Aluminium Hydroxide + Milk Of Magnesia + Simethicone

Usage

• This combination medication is prescribed for the symptomatic relief of gastrointestinal discomfort associated with hyperacidity, peptic ulcer, duodenal ulcer, dyspepsia, heartburn, gastritis, hiatal hernia, and gaseous distension. It is also used to treat symptoms like acid indigestion, acid reflux, and flatulence.
• Pharmacological Classification: Antacid, antiflatulent.
• Mechanism of Action: This drug works through a combination of actions. Aluminium hydroxide and magnesium hydroxide neutralize excess stomach acid, providing relief from heartburn and acid indigestion. Simethicone is an antiflatulent that works by reducing the surface tension of gas bubbles in the stomach and intestines, allowing them to coalesce and be expelled more easily.

Alternate Names

• Alumina, magnesia, and simethicone
• Aluminum hydroxide/magnesium hydroxide/simethicone
• Brand Names: Gelusil, Antagit DS

How It Works

• Pharmacodynamics: Aluminium hydroxide and magnesium hydroxide react with gastric acid to form aluminum chloride and magnesium chloride, respectively, along with water. This chemical reaction neutralizes excess stomach acid, increasing gastric pH. Simethicone disperses and prevents the formation of mucus-surrounded gas pockets in the gastrointestinal tract, facilitating their expulsion.

• Pharmacokinetics: Aluminium hydroxide and magnesium hydroxide are poorly absorbed systemically. Simethicone is not absorbed and is eliminated unchanged in the feces.

• Mode of Action: Neutralization of gastric acid; defoaming action of simethicone on gas bubbles.

• Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: This combination product does not directly interact with any specific receptors, inhibit enzymes, or modulate neurotransmitters. Its primary action is physicochemical.

• Elimination Pathways: Primarily via fecal excretion. A small amount of aluminum and magnesium may be absorbed and renally excreted.

Dosage

Standard Dosage

Adults:

• Liquid: 10-20 mL (or 30 mL unit dose) orally every 4-6 hours as needed, taken 1 hour before or 3 hours after meals. Do not exceed 120 mL in a 24-hour period or use the maximum dose for more than 2 weeks.
• Chewable Tablets: 2-4 tablets every 4-6 hours; not to exceed 12 tablets/24 hours.

Children:

• Children under 12 years: Maximum of 5 mL (one medicine measure) three times a day.
• Adolescents (12-18 years): 5-20 mL (one to four medicine measures) every three hours daily as needed. Do not exceed 120 mL total daily dose.

Special Cases:

• Elderly Patients: Dose adjustments may be necessary based on renal function.
• Patients with Renal Impairment: Use with caution. Magnesium accumulation may occur. Dosage adjustment is essential.
• Patients with Hepatic Dysfunction: No specific dose adjustment is usually required.
• Patients with Comorbid Conditions: Consider individual patient factors and adjust dosage as needed.

Clinical Use Cases Dosage in these specific medical settings is similar to standard adult recommendations and should be adjusted based on the patient’s clinical status and renal function.

• Intubation
• Surgical Procedures
• Mechanical Ventilation
• Intensive Care Unit (ICU) Use
• Emergency Situations

Dosage Adjustments Individualized dose titration is crucial in patients with renal or hepatic impairment, considering drug clearance and potential for adverse effects.

Side Effects

Common Side Effects

• Constipation
• Diarrhea
• Chalky taste
• Stomach cramps

Rare but Serious Side Effects

• Aluminum toxicity (in patients with renal impairment)
• Hypermagnesemia (in patients with renal impairment)
• Milk-alkali syndrome (with prolonged high doses)
• Osteomalacia (with long-term use)
• Fecal impaction

Long-Term Effects Osteomalacia and aluminum toxicity are potential concerns with chronic, excessive usage.

Adverse Drug Reactions (ADR) Milk-alkali syndrome and severe electrolyte imbalances are significant ADRs requiring urgent intervention.

Contraindications

• Hypersensitivity to any component of the formulation
• Severe renal impairment
• Bowel obstruction

Drug Interactions

• This combination may interfere with the absorption of several medications, including tetracyclines, fluoroquinolones, iron supplements, and levothyroxine. Administer other medications at least 1-2 hours apart.
• Antacids can interact with certain H2 blockers and proton pump inhibitors.

Pregnancy and Breastfeeding

• This medication is generally considered safe for occasional use during pregnancy and breastfeeding. Consult with a healthcare professional before use during pregnancy.

Drug Profile Summary

• Mechanism of Action: Neutralizes gastric acid, reduces gas formation.
• Side Effects: Constipation, diarrhea, chalky taste. Rarely: Aluminum toxicity, hypermagnesemia.
• Contraindications: Severe renal impairment, bowel obstruction.
• Drug Interactions: Interferes with the absorption of various drugs.
• Pregnancy & Breastfeeding: Generally safe for occasional use.
• Dosage: Adults: 10-20 mL every 4-6 hours. Adjust dosage in renal impairment.
• Monitoring Parameters: Monitor renal function, electrolyte levels with prolonged use, especially in elderly patients and those with kidney disease.

Popular Combinations Not applicable. This combination itself is commonly used.

Precautions

• General Precautions: Assess renal function before and during prolonged use.
• Specific Populations: Use with caution in elderly patients and patients with renal impairment.

FAQs (Frequently Asked Questions)

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

A: Adults: 10-20 mL or 2-4 chewable tablets every 4-6 hours, not to exceed the maximum daily dose. Pediatric and geriatric dosages should be adjusted as per clinical guidelines.

Q2: What are the common side effects?

A: Common side effects include constipation, diarrhea, chalky taste, and stomach cramps.

Q3: How does this medication work?

A: Aluminum and magnesium hydroxide neutralize stomach acid, and simethicone breaks down gas bubbles.

Q4: Who should not take this medication?

A: Individuals with severe renal impairment or bowel obstruction should not take this medication.

Q5: Can pregnant or breastfeeding women take this medicine?

A: Consult a healthcare professional before use during pregnancy or while breastfeeding, although occasional use is generally considered safe.

Q6: What are the signs of an allergic reaction?

A: Signs of an allergic reaction include rash, itching, swelling, severe dizziness, and trouble breathing. Seek immediate medical attention if these occur.

Q7: Can this drug interact with other medications?

A: Yes, this combination can interact with certain medications like tetracyclines and fluoroquinolones, reducing their absorption.

Q8: What should I do if I miss a dose?

A: Take the missed dose as soon as you remember, unless it’s almost time for your next dose. Do not double the dose to catch up.

Q9: How long can I take this medicine?

A: Do not use the maximum dose for more than two weeks without consulting a doctor.

Q10: Are there any dietary restrictions while taking this medicine?

A: No specific dietary restrictions are associated with this medication, but maintaining a healthy diet is always recommended.