Aluminum Hydroxide and Magnesium Hydroxide Antacid

Aka: Aluminum Hydroxide and Magnesium Hydroxide Antacid, Aluminum and Magnesium Salt Antacid, Maalox, Mylanta, Gaviscon

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II. Indications

  1. Gastroesophageal Reflux
  2. Peptic Ulcer Disease

III. Contraindications

  1. Severe Chronic Kidney Disease
    1. Risk of Magnesium accumulation

IV. Mechanism

  1. Magnesium Hydroxide is a rapid acting Antacid
  2. Aluminum hydroxide has delayed Antacid activity

V. Medications

  1. Aluminum Hydroxide and Magnesium Hydroxide Antacid (e.g. Mylanta)
    1. Available as 225 mg/200 mg per 5 ml suspension
    2. Adult
      1. FDA approved: 10 to 20 ml orally four times daily (max: 80 ml/day)
      2. Off label: 15 to 45 ml orally at 1 to 3 hours after meals and at bedtime
    3. Child (off Label)
      1. Newborn: 1 ml/kg/dose every 4 hours as neded
      2. Infants: 2 to 5 ml orally every 1 to 2 hours as needed
      3. Child: 5 to 15 ml orally every 1 to 2 hours as needed
  2. Aluminum Hydroxide and Magnesium Hydroxide and SimethiconeAntacid (e.g. Maalox)
    1. Available in various forms
    2. Maalox, Mylanta and other products add Simethicone as "anti-gas" formulations
      1. Simethicone offers little added benefit (beyond Placebo Effect)
    3. Adult (and age >=12 years)
      1. FDA approved: 10 to 20 ml orally four times daily (max: 80 ml/day)
      2. Off label: 15 to 45 ml orally at 1 to 3 hours after meals and at bedtime
    4. Child (off Label)
      1. Give 0.5 to 2 ml/kg/dose up to 5 to 15 ml orally after meals and at bedtime
  3. Aluminum Hydroxide and Magnesium Carbonate (Gaviscon)
    1. Available in various concentrations
    2. Also contains Alginic acid (forms foam barrier protection against acid)
    3. Regular Strength (95 mg/358 mg per 15 ml)
      1. Adult (FDA approved): 15 to 30 ml orally four times daily
      2. Child (off label): 5 to 15 ml orally after meals and at bedtime

VI. Adverse Effects

  1. Diarrhea
  2. Constipation
    1. Aluminum decrease Constipation risk
  3. Hypermagnesemia
    1. Rare outside severe renal disease (see contraindications above)
  4. Metabolic Alkalosis
    1. May occur with chronic use of Gaviscon (due to alginic acid)

VII. Drug Interactions

  1. Interferes with absorption of other agents
  2. Aspirin (buffered, enteric)
  3. Diazepam
  4. Digoxin
  5. Fluoroquinolone
  6. Iron
  7. Isoniazid
  8. Tetracyclines

VIII. Pharmacokinetics

  1. Magnesium is well absorbed orally
  2. Rapid renal excretion

IX. Safety

  1. Pregnancy Category C
    1. Exception Gaviscon (unknown safety)
  2. Unknown safety in Lactation

X. Resources

  1. Aluminum Hydroxide and Magnesium Hydroxide and SimethiconeAntacid (e.g. Mylanta, DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bd58baac-5790-455a-9c77-236680992579
  2. Aluminum Hydroxide and Magnesium Hydroxide Antacid (e.g. Mylanta)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b1f2d137-f5f7-4800-a1df-ef5d25544bc9

XI. References

  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 90
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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