic relief of heartburn, acid indigestion, sour stomach, upset stomach, and bloating associated with conditions like gastroesophageal reflux disease (GERD), gastritis, peptic ulcer disease, and hiatal hernia. It is also used to relieve gas. It falls under the pharmacological classifications of antacids and antiflatulents.
The Aluminium Hydroxide and Milk of Magnesia (Magnesium Hydroxide) components neutralize excess stomach acid by raising the gastric pH. Dimethicone, an antifoaming agent, works by reducing the surface tension of gas bubbles, facilitating their expulsion and preventing their formation in the digestive tract.
Alternate Names
While “Aluminium Hydroxide + Dimethicone + Milk Of Magnesia” accurately describes the drug’s composition, variations may exist. Milk of magnesia is another name for magnesium hydroxide. There may be alternate International Nonproprietary Names (INNs) depending on the specific formulation. Brand names for this combination or similar combinations include Gelusil and Antagil.
How It Works
Pharmacodynamics: Aluminium Hydroxide and Magnesium Hydroxide neutralize gastric acid, increasing gastric pH and relieving symptoms of hyperacidity. Dimethicone reduces gas formation and facilitates its expulsion.
Pharmacokinetics: Aluminium Hydroxide and Magnesium Hydroxide have limited systemic absorption. Dimethicone is not absorbed and is eliminated through the feces. Small amounts of aluminum and magnesium that are absorbed are primarily excreted renally. Metabolism is not a significant factor for these components. The mode of action for the antacids involves direct chemical neutralization of hydrochloric acid in the stomach. Dimethicone works physically by altering surface tension.
Elimination Pathways: Primarily renal excretion for aluminum and magnesium. Fecal excretion for dimethicone.
Dosage
Standard Dosage
Adults:
The typical adult dose for this combination varies depending on the specific product and its formulation (suspension, tablet, etc.). Generally, it is advised to take the medication after meals and at bedtime, or as directed by a physician. The usual dose ranges from 10-20 mL of the suspension or 1-2 tablets, taken 4 times daily or as needed. The maximum daily dose should not exceed the manufacturer’s recommendations, typically around 80 mL or 12 tablets per day.
Children:
This combination is generally not recommended for children under 6 years old. Dosing for children over 6 should be determined by a pediatrician, considering factors like age and weight. For children between 2-6 years, 5-15 ml of regular-strength liquid can be given orally at bedtime or in divided doses. For those between 6-12 years, 15-30ml a day can be given. For 12 years and above, 30-60 ml can be given at bedtime or in divided doses. Pediatric safety considerations include monitoring for potential adverse effects like constipation or diarrhea.
Special Cases:
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Elderly Patients: Use with caution due to potential for decreased renal function and risk of aluminum or magnesium accumulation. Monitor renal function and electrolyte levels.
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Patients with Renal Impairment: Use with caution and monitor serum aluminum and magnesium levels due to the risk of toxicity. Dosage adjustment may be necessary.
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Patients with Hepatic Dysfunction: No specific adjustments are typically required but use with caution.
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Patients with Comorbid Conditions: Consider the sorbitol content if present in some formulations for patients with diabetes. Monitor for interactions with other medications for various comorbidities.
Clinical Use Cases
This specific combination is not typically indicated for use in clinical settings such as intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Dosage adjustments may be necessary based on patient-specific factors like renal impairment, other comorbid conditions, and concomitant medications. Always consider the potential for drug interactions and monitor for adverse effects.
Side Effects
Common Side Effects:
Constipation (Aluminium Hydroxide), diarrhea (Milk of Magnesia), chalky taste, nausea, stomach cramps, loss of appetite, weakness.
Rare but Serious Side Effects:
Allergic reactions (rash, itching, swelling), aluminum toxicity (muscle weakness, bone pain, seizures) primarily in patients with renal impairment, hypermagnesemia (nausea, vomiting, muscle weakness, low blood pressure).
Long-Term Effects:
Osteoporosis (from prolonged aluminum use), electrolyte imbalances (from prolonged magnesium hydroxide use).
Adverse Drug Reactions (ADR):
Severe allergic reactions require immediate medical intervention. Monitor for signs of aluminum or magnesium toxicity.
Contraindications
Hypersensitivity to any component, severe renal impairment, hypermagnesemia, severe dehydration, gastrointestinal obstruction, appendicitis, inflammatory bowel disease, severe abdominal pain, rectal bleeding, hypophosphatemia.
Drug Interactions
This combination can interact with various medications, including certain antibiotics (tetracyclines, quinolones, ciprofloxacin), bisphosphonates (alendronate), thyroid hormones (levothyroxine), antiretrovirals, antifungals, osteoporosis medications, antipsychotics, and anticonvulsants. It may also interact with certain vitamins and minerals. Alcohol should be avoided as it increases stomach acid production. Food interactions can occur with citrate-containing foods, as citrate increases aluminum absorption.
Pregnancy and Breastfeeding
Consult with a physician before use during pregnancy or breastfeeding. While limited amounts may be excreted in breast milk, it is generally advised to use with caution.
Drug Profile Summary
- Mechanism of Action: Aluminum and magnesium hydroxide neutralize stomach acid. Dimethicone reduces surface tension of gas bubbles.
- Side Effects: Constipation, diarrhea, chalky taste, nausea, stomach cramps. Rarely, allergic reactions or mineral toxicity.
- Contraindications: Hypersensitivity, severe renal impairment, bowel obstruction, hypermagnesemia.
- Drug Interactions: Numerous drug interactions exist, consult a comprehensive drug interaction resource.
- Pregnancy & Breastfeeding: Use with caution, consult physician.
- Dosage: Varies by formulation; generally after meals and at bedtime.
- Monitoring Parameters: Renal function, electrolyte levels, especially in long-term use or renal impairment.
Popular Combinations
This particular combination itself is a popular therapeutic option. Sometimes simethicone is included in similar formulations.
Precautions
Screen for allergies and pre-existing conditions like renal disease. Caution in pregnancy/breastfeeding, children, and elderly. Advise patients about lifestyle modifications (diet, avoiding alcohol).
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Aluminium Hydroxide + Dimethicone + Milk Of Magnesia?
A: Dosage varies based on the specific product formulation and individual patient factors. Refer to the product’s prescribing information and consider patient-specific factors. Generally, adults can take 10-20 mL of suspension or 1-2 tablets four times daily or as needed, not exceeding the maximum daily dose.
Q2: How should this combination be administered?
A: Oral administration, usually after meals and at bedtime or as directed by a physician. Chew tablets thoroughly before swallowing. Shake liquid suspensions well before each use.
Q3: What are the key patient counseling points for this medication?
A: Inform patients about potential side effects, drug interactions, and precautions. Advise them to avoid alcohol and discuss any other medications or supplements they are taking.
Q4: Can this medication be used long-term?
A: Generally, antacid use should be limited to two weeks unless under a physician’s supervision. Long-term use can lead to adverse effects.
Q5: Are there any dietary recommendations while taking this medication?
A: Avoiding triggering foods like spicy or fatty foods can help manage symptoms. Smaller, more frequent meals may also be beneficial.
Q6: What should I do if a patient experiences constipation while on this medication?
A: Advise increased fluid intake and a high-fiber diet. If severe, consider an alternative antacid formulation.
Q7: Can this medication be used in patients with kidney disease?
A: Use with extreme caution in patients with renal impairment. Monitor aluminum and magnesium levels and adjust dosage as needed.
Q8: Does this medication interact with other commonly prescribed drugs?
A: Yes, numerous drug interactions exist. It is crucial to consult a drug interaction resource or pharmacist to ensure no significant interactions are present. Consult with a physician before concurrent use with other medicines.
Q9: Is it safe to operate machinery or drive while taking this medicine?
A: Generally, this medication does not impair cognitive function. However, patients should be cautious and refrain from these activities if experiencing dizziness or drowsiness.
