Usage
This combination medication is primarily prescribed for the symptomatic relief of gastroesophageal reflux disease (GERD) and its associated symptoms, such as heartburn, acid regurgitation, and indigestion. It is also used to manage symptoms related to excess stomach acid (hyperacidity). It belongs to the pharmacological classification of antacids and anti-reflux agents.
The mechanism of action involves a dual approach: the sodium alginate component reacts with stomach acid to create a viscous gel that floats on top of the stomach contents, forming a physical barrier against acid refluxing into the esophagus. The calcium carbonate and sodium bicarbonate components act as antacids, neutralizing excess stomach acid and providing rapid relief from heartburn and indigestion.
Alternate Names
While “Calcium Carbonate + Sodium Alginate + Sodium Bicarbonate” accurately represents the drug’s composition, it is often referred to simply as an “antacid and anti-reflux agent”. Brand names under which this combination is marketed include Gaviscon, Acidex, and Peptac. Algina is another brand name available in the Philippines.
How It Works
Pharmacodynamics: The combination exerts its therapeutic effect through the synergistic action of its components. Sodium alginate creates a protective raft over the stomach contents, preventing reflux. Calcium carbonate and sodium bicarbonate neutralize gastric acid, increasing the pH and alleviating heartburn and indigestion. The raft may also trap bile and pepsin, offering additional esophageal protection.
Pharmacokinetics: The components of the combination have limited systemic absorption. Sodium alginate, a large polysaccharide, remains primarily in the gastrointestinal tract. Calcium carbonate and sodium bicarbonate partially react with stomach acid to form soluble salts. A small amount of calcium and bicarbonate may be absorbed systemically, but this is usually minimal and not clinically significant in healthy individuals. Elimination primarily occurs through fecal excretion, with a small portion of absorbed calcium and bicarbonate excreted renally.
Dosage
Standard Dosage
Adults: The standard dose is 10-20 ml of the oral suspension or 2-4 chewable tablets, taken after meals and at bedtime, up to four times per day.
Children:
- 12 years and over: Same as adult dosage.
- 6 to 11 years: 5-10 mL, as directed by a physician, after meals and at bedtime, up to four times per day.
- Under 6 years: Use is generally not recommended, except on medical advice.
Special Cases:
- Elderly Patients: Dose adjustment is not typically required.
- Patients with Renal Impairment: Caution is advised in patients with moderate to severe renal insufficiency due to the sodium content. Dosage adjustments may be needed. Close monitoring is necessary for patients with hypercalcemia, nephrocalcinosis, and recurrent calcium-containing renal stones.
- Patients with Hepatic Dysfunction: No dose adjustment is usually necessary.
- Patients with Comorbid Conditions: Patients on a low-sodium diet (e.g., congestive heart failure) should use this medication with caution due to the sodium content.
Clinical Use Cases
The provided sources do not detail dosage recommendations for intubation, surgical procedures, mechanical ventilation, ICU use, or specific emergency situations. In such cases, refer to specialized guidelines or consult with appropriate specialists.
Dosage Adjustments
Dosage adjustments might be needed based on individual patient factors, including the severity of symptoms and the presence of renal impairment. Patients on sodium-restricted diets may require dose modifications or alternative therapies.
Side Effects
Common Side Effects:
Constipation, flatulence, nausea, vomiting, stomach cramps, burping.
Rare but Serious Side Effects:
Hypersensitivity reactions (rash, difficulty breathing), milk-alkali syndrome (with prolonged high doses of calcium carbonate), hypercalcemia.
Long-Term Effects:
No specific long-term effects are commonly associated with appropriate use.
Adverse Drug Reactions (ADR):
Severe allergic reactions are rare but require urgent medical attention.
Contraindications
- Hypersensitivity to any of the components (sodium alginate, sodium bicarbonate, calcium carbonate, or excipients).
- Moderate to severe renal insufficiency.
- Hypophosphatemia.
Drug Interactions
This combination can interact with certain medications, including some antibiotics (tetracyclines, quinolones), heart medications (digoxin), anticonvulsants (phenytoin, diazepam), iron supplements, and drugs with enteric coatings. It is crucial to consider potential interactions with concomitant medications. Consult a drug interaction database for comprehensive information.
Pregnancy and Breastfeeding
While generally considered safe during pregnancy and breastfeeding, the safety has not been fully evaluated. Use only when clearly needed and under the guidance of a physician. Monitor calcium levels during pregnancy.
Drug Profile Summary
- Mechanism of Action: Forms a protective gel barrier, neutralizes stomach acid.
- Side Effects: Constipation, flatulence, nausea, vomiting.
- Contraindications: Hypersensitivity, renal impairment.
- Drug Interactions: Tetracyclines, quinolones, digoxin, iron.
- Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks.
- Dosage: Adults/Children 12+: 10-20 ml/2-4 tablets up to four times daily.
- Monitoring Parameters: In long-term use or high doses, monitor calcium levels.
Popular Combinations
This combination is often used alone. However, in cases of persistent GERD, it may be used in conjunction with H2 receptor antagonists or proton pump inhibitors for more comprehensive symptom control, but with caution.
Precautions
Screen for pre-existing conditions, especially renal impairment. In pregnant or breastfeeding women, careful risk-benefit assessment is necessary. Not recommended for children under 6. Advise patients about potential sodium load.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Calcium Carbonate + Sodium Alginate + Sodium Bicarbonate?
A: Adults and children 12 years and older: 10-20 ml of the liquid or 2-4 chewable tablets after meals and at bedtime, up to four times a day. Children 6 to 11 years: 5-10 ml as prescribed, after meals and at bedtime, up to four times per day. Children under 6: Not recommended unless on medical advice.
Q2: How does this combination work?
A: It forms a protective raft over the stomach contents and neutralizes gastric acid.
Q3: What are the common side effects?
A: Constipation, gas, nausea, and vomiting are possible side effects.
Q4: Can pregnant or breastfeeding women use this combination?
A: It is generally considered safe, but use only if clearly needed and under medical supervision.
Q5: Are there any drug interactions I should be aware of?
A: Yes, it can interact with certain antibiotics, heart medications, anticonvulsants, and iron supplements. Inform your doctor about all medications you are taking.
Q6: What should I do if symptoms persist despite taking this medication?
A: Consult your doctor if symptoms don’t improve after 7 days.
Q7: Is this combination safe for patients with kidney problems?
A: Use with caution in patients with mild renal impairment and avoid in moderate to severe renal failure.
Q8: Can I consume alcohol while taking this medication?
A: It’s best to avoid alcohol as it can worsen GERD symptoms and interact with the medication.
Q9: Is this medication safe for long-term use?
A: Generally safe for long-term use, but it’s best to consult with a physician for ongoing management.
Q10: What are the symptoms of an overdose?
A: Overdose can lead to bloating. Seek medical advice if you suspect an overdose.
