Usage
This combination medication is primarily prescribed for the symptomatic relief of gastrointestinal discomfort associated with conditions like dyspepsia, gastroesophageal reflux disease (GERD), heartburn, bloating, and gas.
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Pharmacological Classification: This is a combination product containing a gastroprokinetic (domperidone), an antacid (magaldrate), and an anti-flatulent (simethicone).
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Mechanism of Action: Domperidone blocks dopamine receptors, increasing gastrointestinal motility and reducing nausea and vomiting. Magaldrate neutralizes stomach acid, offering relief from heartburn and indigestion. Simethicone reduces the surface tension of gas bubbles, facilitating their expulsion.
Alternate Names
No widely recognized alternate names exist for this specific combination. Several brand names are available depending on the manufacturer and region. Some examples include Aciset-7D, Ambifast, Antav D, Kastdom, Domheal, Antaric DM, and Wellcid-D.
How It Works
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Pharmacodynamics: Domperidone, a dopamine D2 receptor antagonist, enhances gastric emptying and reduces esophageal reflux. Magaldrate, a combination of magnesium and aluminum hydroxides, neutralizes gastric acid. Simethicone, a surfactant, disperses gas bubbles.
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Pharmacokinetics: Domperidone is rapidly absorbed orally, metabolized by the liver (CYP3A4), and excreted in urine and feces. Magaldrate is not absorbed systemically, acting locally in the gastrointestinal tract and excreted in feces. Simethicone is not absorbed, passing through the digestive system unchanged and eliminated in feces.
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Mode of Action: Domperidone acts on dopamine receptors in the chemoreceptor trigger zone and the gastrointestinal tract. Magaldrate chemically neutralizes hydrochloric acid in the stomach. Simethicone alters the surface tension of gas bubbles, causing them to coalesce and be expelled more easily.
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Elimination Pathways: Domperidone: Hepatic metabolism (CYP3A4), renal and fecal excretion. Magaldrate: Fecal excretion. Simethicone: Fecal excretion unchanged.
Dosage
Standard Dosage
Adults:
The typical adult dosage is 5-10 ml of the suspension, taken orally three times daily, after meals and at bedtime. Dosage may vary based on the formulation and should be taken as directed by a physician.
Children:
Use in children under 12 is generally not recommended. For children over 12, the adult dose may be appropriate, but a doctor should be consulted.
Special Cases:
- Elderly Patients: Dosage adjustments may be necessary based on renal and hepatic function.
- Patients with Renal Impairment: Caution is advised, and dosage adjustments may be required.
- Patients with Hepatic Dysfunction: Domperidone metabolism may be affected, requiring dosage adjustments.
- Patients with Comorbid Conditions: Careful consideration is required in patients with heart conditions due to the potential for QT prolongation with domperidone.
Clinical Use Cases
The combination is not specifically indicated for use in clinical settings like intubation, surgical procedures, mechanical ventilation, or ICU. It primarily addresses symptomatic relief of gastrointestinal issues.
Dosage Adjustments
Adjustments should be made based on patient-specific factors such as renal and hepatic function, cardiac conditions, and concomitant medications.
Side Effects
Common Side Effects
Constipation, diarrhea, dry mouth, altered taste, headache, dizziness, drowsiness.
Rare but Serious Side Effects
Allergic reactions, cardiac arrhythmias (QT prolongation), extrapyramidal symptoms (with high doses of domperidone).
Long-Term Effects
Long-term use of domperidone may be associated with an increased risk of cardiac events, particularly in older adults and those with underlying cardiac conditions.
Adverse Drug Reactions (ADR)
Serious ADRs are rare but may include cardiac arrhythmias, hypersensitivity reactions, and neurologic effects.
Contraindications
Hypersensitivity to any component, gastrointestinal bleeding, mechanical obstruction or perforation of the GI tract, prolactinoma, concurrent use of QT prolonging drugs, severe hepatic or renal impairment.
Drug Interactions
QT prolonging drugs, anticholinergic drugs, ketoconazole, itraconazole, erythromycin, clarithromycin, antacids containing aluminum or magnesium, certain antihypertensives, alcohol.
Pregnancy and Breastfeeding
Use with caution during pregnancy and breastfeeding. Consult a healthcare professional for guidance. Domperidone is excreted in breast milk.
Drug Profile Summary
- Mechanism of Action: Prokinetic (domperidone), antacid (magaldrate), anti-flatulent (simethicone)
- Side Effects: Constipation, diarrhea, dry mouth, headache, dizziness
- Contraindications: Hypersensitivity, GI bleeding, obstruction, prolactinoma
- Drug Interactions: QT prolonging drugs, anticholinergics, antifungals, macrolides, antacids, alcohol
- Pregnancy & Breastfeeding: Use with caution; consult a physician
- Dosage: 5-10 ml TID, after meals (adults); not recommended for children under 12
- Monitoring Parameters: Electrolytes, cardiac function (with long-term domperidone use)
Popular Combinations
This triple combination is itself a popular formulation. Sometimes, it may be prescribed along with proton pump inhibitors or H2 blockers for added relief from GERD.
Precautions
Pre-existing heart, liver, or kidney disease; pregnancy and breastfeeding; use in children; alcohol consumption; operating machinery (due to potential drowsiness).
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Domperidone + Magaldrate + Simethicone?
A: 5-10 ml of the suspension, taken orally three times a day, after meals and at bedtime. Not generally recommended for children under 12.
Q2: What are the common side effects?
A: Constipation, diarrhea, dry mouth, altered taste, headache, dizziness, and drowsiness.
Q3: Can pregnant or breastfeeding women take this medication?
A: Use with caution. Consult a healthcare professional for advice.
Q4: How does domperidone work in this combination?
A: Domperidone is a prokinetic agent that increases gut motility and helps to relieve symptoms like nausea and vomiting.
Q5: What is the role of magaldrate?
A: Magaldrate is an antacid that neutralizes stomach acid, providing relief from heartburn.
Q6: How does simethicone work?
A: Simethicone is an anti-flatulent that helps to break down gas bubbles in the digestive tract, relieving bloating and discomfort.
Q7: Are there any serious drug interactions I should be aware of?
A: Yes. This combination can interact with certain medications, including QT prolonging drugs, antifungals, and macrolides. Always inform your doctor about all other medications you are taking.
Q8: What should I do if I miss a dose?
A: If you miss a dose, take it as soon as you remember. If it is close to the time of your next dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose.
Q9: Can this medication be used long-term?
A: Long-term use of domperidone carries potential risks, particularly for cardiac events. Consult with a physician about the suitability of long-term use.
Q10: What precautions should be taken in elderly patients?
A: Elderly patients may be more susceptible to adverse effects. Renal and hepatic function should be assessed, and dosage adjustments may be necessary.
