Aluminium Hydroxide + Milk Of Magnesia + Oxetacaine + Simethicone + Sorbitol

Usage

This combination medication is prescribed for the symptomatic relief of gastrointestinal discomfort associated with hyperacidity, gas, and occasional constipation. It is used to treat heartburn, upset stomach, acid indigestion, and symptoms related to gas and bloating.

Pharmacological Classification: This combination product encompasses multiple classifications: antacid (aluminum hydroxide, magnesium hydroxide), antiflatulent (simethicone), local anesthetic (oxetacaine), and osmotic laxative (sorbitol).

Mechanism of Action: The components work synergistically to address various gastrointestinal issues. Aluminum hydroxide and magnesium hydroxide neutralize excess stomach acid, raising intragastric pH. Simethicone reduces surface tension of gas bubbles, aiding their coalescence and expulsion. Oxetacaine provides local anesthetic action on the esophageal and gastric mucosa. Sorbitol acts as an osmotic laxative to counteract the constipating effects of aluminum hydroxide.

Alternate Names

No officially recognized alternate names exist for this specific five-ingredient combination. Brand names include Diovol LA Forte Suspension. Regional variations may occur. Products containing subsets of these ingredients are marketed under various brand names (e.g., Maalox, Mylanta for aluminum/magnesium hydroxide/simethicone).

How It Works

Pharmacodynamics: The antacids neutralize gastric acid, increasing gastric pH. Simethicone reduces gas formation and bloating. Oxetacaine provides local anesthetic action on the gastrointestinal mucosa, relieving pain and discomfort. Sorbitol increases water content in the stool, promoting bowel movements.

Pharmacokinetics:

• Absorption: Aluminum hydroxide and magnesium hydroxide are poorly absorbed systemically. Oxetacaine is absorbed to some extent from the GI tract. Simethicone is not absorbed. Sorbitol is partially absorbed.
• Metabolism: Oxetacaine is metabolized in the liver.
• Elimination: Aluminum and magnesium are primarily excreted renally. Oxetacaine’s metabolites are excreted in urine. Simethicone is eliminated unchanged in feces. Sorbitol is partially metabolized, with the remainder excreted in urine.

Mode of Action: Aluminum and magnesium hydroxide chemically neutralize gastric acid. Simethicone alters the surface tension of gas bubbles. Oxetacaine blocks nerve impulses by inhibiting sodium influx in nerve fibers. Sorbitol exerts its laxative effect by drawing water into the intestinal lumen. Specific receptor binding or enzyme inhibition for the components is not clinically significant for their intended use.

Dosage

Standard Dosage

Adults: 5-10 mL of the suspension, administered 20 minutes to 1 hour after meals and at bedtime, or as needed. Maximum daily dose: 40 mL. Always refer to the specific product labeling for precise instructions.

Children: Not recommended for children under 12 years of age. For older children (12-17 years), a reduced dose proportionate to the adult dose may be considered under medical supervision. Consult product labeling or a pediatrician.

Special Cases:

• Elderly Patients: Standard adult dose, but monitor for potential adverse effects, especially constipation.
• Patients with Renal Impairment: Contraindicated in severe renal impairment due to aluminum and magnesium accumulation risk. Caution advised in mild to moderate impairment.
• Patients with Hepatic Dysfunction: Caution is advised as oxetacaine is metabolized in the liver.
• Patients with Comorbid Conditions: Exercise caution in patients with electrolyte imbalances, gastrointestinal obstruction, or taking interacting medications.

Clinical Use Cases

This combination is not typically indicated for specialized clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Its use is primarily focused on outpatient symptomatic relief of common gastrointestinal complaints.

Dosage Adjustments

Adjustments should be made in renal impairment. Dose reduction may be necessary in hepatic dysfunction depending on severity.

Side Effects

Common Side Effects:

Constipation, diarrhea, nausea, stomach cramps, chalky taste, dizziness, drowsiness.

Rare but Serious Side Effects:

Allergic reactions (rash, itching, swelling), hypermagnesemia (confusion, muscle weakness, irregular heartbeat), metabolic alkalosis.

Long-Term Effects: With prolonged high doses, especially in renal impairment, aluminum accumulation can lead to osteomalacia and other toxicities. Hypophosphatemia can occur with chronic use.

Adverse Drug Reactions (ADR): Severe allergic reactions require immediate medical attention. Electrolyte imbalances, particularly hypermagnesemia, require monitoring and correction.

Contraindications

Hypersensitivity to any component; severe renal impairment; bowel obstruction; appendicitis or its symptoms; hypophosphatemia; myocardial damage.

Drug Interactions

This combination may interact with numerous medications. Antacids can interfere with the absorption of tetracyclines, fluoroquinolones, iron supplements, and some antifungal drugs. Separate administration of other medications by at least 2 hours. Consult drug interaction resources for detailed information. It may also interact with some antibiotics, levothyroxine, medications for osteoporosis or viral infections, iron, digoxin, ibuprofen, penicillamine, bisphosphonates, ketoconazole, quinolones, tetracycline, enteric-coated tablets, aspirin, and certain anti-asthmatics, anti-diabetics, and vitamins.

Pregnancy and Breastfeeding

Pregnancy: Caution advised. Use only if potential benefit outweighs potential risk.

Breastfeeding: Limited data available. Likely safe for short-term use, consult a doctor before use.

Drug Profile Summary

• Mechanism of Action: Neutralization of gastric acid, local anesthetic effect, antiflatulent action, osmotic laxative effect.
• Side Effects: Constipation, diarrhea, nausea, changes in bowel habits, chalky taste.
• Contraindications: Hypersensitivity, severe renal impairment, bowel obstruction.
• Drug Interactions: Interferes with the absorption of several medications.
• Pregnancy & Breastfeeding: Consult a doctor before use.
• Dosage: See dosage section.
• Monitoring Parameters: Renal function, serum electrolytes (magnesium, phosphate, calcium).

Popular Combinations

This product itself represents a combination designed for synergistic effects. Individual components are often available in separate formulations.

Precautions

• General Precautions: Assess for allergies, renal function, bowel habits, and electrolyte status.

• Specific Populations: See “Special Cases” under Dosage.

• Lifestyle Considerations: Avoid excessive alcohol use, which can exacerbate acid production. Lifestyle modifications (diet, stress management) are beneficial in managing gastrointestinal discomfort.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Aluminium Hydroxide + Milk Of Magnesia + Oxetacaine + Simethicone + Sorbitol?

A: The typical adult dose is 5-10 mL, taken 20 minutes to 1 hour after meals and at bedtime, or as needed, not to exceed 40 mL in 24 hours. Not recommended for children under 12.

Q2: What conditions does this combination treat?

A: It relieves symptoms of heartburn, acid indigestion, upset stomach, gas, and bloating. It may also address occasional constipation.

Q3: What are the common side effects?

A: Common side effects include constipation, diarrhea, nausea, stomach cramps, and a chalky taste. More serious, but rare, side effects are allergic reactions and electrolyte disturbances.

Q4: Who should not take this medication?

A: Individuals with severe renal impairment, bowel obstruction, or hypersensitivity to any of the ingredients should not take this medication.

Q5: Can pregnant or breastfeeding women use this product?

A: Caution is advised during pregnancy and breastfeeding. Consult a doctor before using.

Q6: How does this combination interact with other medications?

A: It can interfere with the absorption of numerous drugs. Consult a healthcare professional or drug interaction resources for specific information.

Q7: What precautions should be taken while using this medication?

A: Assess renal function and electrolyte status, especially with prolonged use. Avoid excessive alcohol consumption. Lifestyle modifications can also be beneficial.

Q8: Is this product safe for long-term use?

A: Long-term use, particularly at high doses, can pose risks, such as aluminum accumulation and electrolyte imbalances, especially in patients with renal impairment. Consult a doctor for prolonged use.

Q9: How does sorbitol work in this combination?

A: Sorbitol acts as an osmotic laxative to counteract the potential constipation caused by aluminum hydroxide. It draws water into the intestines, softening stool and promoting bowel movements.

Q10: What should I do if my symptoms worsen or persist despite taking this medication?

A: If symptoms persist or worsen after one week of use, seek medical advice. It may indicate a more serious underlying condition.