MEDICATION SAFETY ISSUES
Sound-alike/look-alike issues:
Maalox® may be confused with Maox®, Monodox®
Mylanta® may be confused with Mynatal®
Maalox® is a different formulation than Maalox® Total Stomach Relief®
U.S. BRAND NAMES — Alamag Plus [OTC]; Aldroxicon I [OTC]; Aldroxicon II [OTC]; Almacone Double Strength® [OTC]; Almacone® [OTC]; Gelusil® [OTC]; Maalox® Max [OTC]; Maalox® [OTC]; Mi-Acid Maximum Strength [OTC]; Mi-Acid [OTC]; Mintox Extra Strength [OTC]; Mintox Plus [OTC]; Mylanta® Liquid [OTC]; Mylanta® Maximum Strength Liquid [OTC]
PHARMACOLOGIC CATEGORY
Antacid
Antiflatulent
DOSING: ADULTS — Dyspepsia, abdominal bloating: Oral: 10-20 mL or 2-4 tablets 4-6 times/day between meals and at bedtime; may be used every hour for severe symptoms
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum and/or magnesium may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL); aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Aldroxicon I: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (30 mL)
Aldroxicon II: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (30 mL)
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Almacone Double Strength®: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Maalox®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL, 770 mL) [lemon and mint flavors]
Maalox® Max: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL, 770 mL) [cherry, vanilla creme, and wild berry flavors]
Mi-Acid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Mi-Acid Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Mintox Extra Strength: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL (360 mL) [lemon creme flavor]
Mylanta®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, and mint flavors]
Mylanta® Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, orange creme, and mint flavors]
Suspension (Alamag Plus): Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL (360 mL)
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [cherry flavor]
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg [peppermint flavor]
Gelusil®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [peppermint flavor]
Mintox Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
DOSAGE FORMS: CONCISE
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL; aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Aldroxicon I [OTC], Almacone® [OTC], Maalox® [OTC], Mi-Acid [OTC], Mylanta® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL
Aldroxicon II [OTC], Almacone Double Strength [OTC], Maalox® Max® [OTC], Mi-Acid Maximum Strength [OTC], Mylanta® Maximum Strength [OTC]: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Mintox Extra Strength [OTC]: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL
Suspension:
Alamag Plus [OTC]: Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus [OTC], Gelusil® [OTC], Mintox Plus [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Almacone® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg
GENERIC EQUIVALENT AVAILABLE — Yes
ADMINISTRATION — Administer 1-2 hours apart from oral drugs.
USE — Temporary relief of hyperacidity associated with gas; may also be used for indications associated with other antacids
ADVERSE REACTIONS SIGNIFICANT
>10%: Gastrointestinal: Chalky taste, stomach cramps, constipation, bowel motility decreased, fecal impaction, hemorrhoids
1% to 10%: Gastrointestinal: Nausea, vomiting, discoloration of feces (white speckles)
<1% (Limited to important or life-threatening): Dehydration or fluid restriction, hypomagnesemia, hypophosphatemia
DRUG INTERACTIONS
ACE Inhibitors: Antacids may decrease the serum concentration of ACE Inhibitors. Risk C: Monitor therapy
Allopurinol: Antacids may decrease the absorption of Allopurinol. Risk D: Consider therapy modification
Alpha-/Beta-Agonists: Antacids may decrease the excretion of Alpha-/Beta-Agonists. Exceptions: Dipivefrin. Risk C: Monitor therapy
Amphetamines: Antacids may decrease the excretion of Amphetamines. Risk C: Monitor therapy
Anticonvulsants (Hydantoin): Antacids may decrease the serum concentration of Anticonvulsants (Hydantoin). Risk C: Monitor therapy
Antifungal Agents (Azole Derivatives, Systemic): Antacids may decrease the absorption of Antifungal Agents (Azole Derivatives, Systemic). Exceptions: Fluconazole; Miconazole; Voriconazole. Risk D: Consider therapy modification
Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor therapy
Ascorbic Acid: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Atazanavir: Antacids may decrease the absorption of Atazanavir. Risk D: Consider therapy modification
Bisacodyl: Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Antacids may decrease the absorption of Bisphosphonate Derivatives. Antacids containing aluminum, calcium, or magnesium are of specific concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Magnesium Salts may decrease the absorption of Bisphosphonate Derivatives. Only oral magnesium salts are of concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Calcitriol: May increase the serum concentration of Magnesium Salts. Risk D: Consider therapy modification
Calcium Channel Blockers: May enhance the adverse/toxic effect of Magnesium Salts. Magnesium Salts may enhance the hypotensive effect of Calcium Channel Blockers. Risk C: Monitor therapy
Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy
Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Risk C: Monitor therapy
Citric Acid Derivatives: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Risk D: Consider therapy modification
CycloSPORINE: Antacids may decrease the serum concentration of CycloSPORINE. Specifically when cyclosporine is administered orally. Risk C: Monitor therapy
Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Risk C: Monitor therapy
Dasatinib: Antacids may decrease the absorption of Dasatinib. Risk D: Consider therapy modification
Deferasirox: Aluminum Hydroxide may diminish the therapeutic effect of Deferasirox. Risk D: Consider therapy modification
Delavirdine: Antacids may decrease the absorption of Delavirdine. Risk D: Consider therapy modification
Eltrombopag: Aluminum Hydroxide may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., aluminum-containing products) by at least 4 hours. Risk D: Consider therapy modification
Eltrombopag: Magnesium Salts may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., magnesium-containing products) by at least 4 hours. Risk D: Consider therapy modification
Erlotinib: Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification
Ethambutol: Aluminum Hydroxide may decrease the absorption of Ethambutol. Risk D: Consider therapy modification
Fexofenadine: Antacids may decrease the serum concentration of Fexofenadine. Management: No specific recommendations concerning the time required between their administration are provided. Separate administration of each agent by as much time as possible to decrease the risk of an interaction. Risk D: Consider therapy modification
Iron Salts: Antacids may decrease the absorption of Iron Salts. Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk D: Consider therapy modification
Isoniazid: Antacids may decrease the absorption of Isoniazid. Risk D: Consider therapy modification
Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with sustained-release mesalamine products. Separating antacid and mesalamine administration, and/or using lower antacid doses may be adequate means of avoiding this interaction. Risk D: Consider therapy modification
Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Risk D: Consider therapy modification
Mycophenolate: Antacids may decrease the absorption of Mycophenolate. Risk D: Consider therapy modification
Mycophenolate: Magnesium Salts may decrease the absorption of Mycophenolate. This only applies to oral magnesium salts. Risk D: Consider therapy modification
Neuromuscular-Blocking Agents: Magnesium Salts may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Only of concern in patients with increased serum magnesium concentrations. Risk C: Monitor therapy
Penicillamine: Antacids may decrease the serum concentration of Penicillamine. Risk D: Consider therapy modification
Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Phosphate Supplements: Magnesium Salts may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Protease Inhibitors: Antacids may decrease the absorption of Protease Inhibitors. Exceptions: Darunavir. Risk C: Monitor therapy
QuiNIDine: Antacids may decrease the excretion of QuiNIDine. Risk C: Monitor therapy
QuiNINE: Antacids may decrease the serum concentration of QuiNINE. Risk X: Avoid combination
Quinolone Antibiotics: Antacids may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of quinolones. Risk D: Consider therapy modification
Quinolone Antibiotics: Magnesium Salts may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of both agents. Risk D: Consider therapy modification
Sodium Polystyrene Sulfonate: May enhance the adverse/toxic effect of Antacids. The combined use of these two agents may result in metabolic alkalosis. Risk D: Consider therapy modification
Tetracycline Derivatives: Antacids may decrease the absorption of Tetracycline Derivatives. Risk D: Consider therapy modification
Tetracycline Derivatives: Magnesium Salts may decrease the absorption of Tetracycline Derivatives. Only applicable to oral preparations of each agent. Risk D: Consider therapy modification
Tocainide: Antacids may increase the serum concentration of Tocainide. Risk C: Monitor therapy
Trientine: Antacids may decrease the absorption of Trientine. Risk D: Consider therapy modification
Trientine: May decrease the serum concentration of Magnesium Salts. Magnesium Salts may decrease the serum concentration of Trientine. Risk D: Consider therapy modification
PREGNANCY RISK FACTOR — C (show table)
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals.
PRICING — (data from drugstore.com)
Suspension (Mylanta)
200-200-20 mg/5 mL (355): $7.99
200-200-20 mg/5 mL (355): $9.12
200-200-20 mg/5 mL (710): $8.80
Suspension (Mylanta Double-Strength)
400-400-40 mg/5 mL (355): $7.99
400-400-40 mg/5 mL (710): $10.15
CANADIAN BRAND NAMES — Diovol Plus®; Gelusil®; Mylanta® Double Strength; Mylanta® Extra Strength; Mylanta® Regular Strength
INTERNATIONAL BRAND NAMES — Diovol Plus (CA); Gelusil (CA); Mylanta Double Strength (CA); Mylanta Extra Strength (CA); Mylanta Regular Strength (CA)
Showing posts with label Aluminum hydroxide. Show all posts
Showing posts with label Aluminum hydroxide. Show all posts
Wednesday, June 16, 2010
Aluminum hydroxide, magnesium hydroxide, and simethicon
MEDICATION SAFETY ISSUES
Sound-alike/look-alike issues:
Maalox® may be confused with Maox®, Monodox®
Mylanta® may be confused with Mynatal®
Maalox® is a different formulation than Maalox® Total Stomach Relief®
U.S. BRAND NAMES — Alamag Plus [OTC]; Aldroxicon I [OTC]; Aldroxicon II [OTC]; Almacone Double Strength® [OTC]; Almacone® [OTC]; Gelusil® [OTC]; Maalox® Max [OTC]; Maalox® [OTC]; Mi-Acid Maximum Strength [OTC]; Mi-Acid [OTC]; Mintox Extra Strength [OTC]; Mintox Plus [OTC]; Mylanta® Liquid [OTC]; Mylanta® Maximum Strength Liquid [OTC]
PHARMACOLOGIC CATEGORY
Antacid
Antiflatulent
DOSING: ADULTS — Dyspepsia, abdominal bloating: Oral: 10-20 mL or 2-4 tablets 4-6 times/day between meals and at bedtime; may be used every hour for severe symptoms
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum and/or magnesium may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL); aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Aldroxicon I: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (30 mL)
Aldroxicon II: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (30 mL)
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Almacone Double Strength®: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Maalox®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL, 770 mL) [lemon and mint flavors]
Maalox® Max: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL, 770 mL) [cherry, vanilla creme, and wild berry flavors]
Mi-Acid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Mi-Acid Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Mintox Extra Strength: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL (360 mL) [lemon creme flavor]
Mylanta®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, and mint flavors]
Mylanta® Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, orange creme, and mint flavors]
Suspension (Alamag Plus): Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL (360 mL)
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [cherry flavor]
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg [peppermint flavor]
Gelusil®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [peppermint flavor]
Mintox Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
DOSAGE FORMS: CONCISE
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL; aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Aldroxicon I [OTC], Almacone® [OTC], Maalox® [OTC], Mi-Acid [OTC], Mylanta® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL
Aldroxicon II [OTC], Almacone Double Strength [OTC], Maalox® Max® [OTC], Mi-Acid Maximum Strength [OTC], Mylanta® Maximum Strength [OTC]: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Mintox Extra Strength [OTC]: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL
Suspension:
Alamag Plus [OTC]: Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus [OTC], Gelusil® [OTC], Mintox Plus [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Almacone® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg
GENERIC EQUIVALENT AVAILABLE — Yes
ADMINISTRATION — Administer 1-2 hours apart from oral drugs.
USE — Temporary relief of hyperacidity associated with gas; may also be used for indications associated with other antacids
ADVERSE REACTIONS SIGNIFICANT
>10%: Gastrointestinal: Chalky taste, stomach cramps, constipation, bowel motility decreased, fecal impaction, hemorrhoids
1% to 10%: Gastrointestinal: Nausea, vomiting, discoloration of feces (white speckles)
<1% (Limited to important or life-threatening): Dehydration or fluid restriction, hypomagnesemia, hypophosphatemia
DRUG INTERACTIONS
ACE Inhibitors: Antacids may decrease the serum concentration of ACE Inhibitors. Risk C: Monitor therapy
Allopurinol: Antacids may decrease the absorption of Allopurinol. Risk D: Consider therapy modification
Alpha-/Beta-Agonists: Antacids may decrease the excretion of Alpha-/Beta-Agonists. Exceptions: Dipivefrin. Risk C: Monitor therapy
Amphetamines: Antacids may decrease the excretion of Amphetamines. Risk C: Monitor therapy
Anticonvulsants (Hydantoin): Antacids may decrease the serum concentration of Anticonvulsants (Hydantoin). Risk C: Monitor therapy
Antifungal Agents (Azole Derivatives, Systemic): Antacids may decrease the absorption of Antifungal Agents (Azole Derivatives, Systemic). Exceptions: Fluconazole; Miconazole; Voriconazole. Risk D: Consider therapy modification
Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor therapy
Ascorbic Acid: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Atazanavir: Antacids may decrease the absorption of Atazanavir. Risk D: Consider therapy modification
Bisacodyl: Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Antacids may decrease the absorption of Bisphosphonate Derivatives. Antacids containing aluminum, calcium, or magnesium are of specific concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Magnesium Salts may decrease the absorption of Bisphosphonate Derivatives. Only oral magnesium salts are of concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Calcitriol: May increase the serum concentration of Magnesium Salts. Risk D: Consider therapy modification
Calcium Channel Blockers: May enhance the adverse/toxic effect of Magnesium Salts. Magnesium Salts may enhance the hypotensive effect of Calcium Channel Blockers. Risk C: Monitor therapy
Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy
Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Risk C: Monitor therapy
Citric Acid Derivatives: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Risk D: Consider therapy modification
CycloSPORINE: Antacids may decrease the serum concentration of CycloSPORINE. Specifically when cyclosporine is administered orally. Risk C: Monitor therapy
Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Risk C: Monitor therapy
Dasatinib: Antacids may decrease the absorption of Dasatinib. Risk D: Consider therapy modification
Deferasirox: Aluminum Hydroxide may diminish the therapeutic effect of Deferasirox. Risk D: Consider therapy modification
Delavirdine: Antacids may decrease the absorption of Delavirdine. Risk D: Consider therapy modification
Eltrombopag: Aluminum Hydroxide may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., aluminum-containing products) by at least 4 hours. Risk D: Consider therapy modification
Eltrombopag: Magnesium Salts may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., magnesium-containing products) by at least 4 hours. Risk D: Consider therapy modification
Erlotinib: Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification
Ethambutol: Aluminum Hydroxide may decrease the absorption of Ethambutol. Risk D: Consider therapy modification
Fexofenadine: Antacids may decrease the serum concentration of Fexofenadine. Management: No specific recommendations concerning the time required between their administration are provided. Separate administration of each agent by as much time as possible to decrease the risk of an interaction. Risk D: Consider therapy modification
Iron Salts: Antacids may decrease the absorption of Iron Salts. Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk D: Consider therapy modification
Isoniazid: Antacids may decrease the absorption of Isoniazid. Risk D: Consider therapy modification
Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with sustained-release mesalamine products. Separating antacid and mesalamine administration, and/or using lower antacid doses may be adequate means of avoiding this interaction. Risk D: Consider therapy modification
Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Risk D: Consider therapy modification
Mycophenolate: Antacids may decrease the absorption of Mycophenolate. Risk D: Consider therapy modification
Mycophenolate: Magnesium Salts may decrease the absorption of Mycophenolate. This only applies to oral magnesium salts. Risk D: Consider therapy modification
Neuromuscular-Blocking Agents: Magnesium Salts may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Only of concern in patients with increased serum magnesium concentrations. Risk C: Monitor therapy
Penicillamine: Antacids may decrease the serum concentration of Penicillamine. Risk D: Consider therapy modification
Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Phosphate Supplements: Magnesium Salts may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Protease Inhibitors: Antacids may decrease the absorption of Protease Inhibitors. Exceptions: Darunavir. Risk C: Monitor therapy
QuiNIDine: Antacids may decrease the excretion of QuiNIDine. Risk C: Monitor therapy
QuiNINE: Antacids may decrease the serum concentration of QuiNINE. Risk X: Avoid combination
Quinolone Antibiotics: Antacids may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of quinolones. Risk D: Consider therapy modification
Quinolone Antibiotics: Magnesium Salts may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of both agents. Risk D: Consider therapy modification
Sodium Polystyrene Sulfonate: May enhance the adverse/toxic effect of Antacids. The combined use of these two agents may result in metabolic alkalosis. Risk D: Consider therapy modification
Tetracycline Derivatives: Antacids may decrease the absorption of Tetracycline Derivatives. Risk D: Consider therapy modification
Tetracycline Derivatives: Magnesium Salts may decrease the absorption of Tetracycline Derivatives. Only applicable to oral preparations of each agent. Risk D: Consider therapy modification
Tocainide: Antacids may increase the serum concentration of Tocainide. Risk C: Monitor therapy
Trientine: Antacids may decrease the absorption of Trientine. Risk D: Consider therapy modification
Trientine: May decrease the serum concentration of Magnesium Salts. Magnesium Salts may decrease the serum concentration of Trientine. Risk D: Consider therapy modification
PREGNANCY RISK FACTOR — C (show table)
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals.
PRICING — (data from drugstore.com)
Suspension (Mylanta)
200-200-20 mg/5 mL (355): $7.99
200-200-20 mg/5 mL (355): $9.12
200-200-20 mg/5 mL (710): $8.80
Suspension (Mylanta Double-Strength)
400-400-40 mg/5 mL (355): $7.99
400-400-40 mg/5 mL (710): $10.15
CANADIAN BRAND NAMES — Diovol Plus®; Gelusil®; Mylanta® Double Strength; Mylanta® Extra Strength; Mylanta® Regular Strength
INTERNATIONAL BRAND NAMES — Diovol Plus (CA); Gelusil (CA); Mylanta Double Strength (CA); Mylanta Extra Strength (CA); Mylanta Regular Strength (CA)
Sound-alike/look-alike issues:
Maalox® may be confused with Maox®, Monodox®
Mylanta® may be confused with Mynatal®
Maalox® is a different formulation than Maalox® Total Stomach Relief®
U.S. BRAND NAMES — Alamag Plus [OTC]; Aldroxicon I [OTC]; Aldroxicon II [OTC]; Almacone Double Strength® [OTC]; Almacone® [OTC]; Gelusil® [OTC]; Maalox® Max [OTC]; Maalox® [OTC]; Mi-Acid Maximum Strength [OTC]; Mi-Acid [OTC]; Mintox Extra Strength [OTC]; Mintox Plus [OTC]; Mylanta® Liquid [OTC]; Mylanta® Maximum Strength Liquid [OTC]
PHARMACOLOGIC CATEGORY
Antacid
Antiflatulent
DOSING: ADULTS — Dyspepsia, abdominal bloating: Oral: 10-20 mL or 2-4 tablets 4-6 times/day between meals and at bedtime; may be used every hour for severe symptoms
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum and/or magnesium may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL); aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Aldroxicon I: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (30 mL)
Aldroxicon II: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (30 mL)
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Almacone Double Strength®: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Maalox®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL, 770 mL) [lemon and mint flavors]
Maalox® Max: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL, 770 mL) [cherry, vanilla creme, and wild berry flavors]
Mi-Acid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Mi-Acid Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Mintox Extra Strength: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL (360 mL) [lemon creme flavor]
Mylanta®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, and mint flavors]
Mylanta® Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, orange creme, and mint flavors]
Suspension (Alamag Plus): Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL (360 mL)
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [cherry flavor]
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg [peppermint flavor]
Gelusil®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [peppermint flavor]
Mintox Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
DOSAGE FORMS: CONCISE
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL; aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Aldroxicon I [OTC], Almacone® [OTC], Maalox® [OTC], Mi-Acid [OTC], Mylanta® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL
Aldroxicon II [OTC], Almacone Double Strength [OTC], Maalox® Max® [OTC], Mi-Acid Maximum Strength [OTC], Mylanta® Maximum Strength [OTC]: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Mintox Extra Strength [OTC]: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL
Suspension:
Alamag Plus [OTC]: Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus [OTC], Gelusil® [OTC], Mintox Plus [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Almacone® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg
GENERIC EQUIVALENT AVAILABLE — Yes
ADMINISTRATION — Administer 1-2 hours apart from oral drugs.
USE — Temporary relief of hyperacidity associated with gas; may also be used for indications associated with other antacids
ADVERSE REACTIONS SIGNIFICANT
>10%: Gastrointestinal: Chalky taste, stomach cramps, constipation, bowel motility decreased, fecal impaction, hemorrhoids
1% to 10%: Gastrointestinal: Nausea, vomiting, discoloration of feces (white speckles)
<1% (Limited to important or life-threatening): Dehydration or fluid restriction, hypomagnesemia, hypophosphatemia
DRUG INTERACTIONS
ACE Inhibitors: Antacids may decrease the serum concentration of ACE Inhibitors. Risk C: Monitor therapy
Allopurinol: Antacids may decrease the absorption of Allopurinol. Risk D: Consider therapy modification
Alpha-/Beta-Agonists: Antacids may decrease the excretion of Alpha-/Beta-Agonists. Exceptions: Dipivefrin. Risk C: Monitor therapy
Amphetamines: Antacids may decrease the excretion of Amphetamines. Risk C: Monitor therapy
Anticonvulsants (Hydantoin): Antacids may decrease the serum concentration of Anticonvulsants (Hydantoin). Risk C: Monitor therapy
Antifungal Agents (Azole Derivatives, Systemic): Antacids may decrease the absorption of Antifungal Agents (Azole Derivatives, Systemic). Exceptions: Fluconazole; Miconazole; Voriconazole. Risk D: Consider therapy modification
Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor therapy
Ascorbic Acid: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Atazanavir: Antacids may decrease the absorption of Atazanavir. Risk D: Consider therapy modification
Bisacodyl: Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Antacids may decrease the absorption of Bisphosphonate Derivatives. Antacids containing aluminum, calcium, or magnesium are of specific concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Magnesium Salts may decrease the absorption of Bisphosphonate Derivatives. Only oral magnesium salts are of concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Calcitriol: May increase the serum concentration of Magnesium Salts. Risk D: Consider therapy modification
Calcium Channel Blockers: May enhance the adverse/toxic effect of Magnesium Salts. Magnesium Salts may enhance the hypotensive effect of Calcium Channel Blockers. Risk C: Monitor therapy
Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy
Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Risk C: Monitor therapy
Citric Acid Derivatives: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Risk D: Consider therapy modification
CycloSPORINE: Antacids may decrease the serum concentration of CycloSPORINE. Specifically when cyclosporine is administered orally. Risk C: Monitor therapy
Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Risk C: Monitor therapy
Dasatinib: Antacids may decrease the absorption of Dasatinib. Risk D: Consider therapy modification
Deferasirox: Aluminum Hydroxide may diminish the therapeutic effect of Deferasirox. Risk D: Consider therapy modification
Delavirdine: Antacids may decrease the absorption of Delavirdine. Risk D: Consider therapy modification
Eltrombopag: Aluminum Hydroxide may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., aluminum-containing products) by at least 4 hours. Risk D: Consider therapy modification
Eltrombopag: Magnesium Salts may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., magnesium-containing products) by at least 4 hours. Risk D: Consider therapy modification
Erlotinib: Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification
Ethambutol: Aluminum Hydroxide may decrease the absorption of Ethambutol. Risk D: Consider therapy modification
Fexofenadine: Antacids may decrease the serum concentration of Fexofenadine. Management: No specific recommendations concerning the time required between their administration are provided. Separate administration of each agent by as much time as possible to decrease the risk of an interaction. Risk D: Consider therapy modification
Iron Salts: Antacids may decrease the absorption of Iron Salts. Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk D: Consider therapy modification
Isoniazid: Antacids may decrease the absorption of Isoniazid. Risk D: Consider therapy modification
Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with sustained-release mesalamine products. Separating antacid and mesalamine administration, and/or using lower antacid doses may be adequate means of avoiding this interaction. Risk D: Consider therapy modification
Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Risk D: Consider therapy modification
Mycophenolate: Antacids may decrease the absorption of Mycophenolate. Risk D: Consider therapy modification
Mycophenolate: Magnesium Salts may decrease the absorption of Mycophenolate. This only applies to oral magnesium salts. Risk D: Consider therapy modification
Neuromuscular-Blocking Agents: Magnesium Salts may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Only of concern in patients with increased serum magnesium concentrations. Risk C: Monitor therapy
Penicillamine: Antacids may decrease the serum concentration of Penicillamine. Risk D: Consider therapy modification
Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Phosphate Supplements: Magnesium Salts may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Protease Inhibitors: Antacids may decrease the absorption of Protease Inhibitors. Exceptions: Darunavir. Risk C: Monitor therapy
QuiNIDine: Antacids may decrease the excretion of QuiNIDine. Risk C: Monitor therapy
QuiNINE: Antacids may decrease the serum concentration of QuiNINE. Risk X: Avoid combination
Quinolone Antibiotics: Antacids may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of quinolones. Risk D: Consider therapy modification
Quinolone Antibiotics: Magnesium Salts may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of both agents. Risk D: Consider therapy modification
Sodium Polystyrene Sulfonate: May enhance the adverse/toxic effect of Antacids. The combined use of these two agents may result in metabolic alkalosis. Risk D: Consider therapy modification
Tetracycline Derivatives: Antacids may decrease the absorption of Tetracycline Derivatives. Risk D: Consider therapy modification
Tetracycline Derivatives: Magnesium Salts may decrease the absorption of Tetracycline Derivatives. Only applicable to oral preparations of each agent. Risk D: Consider therapy modification
Tocainide: Antacids may increase the serum concentration of Tocainide. Risk C: Monitor therapy
Trientine: Antacids may decrease the absorption of Trientine. Risk D: Consider therapy modification
Trientine: May decrease the serum concentration of Magnesium Salts. Magnesium Salts may decrease the serum concentration of Trientine. Risk D: Consider therapy modification
PREGNANCY RISK FACTOR — C (show table)
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals.
PRICING — (data from drugstore.com)
Suspension (Mylanta)
200-200-20 mg/5 mL (355): $7.99
200-200-20 mg/5 mL (355): $9.12
200-200-20 mg/5 mL (710): $8.80
Suspension (Mylanta Double-Strength)
400-400-40 mg/5 mL (355): $7.99
400-400-40 mg/5 mL (710): $10.15
CANADIAN BRAND NAMES — Diovol Plus®; Gelusil®; Mylanta® Double Strength; Mylanta® Extra Strength; Mylanta® Regular Strength
INTERNATIONAL BRAND NAMES — Diovol Plus (CA); Gelusil (CA); Mylanta Double Strength (CA); Mylanta Extra Strength (CA); Mylanta Regular Strength (CA)
Aluminum hydroxide
U.S. BRAND NAMES — ALternaGel® [OTC]; Dermagran® [OTC]
PHARMACOLOGIC CATEGORY
Antacid
Antidote
Protectant, Topical
DOSING: ADULTS
Hyperphosphatemia: Oral: Initial: 300-600 mg 3 times/day with meals
Hyperacidity: Oral: 600-1200 mg between meals and at bedtime
Skin protectant: Topical: Apply to affected area as needed; reapply at least every 12 hours
DOSING: PEDIATRIC
(For additional information see "Aluminum hydroxide: Pediatric drug information")
Hyperphosphatemia: Oral: 50-150 mg/kg/24 hours in divided doses every 4-6 hours, titrate dosage to maintain serum phosphorus within normal range
Skin protectant: Topical: Refer to adult dosing.
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Ointment:
Dermagran®: 0.275% (120 g)
Suspension, oral: 320 mg/5 mL (473 mL)
ALternaGel®: 600 mg/5 mL (360 mL)
DOSAGE FORMS: CONCISE
Ointment:
Dermagran® [OTC]: 0.275% (120 g)
Suspension, oral: 320 mg/5 mL
ALternaGel® [OTC]: 600 mg/5 mL
GENERIC EQUIVALENT AVAILABLE — Yes: Suspension
ADMINISTRATION
Oral: Dose should be followed with water.
Topical: Apply as needed to affected area; reapply at least every 12 hours.
USE — Treatment of hyperacidity; hyperphosphatemia; temporary protection of minor cuts, scrapes, and burns
ADVERSE REACTIONS SIGNIFICANT — Frequency not defined.
Gastrointestinal: Constipation, discoloration of feces (white speckles), fecal impaction, nausea, stomach cramps, vomiting
Endocrine & metabolic: Hypomagnesemia, hypophosphatemia
CONTRAINDICATIONS — Hypersensitivity to aluminum salts or any component of the formulation
WARNINGS / PRECAUTIONS
Dosage form specific issues: Oral: Hypophosphatemia may occur with prolonged administration or large doses; aluminum intoxication and osteomalacia may occur in patients with uremia. Use with caution in patients with HF, renal failure, edema, cirrhosis, and low sodium diets, and patients who have recently suffered gastrointestinal hemorrhage; uremic patients not receiving dialysis may develop osteomalacia and osteoporosis due to phosphate depletion. When used as an antacid in ulcer treatment, consider buffer capacity (mEq/mL) to calculate dose. Elderly may be predisposed to constipation and fecal impaction. Careful evaluation of possible drug interactions must be done. Topical: Not for application over deep wounds, puncture wounds, infected areas, or lacerations. When used for self medication (OTC use), consult with healthcare provider if needed for >7 days or for use in children <6 months of age.
DRUG INTERACTIONS
ACE Inhibitors: Antacids may decrease the serum concentration of ACE Inhibitors. Risk C: Monitor therapy
Allopurinol: Antacids may decrease the absorption of Allopurinol. Risk D: Consider therapy modification
Amphetamines: Antacids may decrease the excretion of Amphetamines. Risk C: Monitor therapy
Anticonvulsants (Hydantoin): Antacids may decrease the serum concentration of Anticonvulsants (Hydantoin). Risk C: Monitor therapy
Antifungal Agents (Azole Derivatives, Systemic): Antacids may decrease the absorption of Antifungal Agents (Azole Derivatives, Systemic). Exceptions: Fluconazole; Miconazole; Voriconazole. Risk D: Consider therapy modification
Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor therapy
Ascorbic Acid: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Atazanavir: Antacids may decrease the absorption of Atazanavir. Risk D: Consider therapy modification
Bisacodyl: Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Antacids may decrease the absorption of Bisphosphonate Derivatives. Antacids containing aluminum, calcium, or magnesium are of specific concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy
Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Risk C: Monitor therapy
Citric Acid Derivatives: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Risk D: Consider therapy modification
CycloSPORINE: Antacids may decrease the serum concentration of CycloSPORINE. Specifically when cyclosporine is administered orally. Risk C: Monitor therapy
Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Risk C: Monitor therapy
Dasatinib: Antacids may decrease the absorption of Dasatinib. Risk D: Consider therapy modification
Deferasirox: Aluminum Hydroxide may diminish the therapeutic effect of Deferasirox. Risk D: Consider therapy modification
Delavirdine: Antacids may decrease the absorption of Delavirdine. Risk D: Consider therapy modification
Eltrombopag: Aluminum Hydroxide may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., aluminum-containing products) by at least 4 hours. Risk D: Consider therapy modification
Erlotinib: Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification
Ethambutol: Aluminum Hydroxide may decrease the absorption of Ethambutol. Risk D: Consider therapy modification
Fexofenadine: Antacids may decrease the serum concentration of Fexofenadine. Management: No specific recommendations concerning the time required between their administration are provided. Separate administration of each agent by as much time as possible to decrease the risk of an interaction. Risk D: Consider therapy modification
Iron Salts: Antacids may decrease the absorption of Iron Salts. Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk D: Consider therapy modification
Isoniazid: Antacids may decrease the absorption of Isoniazid. Risk D: Consider therapy modification
Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with sustained-release mesalamine products. Separating antacid and mesalamine administration, and/or using lower antacid doses may be adequate means of avoiding this interaction. Risk D: Consider therapy modification
Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Risk D: Consider therapy modification
Mycophenolate: Antacids may decrease the absorption of Mycophenolate. Risk D: Consider therapy modification
Penicillamine: Antacids may decrease the serum concentration of Penicillamine. Risk D: Consider therapy modification
Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Protease Inhibitors: Antacids may decrease the absorption of Protease Inhibitors. Exceptions: Darunavir. Risk C: Monitor therapy
QuiNINE: Antacids may decrease the serum concentration of QuiNINE. Risk X: Avoid combination
Quinolone Antibiotics: Antacids may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of quinolones. Risk D: Consider therapy modification
Sodium Polystyrene Sulfonate: May enhance the adverse/toxic effect of Antacids. The combined use of these two agents may result in metabolic alkalosis. Risk D: Consider therapy modification
Tetracycline Derivatives: Antacids may decrease the absorption of Tetracycline Derivatives. Risk D: Consider therapy modification
Tocainide: Antacids may increase the serum concentration of Tocainide. Risk C: Monitor therapy
Trientine: Antacids may decrease the absorption of Trientine. Risk D: Consider therapy modification
PREGNANCY RISK FACTOR — C (show table)
PREGNANCY IMPLICATIONS — No data available on clinical effects on the fetus; available evidence suggests safe use during pregnancy and breast-feeding.
LACTATION — Excretion in breast milk unknown
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals when used as an antacid. When used to decrease phosphorus, should be taken within 20 minutes of a meal.
MONITORING PARAMETERS — Monitor phosphorus levels periodically when patient is on chronic therapy.
CANADIAN BRAND NAMES — Amphojel®; Basaljel®
INTERNATIONAL BRAND NAMES — Aldrox (BE); Algeldraat (NL); Alu-Cap (AE, BF, BH, BJ, CI, CY, EG, ET, GH, GM, GN, IL, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, QA, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZA, ZM, ZW); Alu-Tab (AU, HK, PH, SG); Alucol (IT); Aludrox (DE); Alugel (DE, TW); Alumigel (JP); Alutab (MY); Alzinox (PH); Amphogel (KP); Amphojel (ZA); Pepsamar (BF, BJ, BR, CI, CN, CO, ES, ET, GH, GM, GN, GR, KE, LR, MA, ML, MR, MU, MW, NE, NG, PE, PT, SC, SD, SL, SN, TN, TZ, UG, VE, ZA, ZM, ZW); Rocgel (FR); Ulcerin-P (TW)
MECHANISM OF ACTION — Neutralizes hydrochloride in stomach to form Al (Cl)3 salt + H2O
PATIENT INFORMATION — Do not take oral drugs within 1-2 hours of administration; notify prescriber if relief is not obtained or if there are any signs to suggest bleeding from the GI tract
PHARMACOLOGIC CATEGORY
Antacid
Antidote
Protectant, Topical
DOSING: ADULTS
Hyperphosphatemia: Oral: Initial: 300-600 mg 3 times/day with meals
Hyperacidity: Oral: 600-1200 mg between meals and at bedtime
Skin protectant: Topical: Apply to affected area as needed; reapply at least every 12 hours
DOSING: PEDIATRIC
(For additional information see "Aluminum hydroxide: Pediatric drug information")
Hyperphosphatemia: Oral: 50-150 mg/kg/24 hours in divided doses every 4-6 hours, titrate dosage to maintain serum phosphorus within normal range
Skin protectant: Topical: Refer to adult dosing.
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Ointment:
Dermagran®: 0.275% (120 g)
Suspension, oral: 320 mg/5 mL (473 mL)
ALternaGel®: 600 mg/5 mL (360 mL)
DOSAGE FORMS: CONCISE
Ointment:
Dermagran® [OTC]: 0.275% (120 g)
Suspension, oral: 320 mg/5 mL
ALternaGel® [OTC]: 600 mg/5 mL
GENERIC EQUIVALENT AVAILABLE — Yes: Suspension
ADMINISTRATION
Oral: Dose should be followed with water.
Topical: Apply as needed to affected area; reapply at least every 12 hours.
USE — Treatment of hyperacidity; hyperphosphatemia; temporary protection of minor cuts, scrapes, and burns
ADVERSE REACTIONS SIGNIFICANT — Frequency not defined.
Gastrointestinal: Constipation, discoloration of feces (white speckles), fecal impaction, nausea, stomach cramps, vomiting
Endocrine & metabolic: Hypomagnesemia, hypophosphatemia
CONTRAINDICATIONS — Hypersensitivity to aluminum salts or any component of the formulation
WARNINGS / PRECAUTIONS
Dosage form specific issues: Oral: Hypophosphatemia may occur with prolonged administration or large doses; aluminum intoxication and osteomalacia may occur in patients with uremia. Use with caution in patients with HF, renal failure, edema, cirrhosis, and low sodium diets, and patients who have recently suffered gastrointestinal hemorrhage; uremic patients not receiving dialysis may develop osteomalacia and osteoporosis due to phosphate depletion. When used as an antacid in ulcer treatment, consider buffer capacity (mEq/mL) to calculate dose. Elderly may be predisposed to constipation and fecal impaction. Careful evaluation of possible drug interactions must be done. Topical: Not for application over deep wounds, puncture wounds, infected areas, or lacerations. When used for self medication (OTC use), consult with healthcare provider if needed for >7 days or for use in children <6 months of age.
DRUG INTERACTIONS
ACE Inhibitors: Antacids may decrease the serum concentration of ACE Inhibitors. Risk C: Monitor therapy
Allopurinol: Antacids may decrease the absorption of Allopurinol. Risk D: Consider therapy modification
Amphetamines: Antacids may decrease the excretion of Amphetamines. Risk C: Monitor therapy
Anticonvulsants (Hydantoin): Antacids may decrease the serum concentration of Anticonvulsants (Hydantoin). Risk C: Monitor therapy
Antifungal Agents (Azole Derivatives, Systemic): Antacids may decrease the absorption of Antifungal Agents (Azole Derivatives, Systemic). Exceptions: Fluconazole; Miconazole; Voriconazole. Risk D: Consider therapy modification
Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor therapy
Ascorbic Acid: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Atazanavir: Antacids may decrease the absorption of Atazanavir. Risk D: Consider therapy modification
Bisacodyl: Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Antacids may decrease the absorption of Bisphosphonate Derivatives. Antacids containing aluminum, calcium, or magnesium are of specific concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy
Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Risk C: Monitor therapy
Citric Acid Derivatives: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Risk D: Consider therapy modification
CycloSPORINE: Antacids may decrease the serum concentration of CycloSPORINE. Specifically when cyclosporine is administered orally. Risk C: Monitor therapy
Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Risk C: Monitor therapy
Dasatinib: Antacids may decrease the absorption of Dasatinib. Risk D: Consider therapy modification
Deferasirox: Aluminum Hydroxide may diminish the therapeutic effect of Deferasirox. Risk D: Consider therapy modification
Delavirdine: Antacids may decrease the absorption of Delavirdine. Risk D: Consider therapy modification
Eltrombopag: Aluminum Hydroxide may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., aluminum-containing products) by at least 4 hours. Risk D: Consider therapy modification
Erlotinib: Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification
Ethambutol: Aluminum Hydroxide may decrease the absorption of Ethambutol. Risk D: Consider therapy modification
Fexofenadine: Antacids may decrease the serum concentration of Fexofenadine. Management: No specific recommendations concerning the time required between their administration are provided. Separate administration of each agent by as much time as possible to decrease the risk of an interaction. Risk D: Consider therapy modification
Iron Salts: Antacids may decrease the absorption of Iron Salts. Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk D: Consider therapy modification
Isoniazid: Antacids may decrease the absorption of Isoniazid. Risk D: Consider therapy modification
Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with sustained-release mesalamine products. Separating antacid and mesalamine administration, and/or using lower antacid doses may be adequate means of avoiding this interaction. Risk D: Consider therapy modification
Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Risk D: Consider therapy modification
Mycophenolate: Antacids may decrease the absorption of Mycophenolate. Risk D: Consider therapy modification
Penicillamine: Antacids may decrease the serum concentration of Penicillamine. Risk D: Consider therapy modification
Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Protease Inhibitors: Antacids may decrease the absorption of Protease Inhibitors. Exceptions: Darunavir. Risk C: Monitor therapy
QuiNINE: Antacids may decrease the serum concentration of QuiNINE. Risk X: Avoid combination
Quinolone Antibiotics: Antacids may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of quinolones. Risk D: Consider therapy modification
Sodium Polystyrene Sulfonate: May enhance the adverse/toxic effect of Antacids. The combined use of these two agents may result in metabolic alkalosis. Risk D: Consider therapy modification
Tetracycline Derivatives: Antacids may decrease the absorption of Tetracycline Derivatives. Risk D: Consider therapy modification
Tocainide: Antacids may increase the serum concentration of Tocainide. Risk C: Monitor therapy
Trientine: Antacids may decrease the absorption of Trientine. Risk D: Consider therapy modification
PREGNANCY RISK FACTOR — C (show table)
PREGNANCY IMPLICATIONS — No data available on clinical effects on the fetus; available evidence suggests safe use during pregnancy and breast-feeding.
LACTATION — Excretion in breast milk unknown
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals when used as an antacid. When used to decrease phosphorus, should be taken within 20 minutes of a meal.
MONITORING PARAMETERS — Monitor phosphorus levels periodically when patient is on chronic therapy.
CANADIAN BRAND NAMES — Amphojel®; Basaljel®
INTERNATIONAL BRAND NAMES — Aldrox (BE); Algeldraat (NL); Alu-Cap (AE, BF, BH, BJ, CI, CY, EG, ET, GH, GM, GN, IL, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, QA, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZA, ZM, ZW); Alu-Tab (AU, HK, PH, SG); Alucol (IT); Aludrox (DE); Alugel (DE, TW); Alumigel (JP); Alutab (MY); Alzinox (PH); Amphogel (KP); Amphojel (ZA); Pepsamar (BF, BJ, BR, CI, CN, CO, ES, ET, GH, GM, GN, GR, KE, LR, MA, ML, MR, MU, MW, NE, NG, PE, PT, SC, SD, SL, SN, TN, TZ, UG, VE, ZA, ZM, ZW); Rocgel (FR); Ulcerin-P (TW)
MECHANISM OF ACTION — Neutralizes hydrochloride in stomach to form Al (Cl)3 salt + H2O
PATIENT INFORMATION — Do not take oral drugs within 1-2 hours of administration; notify prescriber if relief is not obtained or if there are any signs to suggest bleeding from the GI tract
Aluminum hydroxide
U.S. BRAND NAMES — ALternaGel® [OTC]; Dermagran® [OTC]
PHARMACOLOGIC CATEGORY
Antacid
Antidote
Protectant, Topical
DOSING: ADULTS
Hyperphosphatemia: Oral: Initial: 300-600 mg 3 times/day with meals
Hyperacidity: Oral: 600-1200 mg between meals and at bedtime
Skin protectant: Topical: Apply to affected area as needed; reapply at least every 12 hours
DOSING: PEDIATRIC
(For additional information see "Aluminum hydroxide: Pediatric drug information")
Hyperphosphatemia: Oral: 50-150 mg/kg/24 hours in divided doses every 4-6 hours, titrate dosage to maintain serum phosphorus within normal range
Skin protectant: Topical: Refer to adult dosing.
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Ointment:
Dermagran®: 0.275% (120 g)
Suspension, oral: 320 mg/5 mL (473 mL)
ALternaGel®: 600 mg/5 mL (360 mL)
DOSAGE FORMS: CONCISE
Ointment:
Dermagran® [OTC]: 0.275% (120 g)
Suspension, oral: 320 mg/5 mL
ALternaGel® [OTC]: 600 mg/5 mL
GENERIC EQUIVALENT AVAILABLE — Yes: Suspension
ADMINISTRATION
Oral: Dose should be followed with water.
Topical: Apply as needed to affected area; reapply at least every 12 hours.
USE — Treatment of hyperacidity; hyperphosphatemia; temporary protection of minor cuts, scrapes, and burns
ADVERSE REACTIONS SIGNIFICANT — Frequency not defined.
Gastrointestinal: Constipation, discoloration of feces (white speckles), fecal impaction, nausea, stomach cramps, vomiting
Endocrine & metabolic: Hypomagnesemia, hypophosphatemia
CONTRAINDICATIONS — Hypersensitivity to aluminum salts or any component of the formulation
WARNINGS / PRECAUTIONS
Dosage form specific issues: Oral: Hypophosphatemia may occur with prolonged administration or large doses; aluminum intoxication and osteomalacia may occur in patients with uremia. Use with caution in patients with HF, renal failure, edema, cirrhosis, and low sodium diets, and patients who have recently suffered gastrointestinal hemorrhage; uremic patients not receiving dialysis may develop osteomalacia and osteoporosis due to phosphate depletion. When used as an antacid in ulcer treatment, consider buffer capacity (mEq/mL) to calculate dose. Elderly may be predisposed to constipation and fecal impaction. Careful evaluation of possible drug interactions must be done. Topical: Not for application over deep wounds, puncture wounds, infected areas, or lacerations. When used for self medication (OTC use), consult with healthcare provider if needed for >7 days or for use in children <6 months of age.
DRUG INTERACTIONS
ACE Inhibitors: Antacids may decrease the serum concentration of ACE Inhibitors. Risk C: Monitor therapy
Allopurinol: Antacids may decrease the absorption of Allopurinol. Risk D: Consider therapy modification
Amphetamines: Antacids may decrease the excretion of Amphetamines. Risk C: Monitor therapy
Anticonvulsants (Hydantoin): Antacids may decrease the serum concentration of Anticonvulsants (Hydantoin). Risk C: Monitor therapy
Antifungal Agents (Azole Derivatives, Systemic): Antacids may decrease the absorption of Antifungal Agents (Azole Derivatives, Systemic). Exceptions: Fluconazole; Miconazole; Voriconazole. Risk D: Consider therapy modification
Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor therapy
Ascorbic Acid: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Atazanavir: Antacids may decrease the absorption of Atazanavir. Risk D: Consider therapy modification
Bisacodyl: Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Antacids may decrease the absorption of Bisphosphonate Derivatives. Antacids containing aluminum, calcium, or magnesium are of specific concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy
Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Risk C: Monitor therapy
Citric Acid Derivatives: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Risk D: Consider therapy modification
CycloSPORINE: Antacids may decrease the serum concentration of CycloSPORINE. Specifically when cyclosporine is administered orally. Risk C: Monitor therapy
Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Risk C: Monitor therapy
Dasatinib: Antacids may decrease the absorption of Dasatinib. Risk D: Consider therapy modification
Deferasirox: Aluminum Hydroxide may diminish the therapeutic effect of Deferasirox. Risk D: Consider therapy modification
Delavirdine: Antacids may decrease the absorption of Delavirdine. Risk D: Consider therapy modification
Eltrombopag: Aluminum Hydroxide may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., aluminum-containing products) by at least 4 hours. Risk D: Consider therapy modification
Erlotinib: Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification
Ethambutol: Aluminum Hydroxide may decrease the absorption of Ethambutol. Risk D: Consider therapy modification
Fexofenadine: Antacids may decrease the serum concentration of Fexofenadine. Management: No specific recommendations concerning the time required between their administration are provided. Separate administration of each agent by as much time as possible to decrease the risk of an interaction. Risk D: Consider therapy modification
Iron Salts: Antacids may decrease the absorption of Iron Salts. Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk D: Consider therapy modification
Isoniazid: Antacids may decrease the absorption of Isoniazid. Risk D: Consider therapy modification
Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with sustained-release mesalamine products. Separating antacid and mesalamine administration, and/or using lower antacid doses may be adequate means of avoiding this interaction. Risk D: Consider therapy modification
Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Risk D: Consider therapy modification
Mycophenolate: Antacids may decrease the absorption of Mycophenolate. Risk D: Consider therapy modification
Penicillamine: Antacids may decrease the serum concentration of Penicillamine. Risk D: Consider therapy modification
Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Protease Inhibitors: Antacids may decrease the absorption of Protease Inhibitors. Exceptions: Darunavir. Risk C: Monitor therapy
QuiNINE: Antacids may decrease the serum concentration of QuiNINE. Risk X: Avoid combination
Quinolone Antibiotics: Antacids may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of quinolones. Risk D: Consider therapy modification
Sodium Polystyrene Sulfonate: May enhance the adverse/toxic effect of Antacids. The combined use of these two agents may result in metabolic alkalosis. Risk D: Consider therapy modification
Tetracycline Derivatives: Antacids may decrease the absorption of Tetracycline Derivatives. Risk D: Consider therapy modification
Tocainide: Antacids may increase the serum concentration of Tocainide. Risk C: Monitor therapy
Trientine: Antacids may decrease the absorption of Trientine. Risk D: Consider therapy modification
PREGNANCY RISK FACTOR — C (show table)
PREGNANCY IMPLICATIONS — No data available on clinical effects on the fetus; available evidence suggests safe use during pregnancy and breast-feeding.
LACTATION — Excretion in breast milk unknown
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals when used as an antacid. When used to decrease phosphorus, should be taken within 20 minutes of a meal.
MONITORING PARAMETERS — Monitor phosphorus levels periodically when patient is on chronic therapy.
CANADIAN BRAND NAMES — Amphojel®; Basaljel®
INTERNATIONAL BRAND NAMES — Aldrox (BE); Algeldraat (NL); Alu-Cap (AE, BF, BH, BJ, CI, CY, EG, ET, GH, GM, GN, IL, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, QA, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZA, ZM, ZW); Alu-Tab (AU, HK, PH, SG); Alucol (IT); Aludrox (DE); Alugel (DE, TW); Alumigel (JP); Alutab (MY); Alzinox (PH); Amphogel (KP); Amphojel (ZA); Pepsamar (BF, BJ, BR, CI, CN, CO, ES, ET, GH, GM, GN, GR, KE, LR, MA, ML, MR, MU, MW, NE, NG, PE, PT, SC, SD, SL, SN, TN, TZ, UG, VE, ZA, ZM, ZW); Rocgel (FR); Ulcerin-P (TW)
MECHANISM OF ACTION — Neutralizes hydrochloride in stomach to form Al (Cl)3 salt + H2O
PATIENT INFORMATION — Do not take oral drugs within 1-2 hours of administration; notify prescriber if relief is not obtained or if there are any signs to suggest bleeding from the GI tract
PHARMACOLOGIC CATEGORY
Antacid
Antidote
Protectant, Topical
DOSING: ADULTS
Hyperphosphatemia: Oral: Initial: 300-600 mg 3 times/day with meals
Hyperacidity: Oral: 600-1200 mg between meals and at bedtime
Skin protectant: Topical: Apply to affected area as needed; reapply at least every 12 hours
DOSING: PEDIATRIC
(For additional information see "Aluminum hydroxide: Pediatric drug information")
Hyperphosphatemia: Oral: 50-150 mg/kg/24 hours in divided doses every 4-6 hours, titrate dosage to maintain serum phosphorus within normal range
Skin protectant: Topical: Refer to adult dosing.
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Ointment:
Dermagran®: 0.275% (120 g)
Suspension, oral: 320 mg/5 mL (473 mL)
ALternaGel®: 600 mg/5 mL (360 mL)
DOSAGE FORMS: CONCISE
Ointment:
Dermagran® [OTC]: 0.275% (120 g)
Suspension, oral: 320 mg/5 mL
ALternaGel® [OTC]: 600 mg/5 mL
GENERIC EQUIVALENT AVAILABLE — Yes: Suspension
ADMINISTRATION
Oral: Dose should be followed with water.
Topical: Apply as needed to affected area; reapply at least every 12 hours.
USE — Treatment of hyperacidity; hyperphosphatemia; temporary protection of minor cuts, scrapes, and burns
ADVERSE REACTIONS SIGNIFICANT — Frequency not defined.
Gastrointestinal: Constipation, discoloration of feces (white speckles), fecal impaction, nausea, stomach cramps, vomiting
Endocrine & metabolic: Hypomagnesemia, hypophosphatemia
CONTRAINDICATIONS — Hypersensitivity to aluminum salts or any component of the formulation
WARNINGS / PRECAUTIONS
Dosage form specific issues: Oral: Hypophosphatemia may occur with prolonged administration or large doses; aluminum intoxication and osteomalacia may occur in patients with uremia. Use with caution in patients with HF, renal failure, edema, cirrhosis, and low sodium diets, and patients who have recently suffered gastrointestinal hemorrhage; uremic patients not receiving dialysis may develop osteomalacia and osteoporosis due to phosphate depletion. When used as an antacid in ulcer treatment, consider buffer capacity (mEq/mL) to calculate dose. Elderly may be predisposed to constipation and fecal impaction. Careful evaluation of possible drug interactions must be done. Topical: Not for application over deep wounds, puncture wounds, infected areas, or lacerations. When used for self medication (OTC use), consult with healthcare provider if needed for >7 days or for use in children <6 months of age.
DRUG INTERACTIONS
ACE Inhibitors: Antacids may decrease the serum concentration of ACE Inhibitors. Risk C: Monitor therapy
Allopurinol: Antacids may decrease the absorption of Allopurinol. Risk D: Consider therapy modification
Amphetamines: Antacids may decrease the excretion of Amphetamines. Risk C: Monitor therapy
Anticonvulsants (Hydantoin): Antacids may decrease the serum concentration of Anticonvulsants (Hydantoin). Risk C: Monitor therapy
Antifungal Agents (Azole Derivatives, Systemic): Antacids may decrease the absorption of Antifungal Agents (Azole Derivatives, Systemic). Exceptions: Fluconazole; Miconazole; Voriconazole. Risk D: Consider therapy modification
Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor therapy
Ascorbic Acid: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Atazanavir: Antacids may decrease the absorption of Atazanavir. Risk D: Consider therapy modification
Bisacodyl: Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Antacids may decrease the absorption of Bisphosphonate Derivatives. Antacids containing aluminum, calcium, or magnesium are of specific concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy
Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Risk C: Monitor therapy
Citric Acid Derivatives: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Risk D: Consider therapy modification
CycloSPORINE: Antacids may decrease the serum concentration of CycloSPORINE. Specifically when cyclosporine is administered orally. Risk C: Monitor therapy
Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Risk C: Monitor therapy
Dasatinib: Antacids may decrease the absorption of Dasatinib. Risk D: Consider therapy modification
Deferasirox: Aluminum Hydroxide may diminish the therapeutic effect of Deferasirox. Risk D: Consider therapy modification
Delavirdine: Antacids may decrease the absorption of Delavirdine. Risk D: Consider therapy modification
Eltrombopag: Aluminum Hydroxide may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., aluminum-containing products) by at least 4 hours. Risk D: Consider therapy modification
Erlotinib: Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification
Ethambutol: Aluminum Hydroxide may decrease the absorption of Ethambutol. Risk D: Consider therapy modification
Fexofenadine: Antacids may decrease the serum concentration of Fexofenadine. Management: No specific recommendations concerning the time required between their administration are provided. Separate administration of each agent by as much time as possible to decrease the risk of an interaction. Risk D: Consider therapy modification
Iron Salts: Antacids may decrease the absorption of Iron Salts. Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk D: Consider therapy modification
Isoniazid: Antacids may decrease the absorption of Isoniazid. Risk D: Consider therapy modification
Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with sustained-release mesalamine products. Separating antacid and mesalamine administration, and/or using lower antacid doses may be adequate means of avoiding this interaction. Risk D: Consider therapy modification
Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Risk D: Consider therapy modification
Mycophenolate: Antacids may decrease the absorption of Mycophenolate. Risk D: Consider therapy modification
Penicillamine: Antacids may decrease the serum concentration of Penicillamine. Risk D: Consider therapy modification
Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Protease Inhibitors: Antacids may decrease the absorption of Protease Inhibitors. Exceptions: Darunavir. Risk C: Monitor therapy
QuiNINE: Antacids may decrease the serum concentration of QuiNINE. Risk X: Avoid combination
Quinolone Antibiotics: Antacids may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of quinolones. Risk D: Consider therapy modification
Sodium Polystyrene Sulfonate: May enhance the adverse/toxic effect of Antacids. The combined use of these two agents may result in metabolic alkalosis. Risk D: Consider therapy modification
Tetracycline Derivatives: Antacids may decrease the absorption of Tetracycline Derivatives. Risk D: Consider therapy modification
Tocainide: Antacids may increase the serum concentration of Tocainide. Risk C: Monitor therapy
Trientine: Antacids may decrease the absorption of Trientine. Risk D: Consider therapy modification
PREGNANCY RISK FACTOR — C (show table)
PREGNANCY IMPLICATIONS — No data available on clinical effects on the fetus; available evidence suggests safe use during pregnancy and breast-feeding.
LACTATION — Excretion in breast milk unknown
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals when used as an antacid. When used to decrease phosphorus, should be taken within 20 minutes of a meal.
MONITORING PARAMETERS — Monitor phosphorus levels periodically when patient is on chronic therapy.
CANADIAN BRAND NAMES — Amphojel®; Basaljel®
INTERNATIONAL BRAND NAMES — Aldrox (BE); Algeldraat (NL); Alu-Cap (AE, BF, BH, BJ, CI, CY, EG, ET, GH, GM, GN, IL, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, QA, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZA, ZM, ZW); Alu-Tab (AU, HK, PH, SG); Alucol (IT); Aludrox (DE); Alugel (DE, TW); Alumigel (JP); Alutab (MY); Alzinox (PH); Amphogel (KP); Amphojel (ZA); Pepsamar (BF, BJ, BR, CI, CN, CO, ES, ET, GH, GM, GN, GR, KE, LR, MA, ML, MR, MU, MW, NE, NG, PE, PT, SC, SD, SL, SN, TN, TZ, UG, VE, ZA, ZM, ZW); Rocgel (FR); Ulcerin-P (TW)
MECHANISM OF ACTION — Neutralizes hydrochloride in stomach to form Al (Cl)3 salt + H2O
PATIENT INFORMATION — Do not take oral drugs within 1-2 hours of administration; notify prescriber if relief is not obtained or if there are any signs to suggest bleeding from the GI tract
Saturday, April 26, 2008
Aluminum hydroxide, magnesium hydroxide, and simethicon
U.S. BRAND NAMES — Alamag Plus [OTC]; Aldroxicon I [OTC]; Aldroxicon II [OTC]; Almacone Double Strength® [OTC]; Almacone® [OTC]; Gelusil® [OTC]; Maalox® Max [OTC]; Maalox® [OTC]; Mi-Acid Maximum Strength [OTC]; Mi-Acid [OTC]; Mintox Extra Strength [OTC]; Mintox Plus [OTC]; Mylanta® Liquid [OTC]; Mylanta® Maximum Strength Liquid [OTC]
PHARMACOLOGIC CATEGORY
Antacid
Antiflatulent
DOSING: ADULTS — Dyspepsia, abdominal bloating: Oral: 10-20 mL or 2-4 tablets 4-6 times/day between meals and at bedtime; may be used every hour for severe symptoms
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum and/or magnesium may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL); aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Aldroxicon I: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (30 mL)
Aldroxicon II: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (30 mL)
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Almacone Double Strength®: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Maalox®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL, 770 mL) [lemon and mint flavors]
Maalox® Max: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL, 770 mL) [cherry, vanilla creme, and wild berry flavors]
Mi-Acid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Mi-Acid Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Mintox Extra Strength: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL (360 mL) [lemon creme flavor]
Mylanta®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, and mint flavors]
Mylanta® Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, orange creme, and mint flavors]
Suspension (Alamag Plus): Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL (360 mL)
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [cherry flavor]
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg [peppermint flavor]
Gelusil®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [peppermint flavor]
Mintox Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
DOSAGE FORMS: CONCISE
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL; aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Aldroxicon I [OTC], Almacone® [OTC], Maalox® [OTC], Mi-Acid [OTC], Mylanta® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL
Aldroxicon II [OTC], Almacone Double Strength [OTC], Maalox® Max® [OTC], Mi-Acid Maximum Strength [OTC], Mylanta® Maximum Strength [OTC]: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Mintox Extra Strength [OTC]: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL
Suspension:
Alamag Plus [OTC]: Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus [OTC], Gelusil® [OTC], Mintox Plus [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Almacone® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg
GENERIC EQUIVALENT AVAILABLE — Yes
ADMINISTRATION — Administer 1-2 hours apart from oral drugs.
USE — Temporary relief of hyperacidity associated with gas; may also be used for indications associated with other antacids
ADVERSE REACTIONS SIGNIFICANT
>10%: Gastrointestinal: Chalky taste, stomach cramps, constipation, bowel motility decreased, fecal impaction, hemorrhoids
1% to 10%: Gastrointestinal: Nausea, vomiting, discoloration of feces (white speckles)
<1% (Limited to important or life-threatening): Dehydration or fluid restriction, hypomagnesemia, hypophosphatemia
DRUG INTERACTIONS — Decreased effect: Tetracyclines, digoxin, indomethacin, iron salts, isoniazid, allopurinol, benzodiazepines, corticosteroids, penicillamine, phenothiazines, ranitidine, ketoconazole, itraconazole
PREGNANCY RISK FACTOR — C (show table)
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals.
PRICING — (data from drugstore.com)
Suspension (Mylanta)
200-200-20 mg/5 mL (355): $7.99
200-200-20 mg/5 mL (355): $7.99
200-200-20 mg/5 mL (710): $8.80
Suspension (Mylanta Double-Strength)
400-400-40 mg/5 mL (355): $7.99
400-400-40 mg/5 mL (710): $9.51
CANADIAN BRAND NAMES — Diovol Plus®; Gelusil®; Mylanta® Double Strength; Mylanta® Extra Strength; Mylanta® Regular Strength
INTERNATIONAL BRAND NAMES — Diovol Plus (CA); Gelusil (CA); Mylanta Double Strength (CA); Mylanta Extra Strength (CA); Mylanta Regular Strength (CA)
PHARMACOLOGIC CATEGORY
Antacid
Antiflatulent
DOSING: ADULTS — Dyspepsia, abdominal bloating: Oral: 10-20 mL or 2-4 tablets 4-6 times/day between meals and at bedtime; may be used every hour for severe symptoms
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum and/or magnesium may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL); aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Aldroxicon I: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (30 mL)
Aldroxicon II: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (30 mL)
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Almacone Double Strength®: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Maalox®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL, 770 mL) [lemon and mint flavors]
Maalox® Max: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL, 770 mL) [cherry, vanilla creme, and wild berry flavors]
Mi-Acid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Mi-Acid Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Mintox Extra Strength: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL (360 mL) [lemon creme flavor]
Mylanta®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, and mint flavors]
Mylanta® Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, orange creme, and mint flavors]
Suspension (Alamag Plus): Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL (360 mL)
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [cherry flavor]
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg [peppermint flavor]
Gelusil®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [peppermint flavor]
Mintox Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
DOSAGE FORMS: CONCISE
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL; aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Aldroxicon I [OTC], Almacone® [OTC], Maalox® [OTC], Mi-Acid [OTC], Mylanta® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL
Aldroxicon II [OTC], Almacone Double Strength [OTC], Maalox® Max® [OTC], Mi-Acid Maximum Strength [OTC], Mylanta® Maximum Strength [OTC]: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Mintox Extra Strength [OTC]: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL
Suspension:
Alamag Plus [OTC]: Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus [OTC], Gelusil® [OTC], Mintox Plus [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Almacone® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg
GENERIC EQUIVALENT AVAILABLE — Yes
ADMINISTRATION — Administer 1-2 hours apart from oral drugs.
USE — Temporary relief of hyperacidity associated with gas; may also be used for indications associated with other antacids
ADVERSE REACTIONS SIGNIFICANT
>10%: Gastrointestinal: Chalky taste, stomach cramps, constipation, bowel motility decreased, fecal impaction, hemorrhoids
1% to 10%: Gastrointestinal: Nausea, vomiting, discoloration of feces (white speckles)
<1% (Limited to important or life-threatening): Dehydration or fluid restriction, hypomagnesemia, hypophosphatemia
DRUG INTERACTIONS — Decreased effect: Tetracyclines, digoxin, indomethacin, iron salts, isoniazid, allopurinol, benzodiazepines, corticosteroids, penicillamine, phenothiazines, ranitidine, ketoconazole, itraconazole
PREGNANCY RISK FACTOR — C (show table)
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals.
PRICING — (data from drugstore.com)
Suspension (Mylanta)
200-200-20 mg/5 mL (355): $7.99
200-200-20 mg/5 mL (355): $7.99
200-200-20 mg/5 mL (710): $8.80
Suspension (Mylanta Double-Strength)
400-400-40 mg/5 mL (355): $7.99
400-400-40 mg/5 mL (710): $9.51
CANADIAN BRAND NAMES — Diovol Plus®; Gelusil®; Mylanta® Double Strength; Mylanta® Extra Strength; Mylanta® Regular Strength
INTERNATIONAL BRAND NAMES — Diovol Plus (CA); Gelusil (CA); Mylanta Double Strength (CA); Mylanta Extra Strength (CA); Mylanta Regular Strength (CA)
Aluminum hydroxide and magnesium trisilicate
U.S. BRAND NAMES — Alenic Alka Tablet [OTC]; Gaviscon® Tablet [OTC]; Genaton Tablet [OTC]
PHARMACOLOGIC CATEGORY
Antacid
DOSING: ADULTS — Dyspepsia, gastric acidity: Oral: Chew 2-4 tablets 4 times/day or as directed by healthcare provider
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum and/or magnesium may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, chewable: Aluminum hydroxide 80 mg and magnesium trisilicate 20 mg
Alenic Alka: Aluminum hydroxide 80 mg and magnesium trisilicate 20 mg [butterscotch flavor]
Gaviscon®: Aluminum hydroxide 80 mg and magnesium trisilicate 20 mg [contains sodium 0.8 mEq/tablet; butterscotch flavor]
Genaton: Aluminum hydroxide 80 mg and magnesium trisilicate 20 mg
DOSAGE FORMS: CONCISE
Tablet, chewable: Aluminum hydroxide 80 mg and magnesium trisilicate 20 mg
Alenic Alka [OTC], Gaviscon® [OTC], Genaton [OTC]: Aluminum hydroxide 80 mg and magnesium trisilicate 20 mg
GENERIC EQUIVALENT AVAILABLE — Yes
ADMINISTRATION — Tablets should be chewed and not swallowed whole.
USE — Temporary relief of hyperacidity
DRUG INTERACTIONS — Decreased effect: Tetracyclines, digoxin, indomethacin, iron salts, isoniazid, allopurinol, benzodiazepines, corticosteroids, penicillamine, phenothiazines, ranitidine, ketoconazole, itraconazole
PREGNANCY RISK FACTOR — C (show table)
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals with water, milk, or juice. Gaviscon® chewable tablet contains sodium 0.8 mEq/tablet.
PHARMACOLOGIC CATEGORY
Antacid
DOSING: ADULTS — Dyspepsia, gastric acidity: Oral: Chew 2-4 tablets 4 times/day or as directed by healthcare provider
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum and/or magnesium may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, chewable: Aluminum hydroxide 80 mg and magnesium trisilicate 20 mg
Alenic Alka: Aluminum hydroxide 80 mg and magnesium trisilicate 20 mg [butterscotch flavor]
Gaviscon®: Aluminum hydroxide 80 mg and magnesium trisilicate 20 mg [contains sodium 0.8 mEq/tablet; butterscotch flavor]
Genaton: Aluminum hydroxide 80 mg and magnesium trisilicate 20 mg
DOSAGE FORMS: CONCISE
Tablet, chewable: Aluminum hydroxide 80 mg and magnesium trisilicate 20 mg
Alenic Alka [OTC], Gaviscon® [OTC], Genaton [OTC]: Aluminum hydroxide 80 mg and magnesium trisilicate 20 mg
GENERIC EQUIVALENT AVAILABLE — Yes
ADMINISTRATION — Tablets should be chewed and not swallowed whole.
USE — Temporary relief of hyperacidity
DRUG INTERACTIONS — Decreased effect: Tetracyclines, digoxin, indomethacin, iron salts, isoniazid, allopurinol, benzodiazepines, corticosteroids, penicillamine, phenothiazines, ranitidine, ketoconazole, itraconazole
PREGNANCY RISK FACTOR — C (show table)
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals with water, milk, or juice. Gaviscon® chewable tablet contains sodium 0.8 mEq/tablet.
Aluminum hydroxide and magnesium hydroxide
U.S. BRAND NAMES — Alamag [OTC]; Rulox No. 1 [DSC]; Rulox [OTC]
PHARMACOLOGIC CATEGORY
Antacid
DOSING: ADULTS — Dyspepsia: Oral: 5-10 mL 4-6 times/day, between meals and at bedtime; may be used every hour for severe symptoms
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum and/or magnesium may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Suspension: Aluminum hydroxide 225 mg and magnesium hydroxide 200 mg per 5 mL (360 mL)
Alamag, Rulox: Aluminum hydroxide 225 mg and magnesium hydroxide 200 mg per 5 mL (360 mL)
Tablet, chewable:
Alamag: Aluminum hydroxide 300 mg and magnesium hydroxide 150 mg
Rulox No. 1: Aluminum hydroxide 200 mg and magnesium hydroxide 200 mg [DSC]
DOSAGE FORMS: CONCISE
Suspension: Aluminum hydroxide 225 mg and magnesium hydroxide 200 mg per 5 mL
Alamag [OTC], Rulox [OTC]: Aluminum hydroxide 225 mg and magnesium hydroxide 200 mg per 5 mL
Tablet, chewable:
Alamag [OTC]: Aluminum hydroxide 300 mg and magnesium hydroxide 150 mg
GENERIC EQUIVALENT AVAILABLE — Yes
USE — Antacid, hyperphosphatemia in renal failure
ADVERSE REACTIONS SIGNIFICANT
>10%: Gastrointestinal: Constipation, chalky taste, stomach cramps, fecal impaction
1% to 10%: Gastrointestinal: Nausea, vomiting, discoloration of feces (white speckles)
<1% (Limited to important or life-threatening): Hypomagnesemia, hypophosphatemia
DRUG INTERACTIONS — Decreased effect: Tetracyclines, digoxin, indomethacin, iron salts, isoniazid, allopurinol, benzodiazepines, corticosteroids, penicillamine, phenothiazines, ranitidine, ketoconazole, itraconazole
PREGNANCY RISK FACTOR — C (show table)
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals.
CANADIAN BRAND NAMES — Diovol® Ex; Diovol®; Gelusil® Extra Strength; Mylanta™
INTERNATIONAL BRAND NAMES — Diovol (CA); Diovol Ex (CA); Gelusil Extra Strength (CA); Mylanta® (CA)
PHARMACOLOGIC CATEGORY
Antacid
DOSING: ADULTS — Dyspepsia: Oral: 5-10 mL 4-6 times/day, between meals and at bedtime; may be used every hour for severe symptoms
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum and/or magnesium may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Suspension: Aluminum hydroxide 225 mg and magnesium hydroxide 200 mg per 5 mL (360 mL)
Alamag, Rulox: Aluminum hydroxide 225 mg and magnesium hydroxide 200 mg per 5 mL (360 mL)
Tablet, chewable:
Alamag: Aluminum hydroxide 300 mg and magnesium hydroxide 150 mg
Rulox No. 1: Aluminum hydroxide 200 mg and magnesium hydroxide 200 mg [DSC]
DOSAGE FORMS: CONCISE
Suspension: Aluminum hydroxide 225 mg and magnesium hydroxide 200 mg per 5 mL
Alamag [OTC], Rulox [OTC]: Aluminum hydroxide 225 mg and magnesium hydroxide 200 mg per 5 mL
Tablet, chewable:
Alamag [OTC]: Aluminum hydroxide 300 mg and magnesium hydroxide 150 mg
GENERIC EQUIVALENT AVAILABLE — Yes
USE — Antacid, hyperphosphatemia in renal failure
ADVERSE REACTIONS SIGNIFICANT
>10%: Gastrointestinal: Constipation, chalky taste, stomach cramps, fecal impaction
1% to 10%: Gastrointestinal: Nausea, vomiting, discoloration of feces (white speckles)
<1% (Limited to important or life-threatening): Hypomagnesemia, hypophosphatemia
DRUG INTERACTIONS — Decreased effect: Tetracyclines, digoxin, indomethacin, iron salts, isoniazid, allopurinol, benzodiazepines, corticosteroids, penicillamine, phenothiazines, ranitidine, ketoconazole, itraconazole
PREGNANCY RISK FACTOR — C (show table)
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals.
CANADIAN BRAND NAMES — Diovol® Ex; Diovol®; Gelusil® Extra Strength; Mylanta™
INTERNATIONAL BRAND NAMES — Diovol (CA); Diovol Ex (CA); Gelusil Extra Strength (CA); Mylanta® (CA)
Aluminum hydroxide and magnesium carbonate
U.S. BRAND NAMES — Acid Gone Extra Strength [OTC]; Acid Gone [OTC]; Alenic Alka [OTC]; Gaviscon® Extra Strength [OTC]; Gaviscon® Liquid [OTC]; Genaton™ [OTC]
PHARMACOLOGIC CATEGORY
Antacid
DOSING: ADULTS — Dyspepsia, gastric acidity: Oral:
Liquid:
Gaviscon® Regular Strength: 15-30 mL 4 times/day after meals and at bedtime
Gaviscon® Extra Strength Relief: 15-30 mL 4 times/day after meals
Tablet (Gaviscon® Extra Strength Relief): Chew 2-4 tablets 4 times/day
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum and/or magnesium may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Liquid:
Acid Gone: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL (360 mL)
Alenic Alka: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL (355 mL) [contains magnesium 35 mg/5 mL, sodium 13 mg/5 mL, and benzyl alcohol; cool mint flavor]
Gaviscon®: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL (355 mL) [contains sodium 0.57 mEq/5 mL and benzyl alcohol; cool mint flavor]
Gaviscon® Extra Strength: Aluminum hydroxide 84.6 mg and magnesium carbonate 79.1 mg per 5 mL (355 mL) [contains sodium 0.9 mEq/5 mL and benzyl alcohol; cool mint flavor]
Genaton™: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL (360 mL)
Tablet, chewable:
Acid Gone Extra Strength: Aluminum hydroxide 160 mg and magnesium carbonate 105 mg
Gaviscon® Extra Strength: Aluminum hydroxide 160 mg and magnesium carbonate 105 mg [contains sodium 19 mg/tablet (1.3 mEq/tablet); cherry and original flavors]
DOSAGE FORMS: CONCISE
Liquid: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL; aluminum hydroxide 84.6 mg and magnesium carbonate 79.1 mg per 5 mL
Acid Gone [OTC], Alenic Alka [OTC], Gaviscon® [OTC], Genaton™ [OTC]: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL
Gaviscon® Extra Strength [OTC]: Aluminum hydroxide 84.6 mg and magnesium carbonate 79.1 mg per 5 mL
Tablet, chewable: Aluminum hydroxide 160 mg and magnesium carbonate 105 mg
Acid Gone Extra Strength [OTC], Gaviscon® Extra Strength [OTC]: Aluminum hydroxide 160 mg and magnesium carbonate 105 mg
GENERIC EQUIVALENT AVAILABLE — Yes
USE — Temporary relief of symptoms associated with gastric acidity
ADVERSE REACTIONS SIGNIFICANT — 1% to 10%:
Endocrine & metabolic: Hypermagnesemia, aluminum intoxication (prolonged use and concomitant renal failure), hypophosphatemia
Gastrointestinal: Constipation, diarrhea
Neuromuscular & skeletal: Osteomalacia
DRUG INTERACTIONS — Decreased effect: Tetracyclines, digoxin, indomethacin, iron salts, isoniazid, allopurinol, benzodiazepines, corticosteroids, penicillamine, phenothiazines, ranitidine, ketoconazole, itraconazole
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals with water, milk or juice. Some products contain sodium; Gaviscon® regular strength liquid: 0.57 mEq/5 mL, Gaviscon® Extra Strength liquid: 0.9 mEq/5 mL extra strength liquid, Gaviscon® Extra Strength tablet 19 mg [1.3 mEq], Alenic Alka liquid: 13 mg/5 mL
PHARMACOLOGIC CATEGORY
Antacid
DOSING: ADULTS — Dyspepsia, gastric acidity: Oral:
Liquid:
Gaviscon® Regular Strength: 15-30 mL 4 times/day after meals and at bedtime
Gaviscon® Extra Strength Relief: 15-30 mL 4 times/day after meals
Tablet (Gaviscon® Extra Strength Relief): Chew 2-4 tablets 4 times/day
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum and/or magnesium may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Liquid:
Acid Gone: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL (360 mL)
Alenic Alka: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL (355 mL) [contains magnesium 35 mg/5 mL, sodium 13 mg/5 mL, and benzyl alcohol; cool mint flavor]
Gaviscon®: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL (355 mL) [contains sodium 0.57 mEq/5 mL and benzyl alcohol; cool mint flavor]
Gaviscon® Extra Strength: Aluminum hydroxide 84.6 mg and magnesium carbonate 79.1 mg per 5 mL (355 mL) [contains sodium 0.9 mEq/5 mL and benzyl alcohol; cool mint flavor]
Genaton™: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL (360 mL)
Tablet, chewable:
Acid Gone Extra Strength: Aluminum hydroxide 160 mg and magnesium carbonate 105 mg
Gaviscon® Extra Strength: Aluminum hydroxide 160 mg and magnesium carbonate 105 mg [contains sodium 19 mg/tablet (1.3 mEq/tablet); cherry and original flavors]
DOSAGE FORMS: CONCISE
Liquid: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL; aluminum hydroxide 84.6 mg and magnesium carbonate 79.1 mg per 5 mL
Acid Gone [OTC], Alenic Alka [OTC], Gaviscon® [OTC], Genaton™ [OTC]: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL
Gaviscon® Extra Strength [OTC]: Aluminum hydroxide 84.6 mg and magnesium carbonate 79.1 mg per 5 mL
Tablet, chewable: Aluminum hydroxide 160 mg and magnesium carbonate 105 mg
Acid Gone Extra Strength [OTC], Gaviscon® Extra Strength [OTC]: Aluminum hydroxide 160 mg and magnesium carbonate 105 mg
GENERIC EQUIVALENT AVAILABLE — Yes
USE — Temporary relief of symptoms associated with gastric acidity
ADVERSE REACTIONS SIGNIFICANT — 1% to 10%:
Endocrine & metabolic: Hypermagnesemia, aluminum intoxication (prolonged use and concomitant renal failure), hypophosphatemia
Gastrointestinal: Constipation, diarrhea
Neuromuscular & skeletal: Osteomalacia
DRUG INTERACTIONS — Decreased effect: Tetracyclines, digoxin, indomethacin, iron salts, isoniazid, allopurinol, benzodiazepines, corticosteroids, penicillamine, phenothiazines, ranitidine, ketoconazole, itraconazole
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals with water, milk or juice. Some products contain sodium; Gaviscon® regular strength liquid: 0.57 mEq/5 mL, Gaviscon® Extra Strength liquid: 0.9 mEq/5 mL extra strength liquid, Gaviscon® Extra Strength tablet 19 mg [1.3 mEq], Alenic Alka liquid: 13 mg/5 mL
Aluminum hydroxide
U.S. BRAND NAMES — ALternaGel® [OTC]; Dermagran® [OTC]
PHARMACOLOGIC CATEGORY
Antacid
Antidote
Protectant, Topical
DOSING: ADULTS
Hyperphosphatemia: Oral: Initial: 300-600 mg 3 times/day with meals
Hyperacidity: Oral: 600-1200 mg between meals and at bedtime
Skin protectant: Topical: Apply to affected area as needed; reapply at least every 12 hours
DOSING: PEDIATRIC
Hyperphosphatemia: Oral: 50-150 mg/kg/24 hours in divided doses every 4-6 hours, titrate dosage to maintain serum phosphorus within normal range
Skin protectant: Topical: Refer to adult dosing.
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Ointment:
Dermagran®: 0.275% (120 g)
Suspension, oral: 320 mg/5 mL (473 mL)
ALternaGel®: 600 mg/5 mL (360 mL)
DOSAGE FORMS: CONCISE
Ointment:
Dermagran® [OTC]: 0.275% (120 g)
Suspension, oral: 320 mg/5 mL
ALternaGel® [OTC]: 600 mg/5 mL
GENERIC EQUIVALENT AVAILABLE — Yes: Suspension
ADMINISTRATION
Oral: Dose should be followed with water.
Topical: Apply as needed to affected area; reapply at least every 12 hours.
USE — Treatment of hyperacidity; hyperphosphatemia; temporary protection of minor cuts, scrapes, and burns
ADVERSE REACTIONS SIGNIFICANT — Frequency not defined.
Gastrointestinal: Constipation, stomach cramps, fecal impaction, nausea, vomiting, discoloration of feces (white speckles)
Endocrine & metabolic: Hypophosphatemia, hypomagnesemia
CONTRAINDICATIONS — Hypersensitivity to aluminum salts or any component of the formulation
WARNINGS / PRECAUTIONS — Oral: Hypophosphatemia may occur with prolonged administration or large doses; aluminum intoxication and osteomalacia may occur in patients with uremia. Use with caution in patients with CHF, renal failure, edema, cirrhosis, and low sodium diets, and patients who have recently suffered gastrointestinal hemorrhage; uremic patients not receiving dialysis may develop osteomalacia and osteoporosis due to phosphate depletion.
Elderly may be predisposed to constipation and fecal impaction. Careful evaluation of possible drug interactions must be done. When used as an antacid in ulcer treatment, consider buffer capacity (mEq/mL) to calculate dose.
Topical: Not for application over deep wounds, puncture wounds, infected areas, or lacerations. When used for self medication (OTC use), consult with healthcare provider if needed for >7 days or for use in children <6 months of age.
DRUG INTERACTIONS
Decreased effect: Aluminum hydroxide may decrease the absorption of allopurinol, antibiotics (tetracyclines, quinolones, some cephalosporins), bisphosphonate derivatives, corticosteroids, cyclosporine, delavirdine, iron salts, imidazole antifungals, isoniazid, mycophenolate, penicillamine, phosphate supplements, phenytoin, phenothiazines, trientine.
Absorption of aluminum hydroxide may be decreased by citric acid derivatives.
PREGNANCY RISK FACTOR — C (show table)
PREGNANCY IMPLICATIONS — No data available on clinical effects on the fetus; available evidence suggests safe use during pregnancy and breast-feeding.
LACTATION — Excretion in breast milk unknown
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals when used as an antacid. When used to decrease phosphorus, should be taken within 20 minutes of a meal.
MONITORING PARAMETERS — Monitor phosphorus levels periodically when patient is on chronic therapy.
TOXICOLOGY / OVERDOSE COMPREHENSIVE — Aluminum antacids may cause constipation, phosphate depletion, and bezoar or fecalith formation. In patients with renal failure, aluminum may accumulate to toxic levels. Deferoxamine, traditionally used as an iron chelator, has been shown to increase urinary aluminum output. Deferoxamine chelation of aluminum has resulted in improvements of clinical symptoms and bone histology; however, remains an experimental treatment for aluminum poisoning and has a significant potential for adverse effects.
CANADIAN BRAND NAMES — Amphojel®; Basaljel®
INTERNATIONAL BRAND NAMES — Acidex (ZA); Aldrox (BE); Algeldraat (NL); Alu-Cap (AE, BF, BH, BJ, CI, CY, EG, ET, GH, GM, GN, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, QA, SA, SC, SD, SL, SN, SY, TZ, UG, YE, ZM, ZW); Alu-Tab (HK, PH); Alucol (IT); Aludrox (DE, IE); Alugel (DE, TW); Alugelibys (ES); Alumigel (JP); Alutab (MY, NZ); Alzinox (PH); Amphogel (AU); Amphojel (CA, NZ, ZA); Basaljel (CA); Gastracol (CH); Pepsamar (BF, BJ, BR, CI, CL, CO, ES, ET, GH, GM, GN, GR, KE, LR, MA, ML, MR, MU, MW, NE, NG, PE, PT, SC, SD, SL, SN, TZ, UG, VE, ZM, ZW); Rocgel (FR); Ulcerin-P (TW)
MECHANISM OF ACTION — Neutralizes hydrochloride in stomach to form Al (Cl)3 salt + H2O
PATIENT INFORMATION — Do not take oral drugs within 1-2 hours of administration; notify prescriber if relief is not obtained or if there are any signs to suggest bleeding from the GI tract
(For additional information see "Aluminum hydroxide: Patient drug information")
Use of UpToDate is subject to the Subscription and License Agreement. REFERENCES 1. Bohannon, AD, Lyles, KW. Drug-Induced Bone Disease. Clin Geriatr Med 1994; 10:611.
2. Cumming, RG, Klineberg, RJ. Aluminum in Antacids and Cooking Pots and the Risk of Hip Fractures in Elderly People. Age Ageing 1994; 23:468.
3. Gupta, S, Ahlawat, SK. Aluminum Phosphide Poisoning - A Review. J Toxicol Clin Toxicol 1995; 33:19.
4. Maher, ER, Brown, EA, Curtis, JR, et al. Accumulation of Aluminum in Chronic Renal Failure Due to Administration of Albumin Replacement Solutions. Br Med J (Clin Res Ed) 1986; 292:306.
5. Monteagudo, FS, Cassidy, MJ, Folb, PI. Recent Developments in Aluminum Toxicity. Med Toxicol Adverse Drug Exp 1989; 4:1.
6. Robertson, JA, Salusky, IB, Goodman, WG, et al. Sucralfate, Intestinal Aluminum Absorption, and Aluminum Toxicity in a Patient on Dialysis. Ann Intern Med 1989; 111:179.
7. U.S. Department of, Health, Human, Services. Toxicological Profile for Aluminum TP-91/01. Agency for Toxic Substances and Diseases Registry, July 1992.
PHARMACOLOGIC CATEGORY
Antacid
Antidote
Protectant, Topical
DOSING: ADULTS
Hyperphosphatemia: Oral: Initial: 300-600 mg 3 times/day with meals
Hyperacidity: Oral: 600-1200 mg between meals and at bedtime
Skin protectant: Topical: Apply to affected area as needed; reapply at least every 12 hours
DOSING: PEDIATRIC
Hyperphosphatemia: Oral: 50-150 mg/kg/24 hours in divided doses every 4-6 hours, titrate dosage to maintain serum phosphorus within normal range
Skin protectant: Topical: Refer to adult dosing.
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Ointment:
Dermagran®: 0.275% (120 g)
Suspension, oral: 320 mg/5 mL (473 mL)
ALternaGel®: 600 mg/5 mL (360 mL)
DOSAGE FORMS: CONCISE
Ointment:
Dermagran® [OTC]: 0.275% (120 g)
Suspension, oral: 320 mg/5 mL
ALternaGel® [OTC]: 600 mg/5 mL
GENERIC EQUIVALENT AVAILABLE — Yes: Suspension
ADMINISTRATION
Oral: Dose should be followed with water.
Topical: Apply as needed to affected area; reapply at least every 12 hours.
USE — Treatment of hyperacidity; hyperphosphatemia; temporary protection of minor cuts, scrapes, and burns
ADVERSE REACTIONS SIGNIFICANT — Frequency not defined.
Gastrointestinal: Constipation, stomach cramps, fecal impaction, nausea, vomiting, discoloration of feces (white speckles)
Endocrine & metabolic: Hypophosphatemia, hypomagnesemia
CONTRAINDICATIONS — Hypersensitivity to aluminum salts or any component of the formulation
WARNINGS / PRECAUTIONS — Oral: Hypophosphatemia may occur with prolonged administration or large doses; aluminum intoxication and osteomalacia may occur in patients with uremia. Use with caution in patients with CHF, renal failure, edema, cirrhosis, and low sodium diets, and patients who have recently suffered gastrointestinal hemorrhage; uremic patients not receiving dialysis may develop osteomalacia and osteoporosis due to phosphate depletion.
Elderly may be predisposed to constipation and fecal impaction. Careful evaluation of possible drug interactions must be done. When used as an antacid in ulcer treatment, consider buffer capacity (mEq/mL) to calculate dose.
Topical: Not for application over deep wounds, puncture wounds, infected areas, or lacerations. When used for self medication (OTC use), consult with healthcare provider if needed for >7 days or for use in children <6 months of age.
DRUG INTERACTIONS
Decreased effect: Aluminum hydroxide may decrease the absorption of allopurinol, antibiotics (tetracyclines, quinolones, some cephalosporins), bisphosphonate derivatives, corticosteroids, cyclosporine, delavirdine, iron salts, imidazole antifungals, isoniazid, mycophenolate, penicillamine, phosphate supplements, phenytoin, phenothiazines, trientine.
Absorption of aluminum hydroxide may be decreased by citric acid derivatives.
PREGNANCY RISK FACTOR — C (show table)
PREGNANCY IMPLICATIONS — No data available on clinical effects on the fetus; available evidence suggests safe use during pregnancy and breast-feeding.
LACTATION — Excretion in breast milk unknown
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals when used as an antacid. When used to decrease phosphorus, should be taken within 20 minutes of a meal.
MONITORING PARAMETERS — Monitor phosphorus levels periodically when patient is on chronic therapy.
TOXICOLOGY / OVERDOSE COMPREHENSIVE — Aluminum antacids may cause constipation, phosphate depletion, and bezoar or fecalith formation. In patients with renal failure, aluminum may accumulate to toxic levels. Deferoxamine, traditionally used as an iron chelator, has been shown to increase urinary aluminum output. Deferoxamine chelation of aluminum has resulted in improvements of clinical symptoms and bone histology; however, remains an experimental treatment for aluminum poisoning and has a significant potential for adverse effects.
CANADIAN BRAND NAMES — Amphojel®; Basaljel®
INTERNATIONAL BRAND NAMES — Acidex (ZA); Aldrox (BE); Algeldraat (NL); Alu-Cap (AE, BF, BH, BJ, CI, CY, EG, ET, GH, GM, GN, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, QA, SA, SC, SD, SL, SN, SY, TZ, UG, YE, ZM, ZW); Alu-Tab (HK, PH); Alucol (IT); Aludrox (DE, IE); Alugel (DE, TW); Alugelibys (ES); Alumigel (JP); Alutab (MY, NZ); Alzinox (PH); Amphogel (AU); Amphojel (CA, NZ, ZA); Basaljel (CA); Gastracol (CH); Pepsamar (BF, BJ, BR, CI, CL, CO, ES, ET, GH, GM, GN, GR, KE, LR, MA, ML, MR, MU, MW, NE, NG, PE, PT, SC, SD, SL, SN, TZ, UG, VE, ZM, ZW); Rocgel (FR); Ulcerin-P (TW)
MECHANISM OF ACTION — Neutralizes hydrochloride in stomach to form Al (Cl)3 salt + H2O
PATIENT INFORMATION — Do not take oral drugs within 1-2 hours of administration; notify prescriber if relief is not obtained or if there are any signs to suggest bleeding from the GI tract
(For additional information see "Aluminum hydroxide: Patient drug information")
Use of UpToDate is subject to the Subscription and License Agreement. REFERENCES 1. Bohannon, AD, Lyles, KW. Drug-Induced Bone Disease. Clin Geriatr Med 1994; 10:611.
2. Cumming, RG, Klineberg, RJ. Aluminum in Antacids and Cooking Pots and the Risk of Hip Fractures in Elderly People. Age Ageing 1994; 23:468.
3. Gupta, S, Ahlawat, SK. Aluminum Phosphide Poisoning - A Review. J Toxicol Clin Toxicol 1995; 33:19.
4. Maher, ER, Brown, EA, Curtis, JR, et al. Accumulation of Aluminum in Chronic Renal Failure Due to Administration of Albumin Replacement Solutions. Br Med J (Clin Res Ed) 1986; 292:306.
5. Monteagudo, FS, Cassidy, MJ, Folb, PI. Recent Developments in Aluminum Toxicity. Med Toxicol Adverse Drug Exp 1989; 4:1.
6. Robertson, JA, Salusky, IB, Goodman, WG, et al. Sucralfate, Intestinal Aluminum Absorption, and Aluminum Toxicity in a Patient on Dialysis. Ann Intern Med 1989; 111:179.
7. U.S. Department of, Health, Human, Services. Toxicological Profile for Aluminum TP-91/01. Agency for Toxic Substances and Diseases Registry, July 1992.
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