Usage
This combination medication is prescribed for the symptomatic relief of gastrointestinal discomfort associated with hyperacidity, gas, and occasional constipation. It addresses multiple gastrointestinal issues concurrently, such as dyspepsia and abdominal bloating.
Pharmacological Classification:
This combination product falls into multiple pharmacological classifications due to its ingredients:
- Antacid: (Aluminium Hydroxide, Milk of Magnesia)
- Antiflatulent: (Simethicone)
- Local anesthetic: (Oxetacaine)
- Osmotic laxative: (Often contains Sorbitol)
Mechanism of Action:
- Aluminium hydroxide and magnesium hydroxide neutralize gastric acid, increasing intragastric pH.
- Simethicone reduces the surface tension of gas bubbles in the stomach and intestines, allowing them to combine more easily and be expelled.
- Oxetacaine provides topical anesthesia to the esophageal and gastric mucosa, alleviating pain associated with acid reflux or irritation.
- Sorbitol (if present) acts as an osmotic laxative, drawing water into the intestinal lumen to soften stool and stimulate bowel movements, counteracting potential constipation from the aluminum hydroxide.
Alternate Names
There are no officially recognized alternate names for this specific combination. However, similar combinations of aluminum hydroxide, magnesium hydroxide, and simethicone are marketed under various brand names like Diovol LA Forte. Regional variations may exist. Products containing subsets of these ingredients have various brand names (e.g., Maalox, Mylanta for aluminum hydroxide/magnesium hydroxide/simethicone combinations).
How It Works
Pharmacodynamics:
- Aluminium Hydroxide and Magnesium Hydroxide: Neutralize gastric acid by reacting with hydrochloric acid in the stomach, forming aluminum and magnesium chloride and water. This raises the pH, reducing acidity.
- Simethicone: Works physically by decreasing the surface tension of gas bubbles, promoting their coalescence. It doesn’t reduce gas production but facilitates its elimination.
- Oxetacaine: A local anesthetic that blocks nerve impulse transmission in the mucous membranes of the esophagus and stomach, relieving pain and discomfort.
Pharmacokinetics:
- Aluminium Hydroxide and Magnesium Hydroxide: Primarily act locally in the gastrointestinal tract; minimal systemic absorption occurs. Small amounts of absorbed aluminum and magnesium are excreted renally.
- Simethicone: Not absorbed systemically; it passes through the GI tract unchanged and is eliminated in the feces.
- Oxetacaine: Minimally absorbed systemically when used topically in the GI tract; metabolized in the liver and excreted in urine.
Mode of Action/Receptor Binding/Enzyme Inhibition:
This combination does not involve receptor binding, enzyme inhibition, or neurotransmitter modulation in its primary mechanism of action. Its effects are mainly physical and chemical.
Elimination Pathways:
- Aluminium and Magnesium (small absorbed amounts): Renal excretion.
- Simethicone: Fecal excretion.
- Oxetacaine: Hepatic metabolism and renal excretion.
Dosage
Standard Dosage
Adults:
5-10 mL of the suspension, taken 20 minutes to 1 hour after meals and at bedtime, or as needed. Do not exceed 40 mL in 24 hours. Chewable tablets are also available; typical dose is 2-4 tablets every 4-6 hours, not exceeding 12 tablets in 24 hours. Always refer to the specific product labeling.
Children:
Dosage should be adjusted based on age and weight. Use with caution in children under 5 years; the maximum dose is generally 5ml three times a day. Consult pediatric dosing guidelines or a specialist.
Special Cases:
- Elderly Patients: The normal adult dose is generally appropriate, but close monitoring is recommended, especially in patients with renal impairment.
- Patients with Renal Impairment: Dose reduction may be necessary. Monitor renal function closely.
- Patients with Hepatic Dysfunction: Caution is advised. Monitor liver function.
- Patients with Comorbid Conditions: Individualized dosing may be necessary, particularly for patients with diabetes or cardiovascular diseases. Consult specialist advice if needed.
Clinical Use Cases
This specific combination is generally not indicated for intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Its primary use is for symptomatic relief of dyspepsia and related gastrointestinal issues.
Dosage Adjustments
Dose adjustments may be necessary in cases of renal or hepatic impairment and for patients with other comorbid conditions. Consult specialist advice as required.
Side Effects
Common Side Effects:
Constipation, diarrhea, chalky taste.
Rare but Serious Side Effects:
Allergic reactions (rash, itching, swelling), difficulty breathing, mental/mood changes (confusion).
Long-Term Effects:
Long-term, excessive use of aluminum-containing antacids can lead to aluminum toxicity, especially in patients with renal impairment. Osteomalacia (softening of the bones) and hypophosphatemia (low blood phosphate) are potential risks.
Adverse Drug Reactions (ADR):
Severe allergic reactions, bowel obstruction, metabolic alkalosis (especially with excessive magnesium intake).
Contraindications
Hypersensitivity to any of the ingredients. Severe renal impairment, bowel obstruction, appendicitis.
Drug Interactions
Antacids can interfere with the absorption of numerous medications, including certain antibiotics (tetracyclines, fluoroquinolones), iron supplements, and some heart medications. Consult a comprehensive drug interaction database for a complete list.
Pregnancy and Breastfeeding
Consult a physician before using this medication during pregnancy or breastfeeding. While generally considered low risk, oxetacaine and sorbitol’s safety in pregnancy requires evaluation based on individual circumstances. Aluminum-containing antacids should be used cautiously during breastfeeding due to the potential for aluminum accumulation in breast milk.
Drug Profile Summary
- Mechanism of Action: See above.
- Side Effects: See above.
- Contraindications: See above.
- Drug Interactions: See above.
- Pregnancy & Breastfeeding: Consult a physician.
- Dosage: See above.
- Monitoring Parameters: Renal function (if used long-term), serum phosphate levels (with long-term use).
Popular Combinations
This specific four-ingredient combination (often with added sorbitol) is itself a commonly used formulation.
Precautions
- General Precautions: Assess renal and hepatic function before initiating long-term use.
- Specific Populations: As described in the dosage section above.
- Lifestyle Considerations: Advise patients to avoid excessive alcohol intake as it can exacerbate gastrointestinal irritation.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Aluminium Hydroxide + Milk Of Magnesia + Oxetacaine + Simethicone?
A: See Dosage section above. It depends on age, health conditions and other individual specific parameters.
Q2: How does this combination relieve gas?
A: The simethicone component reduces the surface tension of gas bubbles, promoting their coalescence and easier passage.
Q3: Can I take this medication if I am pregnant?
A: Consult your physician before use during pregnancy or breastfeeding.
Q4: What are the possible side effects?
A: Common side effects include constipation, diarrhea, and a chalky taste. More serious side effects are rare but can include allergic reactions and electrolyte imbalances.
Q5: Can I take this with other medications?
A: This combination can interact with several medications. Inform your doctor about all other medications you are taking.
Q6: How long can I take this medication?
A: For occasional symptom relief, short-term use is generally safe. Consult your doctor for prolonged use.
Q7: What should I do if I experience any adverse effects?
A: Discontinue use and contact your doctor immediately.
Q8: Is this medication safe for children?
A: It can be used in children, but the dosage needs to be adjusted based on age and weight. Consult a pediatrician or refer to pediatric dosing guidelines.
Q9: How should this medication be stored?
A: Store at room temperature, away from excessive heat and moisture. Keep out of reach of children.
