Usage
- This combination medication is prescribed for the symptomatic relief of heartburn, acid indigestion, upset stomach, and bloating caused by gas. It is also used to treat symptoms of gas, such as fullness, pressure, and bloating. It neutralizes stomach acid and makes it easier to pass gas.
- Pharmacological classification: This is a combination of an antacid (aluminum hydroxide and magnesium hydroxide) and an antiflatulent (simethicone).
Alternate Names
- This medication is commonly known as aluminum hydroxide/magnesium hydroxide/simethicone.
- Brand names: Almacone, Gelusil, Maalox, Maalox Plus, Mintox, Mintox Plus, Mylanta, Mylanta Maximum Strength, Relcer, and others. (Note: Brand names can vary regionally. This is not an exhaustive list).
How It Works
- Pharmacodynamics: Aluminum hydroxide and magnesium hydroxide neutralize excess stomach acid by raising the pH. Simethicone works by decreasing the surface tension of gas bubbles, making it easier for them to combine and be expelled.
- Pharmacokinetics: Aluminum hydroxide and magnesium hydroxide are poorly absorbed from the gastrointestinal tract, minimizing systemic effects. Simethicone is not absorbed and is eliminated unchanged in the feces.
- Mode of action: Aluminum hydroxide and magnesium hydroxide react chemically with gastric acid (hydrochloric acid) to form aluminum chloride, magnesium chloride, and water, thereby reducing acidity in the stomach. Simethicone alters the surface tension of gas bubbles, allowing them to coalesce, promoting easier passage of gas.
- Elimination pathways: The small amount of aluminum and magnesium that is absorbed is primarily excreted renally. The majority of aluminum and magnesium, along with simethicone, is excreted in the feces.
Dosage
Standard Dosage
Adults:
- Liquid: 10-20 mL orally every 4-6 hours as needed, taken 1 hour before or 3 hours after meals. Do not exceed 12 doses (120 mL) in 24 hours unless directed by a physician.
- Chewable Tablets: 2-4 tablets every 4-6 hours as needed. Do not exceed 12 tablets in 24 hours.
Children:
- Dosing for children under 12 should be determined by a doctor.
- Some formulations are approved for children as young as 6 years old. Dosage is dependent on the specific product and child’s weight.
Special Cases:
- Elderly Patients: Start with the lower end of the dosing range and monitor for adverse effects, particularly constipation and changes in magnesium levels. Renal function should be assessed.
- Patients with Renal Impairment: Use with caution. Dose adjustments may be necessary due to the risk of aluminum and magnesium accumulation.
- Patients with Hepatic Dysfunction: No specific dosage adjustment is typically required.
- Patients with Comorbid Conditions: Patients with conditions such as diabetes, cardiovascular disease, or electrolyte imbalances should be monitored closely.
Clinical Use Cases
- Intubation, Surgical Procedures, Mechanical Ventilation, Intensive Care Unit (ICU) Use, Emergency Situations: The use of this specific combination drug is not typically indicated in these clinical settings. Other agents for managing gastric pH or bowel distension may be preferred.
Dosage Adjustments: Dose adjustments are made primarily based on renal function and patient response.
Side Effects
Common Side Effects
- Constipation
- Diarrhea
- Nausea
- Headache
- Chalky taste
Rare but Serious Side Effects
- Allergic reactions (skin rash, itching, hives, swelling)
- Hypermagnesemia (confusion, drowsiness, muscle weakness, irregular heartbeat)
- Aluminum toxicity (mental/mood changes, seizures, pale skin, shortness of breath)
- Hypophosphatemia (bone pain, muscle weakness)
Long-Term Effects
- Osteomalacia (softening of the bones) with prolonged use, especially in patients with low phosphate levels.
Adverse Drug Reactions (ADR)
- Milk-alkali syndrome (high calcium, high alkalinity, kidney injury) – rare
Contraindications
- Hypersensitivity to any component of the medication
- Severe kidney disease
- Hypophosphatemia
- Bowel obstruction
Drug Interactions
- Aluminum and magnesium hydroxides can decrease the absorption of many medications, including certain antibiotics (tetracyclines, quinolones), antifungals (azoles), and heart medications (digoxin).
- Separate administration of interacting drugs by at least 2 hours.
- Antacids can interact with iron supplements, levothyroxine, and bisphosphonates.
- Consult a drug interaction database for a comprehensive list.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: Not formally assigned. Consult a physician before use if pregnant.
- Minimal amounts of aluminum hydroxide and magnesium hydroxide are excreted into breast milk. Simethicone is not absorbed. Use with caution while breastfeeding.
Drug Profile Summary
- Mechanism of Action: Neutralizes stomach acid, reduces gas bubbles.
- Side Effects: Constipation, diarrhea, nausea. Rarely, hypermagnesemia or aluminum toxicity.
- Contraindications: Kidney disease, hypophosphatemia.
- Drug Interactions: Numerous; separate administration of other medications.
- Pregnancy & Breastfeeding: Use with caution. Consult a physician.
- Dosage: See detailed dosage section above.
- Monitoring Parameters: Serum magnesium, phosphate, and calcium levels, especially with long-term use or renal impairment.
Precautions
- General Precautions: Assess renal function, phosphate levels, and other relevant medical conditions before initiating therapy.
- Specific Populations: Monitor closely for adverse effects in pregnant/breastfeeding women, children, and the elderly.
- Lifestyle Considerations: Avoid excessive alcohol use, as it can increase stomach acid production.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Aluminium Hydroxide + Magnesium + Simethicone?
A: See detailed dosage guidelines above.
Q2: How does this combination medication work?
A: Aluminum and magnesium hydroxide neutralize stomach acid, while simethicone reduces gas bubbles.
Q3: What are the common side effects?
A: Constipation, diarrhea, nausea are common.
Q4: Are there any serious side effects?
A: Rarely, aluminum toxicity or hypermagnesemia can occur.
Q5: Can I take this medication with other drugs?
A: It can interact with many medications. Separate administration by at least 2 hours. Consult a physician or pharmacist.
Q6: Is it safe during pregnancy or breastfeeding?
A: Consult a physician before use if pregnant or breastfeeding.
Q7: Who should not take this medication?
A: People with severe kidney disease, hypophosphatemia, or hypersensitivity to any component.
Q8: Can this medication be used long-term?
A: Long-term use should be monitored by a physician due to potential risks like osteomalacia and aluminum accumulation.
Q9: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it’s close to the time for your next dose. Do not double the dose.
