Usage
This combination medication is primarily prescribed for the symptomatic relief of gastrointestinal discomfort associated with hyperacidity, heartburn, indigestion, gastritis, stomach upset, peptic ulcers, gastroesophageal reflux disease (GERD), and dyspepsia. It is also used to relieve pain associated with these conditions.
Pharmacological Classification: This is a combination product with multiple pharmacological classifications:
- Aluminium Hydroxide and Magnesium Hydroxide: Antacids
- Oxetacaine: Local anesthetic
Alternate Names
There are no officially recognized alternate names for this specific combination. However, the individual components have other names:
- Milk of Magnesia: Magnesium hydroxide
- Brand names: Numerous brand names exist depending on the specific formulation and the inclusion of other ingredients like simethicone. Brand names can vary regionally. Examples include Diovol LA Forte and Maalox Plus (though these may contain simethicone as well).
How It Works
Pharmacodynamics:
- Aluminium Hydroxide and Magnesium Hydroxide: These antacids neutralize gastric acid by raising the pH in the stomach. This reduces irritation to the lining of the stomach and gut. Magnesium hydroxide can also have a laxative effect by drawing water into the intestines.
- Oxetacaine: This local anesthetic works by blocking nerve signals in the gut, thereby reducing pain and discomfort.
Pharmacokinetics:
- Aluminium Hydroxide and Magnesium Hydroxide: Poorly absorbed systemically, primarily acting locally in the gastrointestinal tract. Magnesium, however, may be absorbed to a higher degree than aluminum. Excreted primarily through the feces. Renal excretion plays a role, particularly for magnesium.
- Oxetacaine: Acts topically within the gastrointestinal tract. The extent of systemic absorption can vary but is generally low. Metabolism and elimination pathways are not well-defined for oral use.
Mode of Action:
- Aluminium Hydroxide and Magnesium Hydroxide: Chemically neutralize hydrochloric acid in the stomach.
- Oxetacaine: Blocks sodium channels in nerve cell membranes, inhibiting nerve impulse transmission.
Dosage
Standard Dosage
Adults:
5-10 mL of suspension or 2-4 chewable tablets, taken 20 minutes to 1 hour after meals and at bedtime, or as needed. Maximum dose generally not to exceed 40 mL of suspension or as directed on the product label. Always refer to specific product information.
Children:
Use in children under 12 years is generally not recommended, though some sources suggest dosage based on weight and age for children over 6. Consult product-specific information and pediatric guidelines. Pediatric use should be under the supervision of a healthcare provider.
Special Cases:
- Elderly Patients: Caution is advised due to potential for decreased renal function. Dosage adjustment may be needed.
- Patients with Renal Impairment: Dose reduction or avoidance may be necessary due to magnesium accumulation risk.
- Patients with Hepatic Dysfunction: Use with caution as dosage adjustments might be needed.
- Patients with Comorbid Conditions: Adjustments needed for conditions like hypophosphatemia, intestinal obstruction.
Clinical Use Cases
Dosage for specific clinical situations is not well-defined for this combination and should be based on symptom management and standard adult recommendations. Consult product information.
Dosage Adjustments
Dosage adjustments may be necessary for patients with renal impairment, electrolyte imbalances (e.g., hypophosphatemia), or those taking interacting medications.
Side Effects
Common Side Effects
Constipation, diarrhea, nausea, stomach cramps, chalky taste, dizziness, drowsiness, allergic reactions, abdominal discomfort.
Rare but Serious Side Effects
Hypermagnesemia (especially in patients with renal impairment), aluminum accumulation (potential for osteomalacia or encephalopathy with long-term use), intestinal obstruction or ileus (especially in at-risk individuals).
Long-Term Effects
Chronic complications can arise from prolonged use, including electrolyte imbalances (hypophosphatemia) and potential issues with magnesium or aluminum accumulation.
Adverse Drug Reactions (ADR)
Severe allergic reactions, significant electrolyte disturbances, worsening of bowel conditions.
Contraindications
Hypersensitivity to any of the ingredients, severe renal impairment, hypophosphatemia, appendicitis or symptoms of appendicitis, bowel obstruction.
Drug Interactions
This combination can interact with numerous medications, including:
- Antibiotics: Tetracyclines, quinolones, ciprofloxacin.
- Iron supplements: Ferrous sulfate.
- Digoxin: Can decrease digoxin absorption.
- Other medications: Those affecting gastrointestinal motility, such as metoclopramide, domperidone, and medications known to have interactions with aluminum or magnesium hydroxide.
Pregnancy and Breastfeeding
Consult a physician before use during pregnancy or breastfeeding. Limited absorption suggests minimal amounts may be excreted in breast milk, however, use caution.
Drug Profile Summary
- Mechanism of Action: Neutralizes gastric acid, provides local anesthesia.
- Side Effects: Constipation, diarrhea, nausea.
- Contraindications: Severe renal impairment, hypophosphatemia, appendicitis.
- Drug Interactions: Tetracyclines, quinolones, iron supplements, digoxin.
- Pregnancy & Breastfeeding: Consult physician before use.
- Dosage: See dosage section.
- Monitoring Parameters: Renal function, electrolyte levels.
Popular Combinations
This specific three-drug combination itself is a relatively common preparation in some regions. Often simethicone is added for its anti-flatulent properties.
Precautions
Monitor patients with renal impairment, pre-existing bowel conditions, electrolyte imbalances. Avoid in patients with hypersensitivity to any of the ingredients.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Aluminium Hydroxide + Milk Of Magnesia + Oxetacaine?
A: See dosage section. Dosage varies by formulation and age. Consult specific product information.
Q2: What are the common side effects?
A: Common side effects include constipation, diarrhea, nausea, stomach cramps, and chalky taste.
Q3: Who should not take this medication?
A: Individuals with severe renal impairment, hypophosphatemia, or hypersensitivity to any of the components should avoid this medication.
Q4: Can pregnant or breastfeeding women use this medicine?
A: Consult with a doctor before using during pregnancy or breastfeeding.
Q5: Are there any drug interactions I should be aware of?
A: Yes, this medication can interact with certain antibiotics (tetracyclines, quinolones), iron supplements, digoxin, and other medications.
Q6: How does oxetacaine work in this combination?
A: Oxetacaine provides local anesthetic action, numbing the lining of the stomach and esophagus to relieve pain associated with acidity and irritation.
Q7: Can this combination be used in children?
A: Generally not recommended for children under 12. Consult product-specific information for pediatric dosage guidelines when applicable and if available.
Q8: What should I do if a patient experiences constipation while taking this medicine?
A: Advise increased fluid intake, a high-fiber diet, and potentially consider a stool softener if necessary.
Q9: What are the long-term risks of using this medication?
A: Long-term use can lead to electrolyte imbalances, particularly hypophosphatemia. Aluminum and magnesium accumulation can also be a concern, especially in patients with renal impairment.
