Antacids (Oral-Local)

This monograph includes information on the following:

1) Alumina, Calcium Carbonate, and Sodium Bicarbonate ^*
2) Alumina and Magnesia
3) Alumina, Magnesia, Calcium Carbonate, and Simethicone ^†
4) Alumina, Magnesia, and Magnesium Carbonate ^*
5) Alumina, Magnesia, Magnesium Carbonate, and Simethicone ^*
6) Alumina, Magnesia, and Simethicone
7) Alumina, Magnesium Alginate, and Magnesium Carbonate ^*
8) Alumina and Magnesium Carbonate ^†
9) Alumina, Magnesium Carbonate, and Simethicone ^†
10) Alumina, Magnesium Carbonate, and Sodium Bicarbonate ^†
11) Alumina and Magnesium Trisilicate ^†
12) Alumina, Magnesium Trisilicate, and Sodium Bicarbonate ^†
13) Alumina and Simethicone  ^†
14) Alumina and Sodium Bicarbonate  ^*
15) Aluminum Carbonate, Basic ^†
16) Aluminum Carbonate, Basic, and Simethicone ^†
17) Aluminum Hydroxide
18) Calcium Carbonate ^‡
19) Calcium Carbonate and Magnesia
20) Calcium Carbonate, Magnesia, and Simethicone
21) Calcium Carbonate and Simethicone ^†
22) Calcium and Magnesium Carbonates
23) Magaldrate
24) Magaldrate and Simethicone
25) Magnesium Carbonate and Sodium Bicarbonate ^*
26) Magnesium Hydroxide ^§
27) Magnesium Oxide ^§ †

VA CLASSIFICATION
Alumina, Calcium Carbonate, and Sodium Bicarbonate
Primary: GA199

Alumina and Magnesia
Primary: GA103

Alumina, Magnesia, Calcium Carbonate, and Simethicone
Primary: GA199

Alumina, Magnesia, and Magnesium Carbonate
Primary: GA103

Alumina, Magnesia, Magnesium Carbonate, and Simethicone
Primary: GA199

Alumina, Magnesia, and Simethicone
Primary: GA199

Alumina, Magnesium Alginate, and Magnesium Carbonate
Primary: GA103

Alumina and Magnesium Carbonate
Primary: GA103

Alumina, Magnesium Carbonate, and Simethicone
Primary: GA199

Alumina, Magnesium Carbonate, and Sodium Bicarbonate
Primary: GA104

Alumina and Magnesium Trisilicate
Primary: GA103

Alumina, Magnesium Trisilicate, and Sodium Bicarbonate
Primary: GA104

Alumina and Simethicone
Primary: GA199

Alumina and Sodium Bicarbonate
Primary: GA199

Aluminum Carbonate, Basic
Primary: GA101
Secondary: GU900

Aluminum Carbonate, Basic, and Simethicone
Primary: GA199

Aluminum Hydroxide
Primary: GA101
Secondary: GA208; GU900

Calcium Carbonate
Primary: GA105
Secondary: TN402

Calcium Carbonate and Magnesia
Primary: GA106

Calcium Carbonate, Magnesia, and Simethicone
Primary: GA199

Calcium Carbonate and Simethicone
Primary: GA199

Calcium and Magnesium Carbonates
Primary: GA106

Magaldrate
Primary: GA107

Magaldrate and Simethicone
Primary: GA199

Magnesium Carbonate and Sodium Bicarbonate
Primary: GA109

Magnesium Hydroxide
Primary: GA108
Secondary: GA202; GU900

Magnesium Oxide
Primary: GA108
Secondary: GA202


^‡ See Calcium Supplements (Systemic) for systemic use of calcium carbonate in hypocalcemia
^§ See Laxatives (Local) for laxative use of magnesium hydroxide and magnesium oxide
Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).

^*Not commercially available in the U.S.

^†Not commercially available in Canada.

Category:


Antacid—All drugs included in this monograph are used as antacids;

Antiurolithic (phosphate calculi)—Aluminum Carbonate; Aluminum Hydroxide;

Laxative, hyperosmotic, saline—Magnesium Hydroxide; Magnesium Oxide (see Magnesium Hydroxide and Magnesium Oxide, Laxatives [Local] );

Antihyperphosphatemic—Aluminum Carbonate; Aluminum Hydroxide; Calcium Carbonate (see Calcium Carbonate, Calcium Supplements [Systemic] );

Antihypocalcemic—Calcium Carbonate (see Calcium Carbonate, Calcium Supplements [Systemic] );

Antiurolithic (calcium calculi)—Magnesium Hydroxide;

Indications

Note: Bracketed information in the Indications section refers to uses that are not included in U.S. product labeling.

Accepted

Hyperacidity (treatment)
Ulcer, duodenal (treatment) or
Ulcer, gastric (treatment)—Antacids are indicated for relief of symptoms associated with hyperacidity (heartburn, acid indigestion, and sour stomach). In addition, antacids are used in hyperacidity associated with gastric and duodenal ulcers. However, there have been reports of increased gastrin levels and increased gastric secretion (acid rebound) associated with the use of antacids. ^{{15} {31} {87}}
—Some of the antacid combinations contain other ingredients that have no antacid properties. Simethicone, an antiflatulent, has been added as an aid in those conditions in which the retention of gas may be a problem; however, in the treatment of peptic ulcer diseases, the advantage of using antacid and simethicone combinations rather than antacids alone has not been clearly established. ^{31}

Hypersecretory conditions, gastric (treatment adjunct)
Zollinger-Ellison syndrome (treatment adjunct)
Mastocytosis, systemic (treatment adjunct) or
Adenoma, multiple endocrine (treatment adjunct)—Antacids are indicated in conjunction with histamine H ₂-receptor antagonists or omeprazole for transient symptomatic relief in the treatment of pathological gastric hypersecretion associated with Zollinger-Ellison syndrome (alone or as part of multiple endocrine neoplasia Type-I), systemic mastocytosis, and multiple endocrine adenoma. ^{35}

Reflux, gastroesophageal (treatment)—Antacids are indicated in the symptomatic treatment of gastroesophageal reflux disease. ^{{05} {28} {31} {87}}

Stress-related mucosal damage (prophylaxis and treatment)—Antacids are indicated to prevent and treat upper gastrointestinal, stress-induced ulceration and bleeding, especially in intensive care patients. ^{{69} {82} {98} {99} {100}}

[Hyperphosphatemia (treatment)]¹—Aluminum carbonate and aluminum hydroxide may be used in conjunction with a low-phosphate diet to reduce elevated phosphate levels and demineralization of bones in patients with renal insufficiency. ^{31} However, use of aluminum-containing antacids as phosphate binders may lead to aluminum toxicity in patients with renal insufficiency. ^{{77} {89} {90}} Other agents may be preferable for treating hyperphosphatemia in patients with renal insufficiency.

Hypocalcemia (treatment)—See Calcium Carbonate, Calcium Supplements (Systemic) . ^{23}

—[Aluminum hydroxide has been used in the treatment of neonatal hypocalcemia and diarrhea; however, it generally has been replaced by other agents. Aluminum carbonate and aluminum hydroxide have been used along with a low-phosphate diet to prevent formation of phosphatic (struvite) urinary stones; however, their use has been replaced by other agents.^{104} Magnesium hydroxide has been used to prevent recurrence of calcium stones; however, it has been replaced by other agents.^{104} Use of aluminum-containing antacids in young children and premature infants may lead to aluminum toxicity, especially in those patients with renal failure.^{46}{76}{77}]¹

Unaccepted
Antacids have been used in patients undergoing anesthesia or during labor to lessen the danger from aspiration of gastric contents. However, the use of antacids to prevent acid aspiration has generally been replaced by the equally or more effective histamine H ₂-receptor antagonists or citrate solutions. ^{{07} {42}}

¹ Not included in Canadian product labeling.

Pharmacology/Pharmacokinetics

Physicochemical characteristics:
Molecular weight—
    Aluminum hydroxide: 78
    Calcium carbonate: 100.09
    Magnesium hydroxide: 58.32
    Magnesium oxide: 40.30
    Sodium bicarbonate: 84.01

Mechanism of action/Effect:

Antacid—These medications react chemically to neutralize or buffer existing quantities of stomach acid but have no direct effect on its output. This action results in increased pH value of stomach contents, thus providing relief of hyperacidity symptoms. Also, these medications reduce acid concentration within the lumen of the esophagus. This causes an increase in intra-esophageal pH and a decrease in pepsin activity. ^{69}

Antiurolithic—Aluminum carbonate and aluminum hydroxide bind phosphate ions in the intestine to form insoluble aluminum phosphate, which is excreted in the feces. ^{69} They thereby reduce phosphates in the urine and prevent formation of phosphatic (struvite) urinary stones. Magnesium hydroxide inhibits the precipitation of calcium oxalate and calcium phosphate, thus preventing the formation of calcium stones.

Antihyperphosphatemic—Aluminum carbonate and aluminum hydroxide reduce serum phosphate levels by binding with phosphate ions in the intestine to form insoluble aluminum phosphate, which passes through the intestinal tract unabsorbed. ^{69}

Antihypocalcemic—Aluminum hydroxide may increase the release of calcium from bone ^{68} as a result of the decreased serum phosphate levels.

Antidiarrheal—Aluminum hydroxide's constipating ^{101} properties help decrease the fluidity of stools.


Other actions/effects:

Antacids may increase lower esophageal sphincter (LES) pressure. ^{05} Aluminum-containing antacids have a cytoprotective effect on the gastric mucosa that may be associated with the stimulation of prostaglandin secretion, thus providing protection against mucosal necrosis and hemorrhage caused by corrosive agents, such as aspirin and ethanol. ^{{91} {92}}

Absorption:

Aluminum-containing—Small amounts of the aluminum in aluminum hydroxide are absorbed from the intestine. ^{93}

Calcium-containing—Approximately 15% of the calcium in calcium carbonate is absorbed from the intestine in normal persons. ^{93} The amount of calcium absorbed from the gastrointestinal tract is determined by hormonal factors, particularly parathyroid hormone, and vitamin D. ^{93}

Magnesium-containing—Approximately 10% of the magnesium in magnesium hydroxide (magnesia) is absorbed from the intestine.

Onset and duration of action

Onset of action is dependent upon the ability of the antacid to solubilize in the stomach and react with the hydrochloric acid. ^{69} The poorly soluble antacids (e.g., magnesium trisilicate) ^{69} will thus react more slowly with hydrochloric acid than will the more soluble ones. In most cases with slow-acting antacids, the onset of action is delayed and may not take place if gastric emptying is rapid. ^{31}

Duration of action is determined primarily by gastric emptying time. Depending on the kind of antacid used, the duration of action in fasting patients may range from 20 to 60 minutes. ^{69} However, when the antacid is given 1 hour after meals, the acid-neutralizing effect may be prolonged up to 3 hours. ^{69}

The following table provides a relative comparison of onset and duration of action of different antacids.

Antacid	Onset of action	Duration of action
Aluminum Carbonate	Slow	Short
Aluminum Hydroxide	Slow	Prolonged *
Aluminum Phosphate	Slow	Short
Calcium Carbonate	Fast	Prolonged
Magaldrate	Intermediate	Prolonged
Magnesium Carbonate	Intermediate	Short
Magnesium Hydroxide	Fast	Short
Magnesium Oxide	Fast	Short
Magnesium Trisilicate	Slow	Prolonged †
Sodium Bicarbonate	Fast	Short

^* Absorptive properties of the gel prolong its duration of action
^† If gastric emptying is rapid, stomach may empty before much of the acid is neutralized

Elimination:
    Renal and fecal; ^{{69} {93}} 15 to 30% of the salts formed are absorbed and are then excreted by the kidneys. ^{69}


Precautions to Consider

Pregnancy/Reproduction

Pregnancy—
Antacids are generally considered safe as long as chronic high doses are avoided. ^{40}


Aluminum-, calcium-, or magnesium-containing antacids

Adequate and well-controlled studies in humans have not been done; however, there have been reports of antacids causing such adverse effects as hypercalcemia, hypomagnesemia, hypermagnesemia, and increased tendon reflexes in fetuses and/or neonates whose mothers were chronic users of aluminum-, calcium-, and/or magnesium-containing antacids, especially in high doses.

Studies have not been done in animals.



Sodium bicarbonate–containing antacids

Problems in humans have not been documented; however, risk-benefit must be considered because sodium bicarbonate is absorbed systemically. Chronic use may lead to systemic alkalosis. ^{93} The sodium load that is absorbed can also cause edema and weight gain.


Breast-feeding

Problems in humans have not been documented; although some aluminum, calcium, and magnesium may be distributed into breast milk, the concentration is not great enough to produce an effect in the neonate. ^{41}

Pediatrics

Antacids should not be given to young children (up to 6 years of age) unless prescribed by a physician. Since children are not usually able to describe their symptoms precisely, proper diagnosis should precede the use of an antacid. This will avoid the complication of an existing condition (e.g., appendicitis) or the appearance of severe adverse effects.

Use of magnesium-containing antacids is contraindicated in very young children ^{102} because there is a risk of hypermagnesemia ^{94}, especially in dehydrated children or children with renal failure. ^{68}

Use of aluminum-containing antacids is contraindicated in very young children ^{102} because there is a risk of aluminum toxicity, especially in dehydrated infants and children or infants and children with renal failure. ^{{76} {77}}


Geriatrics


Metabolic bone disease commonly seen in the elderly may be aggravated by the phosphorus depletion ^{30}, hypercalciuria, and inhibition of absorption of intestinal fluoride caused by the chronic use of aluminum-containing antacids. ^{79} Also, elderly patients are more likely to have age-related renal function impairment, which may lead to aluminum retention. ^{{67} {102}}

Although it is not known whether high intake of aluminum leads to Alzheimer's disease, the use of aluminum-containing antacids in Alzheimer's patients is not generally recommended. Research suggests that aluminum may contribute to the disease's development since it has been found to concentrate in neurofibrillary tangles in brain tissue. ^{{46} {80} {83}}

Drug interactions and/or related problems
The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):

Table 1. Drug Interactions and/or Related Problems

The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive: (» = major clinical significance) Note: Combinations containing any of the following medications, depending on the amount present, may also interact with this medication. Only specific interactions between antacids and other oral medications have been identified in this monograph. However, because of antacids" ability to change gastric or urinary pH and to adsorb or form complexes with other drugs, the rate and/or extent of absorption of other medications may be increased or reduced when the medication is used concurrently with antacids {69}. In general, patients should be advised not to take any other oral medications within 1 to 2 hours of antacids.	Legend: I=Aluminum-containing II =Calcium-containing III=Magaldrate IV=Magnesium-containing V=Sodium Bicarbonate– containing
	I	II	III	IV	V
Acidifiers, urinary, such as: Ammonium chloride Ascorbic acid Potassium or sodium phosphates Racemethionine (antacids may alkalinize the urine and counteract the effect of urinary acidifiers; frequent use of antacids, especially in high doses, is best avoided by patients receiving therapy to acidify the urine)
Amphetamines or {63} Quinidine (urinary excretion may be inhibited when these medications are used concurrently with antacids in doses that cause the urine to become alkaline, possibly resulting in toxicity; dosage adjustment may be needed when therapy with these antacids is initiated or discontinued or if dosage is changed) {09} {21} {27} {63} {64}
Anticholinergics or other medications with anticholinergic activity (See Appendix II ) (concurrent use with antacids may decrease absorption, reducing the effectiveness of anticholinergics; doses of these medications should be spaced 1 hour apart from doses of antacids) {63} {68} {69}
(urinary excretion may be delayed by alkalinization of the urine, thus potentiating the side effects of the anticholinergic)
Calcitonin or Etidronate {70} or Gallium nitrate {47} or Pamidronate {108} or Plicamycin (concurrent use with calcium carbonate may antagonize the effect of these medications in the treatment of hypercalcemia) {12}
Calcium-containing preparations (concurrent and prolonged use with sodium bicarbonate may result in the milk-alkali syndrome) {48} {56} {57} {65}
» Cellulose sodium phosphate {16} (concurrent use with calcium-containing antacids may decrease effectiveness of cellulose sodium phosphate in preventing hypercalciuria)
(concurrent use with magnesium-containing antacids may result in binding of magnesium; patients should be advised not to take these medications within 1 hour of cellulose sodium phosphate)
Chenodiol (concurrent use with aluminum-containing antacids may result in binding of chenodiol, thus decreasing its absorption) {17}
Citrates (concurrent use with antacids containing aluminum, calcium carbonates, magaldrate, or sodium bicarbonate may result in systemic alkalosis)
(concurrent use of sodium citrate with sodium bicarbonate may promote the development of calcium stones in patients with uric acid stones, due to sodium ion opposition to the hypocalciuric effect of the alkaline load; may also cause hypernatremia) {36}
(concurrent use of aluminum-containing antacids and magaldrate with citrate salts can increase aluminum absorption, possibly resulting in acute aluminum toxicity, especially in patients with renal insufficiency) {13} {37} {38} {39}
Digitalis glycosides (concurrent use with aluminum- and magnesium-containing antacids may inhibit absorption, possibly decreasing plasma concentrations of digitalis glycosides; although actual clinical importance of this interaction has not been established, it is recommended that doses of antacids and digitalis glycosides be separated by several hours) {09} {27}
Diuretics, potassium-depleting, such as bumetanide, ethacrynic acid, furosemide, indapamide, thiazide diuretics {27} (concurrent use of thiazide diuretics with large doses of calcium carbonate may result in hypercalcemia)
Enteric-coated medications, such as bisacodyl (concurrent administration of antacids with enteric-coated medications may cause the enteric coating to dissolve too rapidly, resulting in gastric or duodenal irritation) {10}
Ephedrine (urine alkalinization induced by sodium bicarbonate may increase the half-life of ephedrine and prolong its duration of action, especially if the urine remains alkaline for several days or longer; dosage adjustment of ephedrine may be necessary) {01} {21}
» Fluoroquinolones {06} {14} {19} {20} {53} {74} {85} {88} (alkalinization of the urine may reduce the solubility of ciprofloxacin and norfloxacin in the urine, especially when the urinary pH exceeds 7.0; if antacids and one of these medications are used concurrently, patients should be observed for signs of crystalluria and nephrotoxicity)
(aluminum- and magnesium-containing antacids may reduce absorption of fluoroquinolones, resulting in lower serum and urine concentrations of these medications; therefore, concurrent use is not recommended; however, if aluminum- and magnesium-containing antacids must be used concurrently with these medications, it is recommended that enoxacin be taken at least 2 hours before or 8 hours after the antacid; ciprofloxacin and lomefloxacin should be taken at least 2 hours before or 6 hours after the antacid; and norfloxacin and ofloxacin should be taken at least 2 hours before or after the antacid)
Folic acid (prolonged use of aluminum- and/or magnesium-containing antacids may decrease folic acid absorption by raising the pH of the small intestine; patients should be advised to take antacids at least 2 hours after folic acid) {73} {75}
Histamine H 2-receptor antagonists (concurrent use with antacids may be indicated in the treatment of peptic ulcer to relieve pain; however, simultaneous administration of medium to high doses [80 mmol to 150 mmol] of antacids is not recommended since absorption of histamine H 2-receptor antagonists may be decreased; patients should be advised not to take any antacids within 1/2 to 1 hour of histamine H 2-receptor antagonists) {09} {18} {21} {53} {59}
Iron preparations, oral (absorption may be decreased when these preparations are used concurrently with magnesium trisilicate or antacids containing carbonate; spacing the doses of the iron preparation as far as possible from doses of the antacid is recommended) {09} {21} {27} {53}
» Isoniazid, oral (concurrent use with aluminum-containing antacids may delay and decrease absorption of oral isoniazid; concurrent use should be avoided or the patient should be advised to take oral isoniazid at least 1 hour before the antacid) {09} {21} {27}
» Ketoconazole (antacids may cause increased gastrointestinal pH; concurrent administration with antacids may result in a marked reduction in absorption of ketoconazole; patients should be advised to take antacids at least 3 hours after ketoconazole) {10} {21}
Lithium (sodium bicarbonate enhances lithium excretion, possibly resulting in decreased efficacy; this may be partly due to the sodium content) {02} {03} {04} {21}
Mexiletine (marked alkalinization of the urine caused by sodium bicarbonate may slow renal excretion of mexiletine) {21}
» Mecamylamine (alkalinization of the urine may slow excretion and prolong the effects of mecamylamine; concurrent use is not recommended) {24}
» Methenamine (concurrent use with antacids that cause the urine to become alkaline may reduce the effectiveness of methenamine by inhibiting its conversion to formaldehyde; concurrent use is not recommended) {84}
Milk or milk products (concurrent and prolonged use with calcium carbonate or sodium bicarbonate may result in the milk-alkali syndrome) {48} {56} {57}
Misoprostol (concurrent use with magnesium-containing antacids may aggravate misoprostol-induced diarrhea) {46}
Pancrelipase (concurrent administration of antacids may be required to prevent inactivation of pancrelipase [except enteric-coated dosage forms] {95} by gastric pepsin and acid pH; however, calcium carbonate– and/or magnesium-containing antacids are not recommended since they may decrease the effectiveness of pancrelipase) {26}
Penicillamine (absorption may be reduced when penicillamine is administered concurrently with aluminum- or magnesium-containing antacids; although more studies are needed to establish the significance of this interaction, it is recommended that doses of antacids and penicillamine be separated by 2 hours) {21} {44} {45} {47}
Phenothiazines, especially chlorpromazine, oral (absorption may be inhibited when these medications are used concurrently with aluminum- or magnesium-containing antacids; although more studies are needed to establish the significance of this interaction, simultaneous administration should be avoided) {21}
Phenytoin (concurrent use with aluminum-, magnesium-, and/or calcium carbonate–containing antacids may decrease absorption of phenytoin, thus reducing serum phenytoin concentrations; although more studies are needed to establish the significance of this interaction, it is recommended that doses of antacids and phenytoin be separated by about 2 to 3 hours) {09} {64} {71} {72}
Phosphates, oral (concurrent use with aluminum- or magnesium-containing antacids may bind the phosphate and prevent its absorption) {61} {62} {65} {66}
(concurrent use with calcium-containing antacids may increase potential of deposition of calcium in soft tissues if serum-ionized calcium is high)
Quinine (concurrent use with aluminum-containing antacids may decrease or delay the absorption of quinine) {25} {32}
Salicylates (alkalinization of the urine may increase renal salicylate excretion and lower serum salicylate levels; dosage adjustments of salicylates may be necessary when chronic high-dose antacid therapy is started or stopped, especially in patients receiving large doses of the salicylate, such as patients with rheumatoid arthritis or rheumatic fever) {21} {27} {63}
Sodium bicarbonate or Vitamin D (concurrent and prolonged use with calcium carbonate may result in the milk-alkali syndrome) {22} {48} {57} {65}
Sodium fluoride (concurrent use with aluminum hydroxide may decrease absorption and increase fecal excretion of fluoride)
(calcium ions may complex with and inhibit absorption of fluoride) {29} {65}
» Sodium polystyrene sulfonate resin (SPSR) (neutralization of gastric acid may be impaired when SPSR is used concurrently with calcium- or magnesium-containing antacids, possibly resulting in systemic alkalosis; concurrent use is not recommended) {21} {27} {58} {64}
Sucralfate (concurrent use with antacids may be indicated in the treatment of duodenal ulcer to relieve pain; however, simultaneous administration is not recommended since antacids may interfere with binding of sucralfate to the mucosa; patients should be advised not to take any antacids within 1/2 hour before or after sucralfate; concurrent use with aluminum-containing antacids may cause aluminum toxicity in patients with chronic renal failure) {50} {51}
» Tetracyclines, oral (absorption may be decreased when oral tetracyclines are used concurrently with antacids because of possible formation of nonabsorbable complexes and/or increase in intragastric pH; patients should be advised not to take antacids within 3 to 4 hours of tetracyclines) {09} {21} {27} {53}
Vitamin D, including calcifediol and calcitriol (concurrent use with magnesium-containing antacids may result in hypermagnesemia, especially in patients with chronic renal failure)
(concurrent use with calcium-containing antacids may result in hypercalcemia) {43} {67}

Laboratory value alterations
The following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):

Table 2. Laboratory Value Alterations

	Legend: I=Aluminum-containing II=Calcium-containing III=Magaldrate IV=Magnesium-containing V=Sodium Bicarbonate– containing
	I	II	III	IV	V
With diagnostic test results » Gastric acid secretion test (concurrent use of antacids may antagonize the effect of pentagastrin and histamine in the evaluation of gastric acid secretory function; administration of antacids is not recommended on the morning of the test)
Meckel"s diverticulum imaging (prior administration of aluminum-containing antacids may decrease stomach and bladder uptake of sodium pertechnetate Tc 99m and thus interfere with Meckel"s diverticulum evaluation) {33}
Reticuloendothelial cell imaging of liver, spleen, or bone marrow with technetium Tc 99m sulfur colloid (high doses of aluminum-containing antacids may impair reticuloendothelial cell imaging due to the polyvalent cations that cause agglomeration of the individual colloidal particles, thus causing them to be trapped by the pulmonary capillary bed rather than by the reticuloendothelial cells of the liver, spleen, and bone marrow) {34}
Skeletal imaging (prior administration of aluminum-containing antacids may result in liver uptake of technetium Tc 99m pyrophosphate due to the formation of submicroscopic precipitates) {33} {86}
With physiology/laboratory test values
Calcium, serum (concentrations may be increased with large doses) {68} {96}
Gastrin, serum (concentrations may be increased) {31}
Phosphate, serum (concentrations may be decreased by excessive and prolonged use) {27}
Systemic and urinary pH (may be increased) {69}

Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).

Table 3. Medical considerations/Contraindications

Note: A blank space usually signifies lack of information; it is not necessarily an indication that a given medical problem is of no concern. However, the pharmacologic similarity of these agents may suggest that if caution is required in particular medical problems for one agent, then it may be required for the others as well.

The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance).	Legend: I=Aluminum-containing II =Calcium-containing III=Magaldrate IV=Magnesium-containing V=Sodium Bicarbonate– containing
	I	II	III	IV	V
Except under special circumstances, these medications should not be used when the following medical problems exist: » Hypercalcemia (increased risk of exacerbation) {93}
» Intestinal obstruction {31}
» Renal function impairment, severe (increased risk of hypermagnesemia) {31}
Risk-benefit should be considered when the following medical problems exist:
» Alzheimer"s disease (may be exacerbated) {49} {80}
» Appendicitis, or symptoms of (may complicate existing condition; laxative or constipating effects may increase danger of perforation or rupture) {31}
Bleeding, gastrointestinal or rectal, undiagnosed {31} (condition may be exacerbated)
Bone fractures {31}	*		*
» Cirrhosis of liver or	†	†
» Congestive heart failure or	†	†
» Edema or	†	†
» Toxemia of pregnancy	†	†
(fluid retention may be increased; low-sodium antacids should be used) {68}
Colitis, ulcerative (may be aggravated by laxative effect of magnesium-containing antacids)
Colostomy or
Diverticulitis or
» Ileostomy (increased risk of fluid or electrolyte imbalance)
» Constipation or
» Fecal impaction (may be exacerbated) {31} {69}
Diarrhea, chronic (possible increased danger of phosphate depletion with aluminum-containing antacids) {30} {78}
(possible increased laxative effect with magnesium-containing antacids) {29}
» Gastric outlet obstruction {31}
» Hemorrhoids (may be aggravated) {31} {69}
» Hypoparathyroidism (calcium excretion may be decreased)
» Hypophosphatemia {30} {31} {49}	*		*
» Renal function impairment (possible increased risk of aluminum toxicity to brain tissue, bone {67}, and parathyroid glands; possible onset of the neurological syndrome—dialysis dementia—in dialysis patients with long-term use of aluminum-containing antacids)
(possible increased danger of milk-alkali syndrome and hypercalcemia with calcium-containing antacids) {31} {48}
(possible increased danger of hypermagnesemia) {31}			‡	‡
(may cause metabolic alkalosis)
» Sarcoidosis (increased risk of hypercalcemia or renal disease) {31}
Sensitivity to aluminum-, calcium-, magnesium-, simethicone-, or sodium bicarbonate–containing medications

^* Aluminum hydroxide has the ability to form the insoluble complex of aluminum phosphate, which is excreted in the feces. This may lead to lowered serum phosphate concentrations and phosphorus mobilization from the bone. If phosphate depletion (e.g., malabsorption syndrome) is already present, osteomalacia, osteoporosis, and fracture may result, especially in patients with other bone disease. ^{{30} {79}} In such patients predisposed to phosphate depletion, other aluminum-containing antacids (except aluminum phosphate) will be of concern only in relation to their ability to form an aluminum phosphate complex
^† Antacids containing more than 5 mEq (115 mg) of sodium per total daily dose should not be used without first checking with physician. The usual amount of sodium allowed in restricted diets is 3 grams or less per day
^‡ In patients with renal function impairment, use of antacids containing more than 50 mEq (608 mg) of magnesium per total daily dose should be carefully considered

Patient monitoring
The following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; » = major clinical significance):

    (

Table 4. Patient Monitoring

	Legend: I=Aluminum-containing II=Calcium-containing III=Magaldrate IV=Magnesium-containing V=Sodium Bicarbonate– containing
	I	II	III	IV	V
Aluminum concentrations, serum (determinations recommended at periodic intervals for patients with impaired renal function receiving aluminum-containing antacids, to prevent aluminum toxicity) {90}
Calcium concentrations, serum (determinations recommended at periodic intervals for patients, especially those with impaired renal function, who are receiving chronic therapy with aluminum-containing antacids) {96}
(recommended weekly when calcium-containing antacids are used in large doses) {69}
Phosphate concentrations, serum (determinations recommended at periodic intervals for patients, especially those with impaired renal function, who are receiving chronic therapy with aluminum-containing antacids) {27} {69}
Potassium concentrations, serum (determinations recommended at periodic intervals for patients, especially those with impaired renal function, who are receiving antacids containing more than 25 mEq [925 mg] of potassium per daily dose)
Renal function determinations (recommended weekly in patients with renal function impairment, and whenever symptoms of hypercalcemia occur in patients receiving calcium-containing antacids in large doses) {31}
(recommended at periodic intervals with long-term use of frequently repeated dosage)

)




Side/Adverse Effects

Table 5. Side/Adverse Effects ^*

The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:	Legend: I=Aluminum-containing II=Calcium-containing III=Magaldrate IV=Magnesium-containing V=Sodium Bicarbonate– containing
	I	II	III	IV	V
Medical attention needed With long-term use in chronic renal failure in dialysis patients Neurotoxicity (mood or mental changes) {31}
With large doses Fecal impaction (continuing severe constipation) {31}
Swelling of feet or lower legs
With large doses or in renal insufficiency Metabolic alkalosis (mood or mental changes; muscle pain or twitching; nervousness or restlessness; slow breathing; unpleasant taste; unusual tiredness or weakness) {29} {30}
With long-term or prolonged use Hypercalcemia associated with milk-alkali syndrome (frequent urge to urinate; continuing headache; continuing loss of appetite; nausea or vomiting; unusual tiredness or weakness) {29} {30} {31}		†
Osteomalacia and osteoporosis due to phosphate depletion (bone pain; swelling of wrists or ankles) {29} {31} {97}			‡
With overuse or prolonged use Renal calculi (difficult or painful urination) {08} {11} {30}				§
With prolonged use or large doses Phosphorus depletion syndrome (continuing feeling of discomfort; continuing loss of appetite; muscle weakness; unusual weight loss) {29} {31}
With prolonged use or large doses and/or in renal disease Hypermagnesemia or other electrolyte imbalance (dizziness or lightheadedness; irregular heartbeat; mood or mental changes; unusual tiredness or weakness) {31}
Medical attention needed only if continuing or bothersome
Chalky taste {31}	M	M	M	M	U
Constipation, mild {31} {105} {106} {107}	M	L	U	U	U
Diarrhea or laxative effect—with overdose {31}	U	U	U	M	U
Increased thirst	U	U	U	U	L
Nausea or vomiting {31}	L	U	U	L	U
Speckling or whitish discoloration of stools (concentrations of fatty acid–salts of aluminum)	L	U	U	U	U
Stomach cramps {31}	M	U	U	L	L

^* Differences in frequency of occurrence may reflect either lack of clinical-use data or actual pharmacologic distinctions among agents (although their pharmacologic similarity suggests that side effects occurring with one may occur with the others). M = more frequent; L = less frequent; R = rare; U = unknown
^† May also occur with large doses and/or in chronic renal failure with calcium carbonate
^‡ Osteomalacia and osteoporosis have been reported after chronic ingestion of large doses of aluminum hydroxide–containing antacids. ^{{30} {79}} Since magaldrate is converted to aluminum and magnesium hydroxides in vivo , it is likely that osteomalacia and osteoporosis may occur with excessive use of magaldrate
^§ Chronic administration of magnesium trisilicate may infrequently produce silica renal stones.



Patient Consultation

Table 6. Patient Consultation

As an aid to patient consultation, refer to Advice for the Patient, Antacids (Oral). In providing consultation, consider emphasizing the following selected information (» = major clinical significance):	Legend: I =Aluminum-containing II=Calcium-containing III=Magaldrate IV =Magnesium-containing V=Sodium Bicarbonate– containing
	I	II	III	IV	V
Before using this medication
» Conditions affecting use, especially: Sensitivity to aluminum-, calcium-, magnesium-, simethicone-, or sodium bicarbonate–containing medication
Pregnancy—Concern for fetus or neonate only with chronic high doses; sodium intake may cause edema and weight gain (for sodium-containing)
Use in children—Not recommended for children up to 6 years of age; proper diagnosis required to avoid medical complications
Use in the elderly— Possible aggravation of metabolic bone disease
Possible exacerbation of Alzheimer"s disease
Other medications, especially:
Cellulose sodium phosphate
Fluoroquinolones
Isoniazid, oral
Ketoconazole
Mecamylamine
Methenamine
Sodium polystyrene sulfonate resin
Tetracyclines, oral
Other medical problems, especially: Alzheimer"s disease
Appendicitis, symptoms of
Constipation or fecal impaction or intestinal obstruction
Edematous conditions
Hemorrhoids
Hypercalcemia
Hypoparathyroidism
Hypophosphatemia
Ileostomy
Renal function impairment
Sarcoidosis
Proper use of this medication Following physician"s or manufacturer"s instructions
» Proper dosing
Missed dose: If on regular dosing schedule—Taking as soon as possible; not taking if almost time for next dose; not doubling doses
» Proper storage
For chewable tablet dosage form Chewing tablets well before swallowing for faster results and maximum effectiveness
For use in treatment of ulcers » Compliance with therapy
Taking 1 and 3 hours after meals and at bedtime for maximum effectiveness
For aluminum carbonate or aluminum hydroxide as an antiurolithic
Drinking plenty of fluids for best results
For aluminum carbonate or aluminum hydroxide as an antihyperphosphatemic Possible need for low-phosphate diet
Precautions while using this medication
Regular visits to physician to check progress of therapy if: —taking large doses
—taking regularly for long period of time
Possible interference with gastric acid secretion tests; need to inform physician of use of medication
» Not taking this medication:
—if symptoms of appendicitis are present; checking with physician for proper diagnosis
—if symptoms of inflamed bowel are present
—within 1 to 2 hours of other oral medication
—with large amounts of milk or milk products
Possible need for sodium restriction
Possible interference with test using radiopharmaceutical; need to inform physician of using aluminum-containing antacid
For antacid use » Not taking this medication for more than 2 weeks or if problem is recurring, unless otherwise directed by physician
Alerting patients to laxative effect when taken too often or in large doses
Side/adverse effects Signs of potential side effects, especially: Neurotoxicity
Fecal impaction
Swelling of feet or lower legs
Metabolic alkalosis
Hypercalcemia
Osteomalacia and osteoporosis
Renal calculi
Phosphorus depletion syndrome
Hypermagnesemia

General Dosing Information

For antacid use
The dose of antacid needed to neutralize gastric acid varies among patients, depending on the amount of acid secreted and the buffering capacity of the particular preparation. ^{69}

It is estimated that 99% of the gastric acid will be neutralized when a gastric pH of 3.3 is achieved. ^{69}

The amount (in mEq) of 1 N hydrochloric acid that can be titrated to pH 3.5 in 15 minutes by a certain dose of antacid is referred to as the neutralizing capacity of the antacid. ^{93} Approximately 15 to 20 mEq of an aluminum- and magnesium-containing antacid are required to neutralize 1 mEq of gastric hydrochloric acid.

Patients with hypersecretory disorders (e.g., duodenal ulcer, Zollinger-Ellison syndrome, multiple endocrine adenomas, and systemic mastocytosis) may require 80 to 160 mEq of buffer at each dose for symptomatic relief; this is approximately 30 to 60 mL of most antacids. ^{103} Only half of this dose is needed for patients with normal acid secretion.

The liquid dosage form of antacids is considered to be more effective than the solid or powder dosage form. ^{69} In most cases, tablets must be thoroughly chewed before being swallowed; otherwise, they may not dissolve completely in the stomach before entering the small intestine. ^{81}

The maximum recommended dosage should not be taken for more than 2 weeks, except under the advice or supervision of a physician. ^{69}

Combinations of antacids containing aluminum and/or calcium ^{{105} {106} {107}} compounds with magnesium salts may offer the advantage of balancing the constipating qualities of aluminum and/or calcium and the laxative qualities of magnesium. ^{69}

For use in peptic ulcer
In the treatment of peptic ulcer disease, to achieve adequate antacid effect in the stomach at the optimum time, most antacids are administered 1 and 3 hours after meals for prolonged acid-neutralizing effect and at bedtime. However, when taken at bedtime, their effect is not prolonged because of rapid gastric emptying. ^{93} Additional doses of antacids may be administered to relieve the pain that may occur between the regularly scheduled doses. ^{69}

Antacid therapy should be continued for at least 4 to 6 weeks after all symptoms have disappeared ^{69}, since there is no correlation between disappearance of symptoms and actual healing of the ulcer.


Aluminum hydroxide:
In the treatment of peptic ulcer, 960 mg to 3.6 grams are given orally every one or two hours during waking hours, the dosage being adjusted as needed. ^{69} For extremely severe symptoms of peptic ulcer (hospitalized patients), 2.6 to 4.8 grams diluted with two to three parts of water may be given intragastrically ^{69} every thirty minutes for periods of twelve or more hours a day.


For antihyperphosphatemic use


Aluminum hydroxide:
In adults, 1.9 to 4.8 grams of aluminum hydroxide are given orally three or four times a day in conjunction with dietary phosphate restriction. ^{104} In children, a dose of 50 to 150 mg per kg of body weight is given in four to six divided doses in conjunction with dietary phosphate restriction. ^{102}


For antiurolithic use


Aluminum carbonate:
In the prevention of phosphate stones the equivalent of 1 to 3 grams of aluminum carbonate is given four times a day, one hour after meals and at bedtime.




Oral Dosage Forms



Strength(s) usually available
U.S.—

Additional information:

Table 7. Oral Dosage Forms

Note: Content and acid neutralizing capacity per capsule, tablet, or 5 mL, unless otherwise stated.
All products are available over-the-counter (OTC) in the U.S. and/or in Canada.

Brand or generic name [availability]	Aluminum component	Calcium component	Magnesium component	Other ingredients	Acid neutralizing capacity	Other content information as per product label	Usual adult and adolescent dose prn † (maximum OTC dose/day)	Usual pediatric dose	Packaging, storage, and labeling §
Advanced Formula Di-Gel Tablets USP (Chewable) [U.S.]		Calcium carbonate 280 mg	Magnesium hydroxide 128 mg	Simethicone 20 mg	10 mEq	Sodium <5 mg	2–4 tabs q 2 hr (24 tabs)		b, g
Alamag Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 225 mg		Magnesium hydroxide 200 mg			Sodium <1.25 mg Sugar free	10–20 mL (80 mL)	‡	b, c, d, e
Alamag Plus Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 225 mg		Magnesium hydroxide 200 mg	Simethicone 25 mg		Sodium <5 mg Sugar free	10–20 mL (80 mL)		b, c, d, e
Alenic Alka Oral Suspension [U.S.]	Aluminum hydroxide 31.7 mg		Magnesium carbonate 137 mg	Sodium alginate		Sodium 13 mg	15–30 mL (120 mL)	‡	b, c, d, e, h
Chewable Tablets [U.S.]	Aluminum hydroxide (dried gel) 80 mg		Magnesium trisilicate 20 mg	Alginic acid, Sodium bicarbonate		Sodium 18.4 mg	2–4 tabs (16 tabs)		a, g, h
Alenic Alka Extra Strength Tablets USP (Chewable) [U.S.]	Aluminum hydroxide 160 mg		Magnesium carbonate 105 mg	Alginic acid, Sodium bicarbonate		Sodium 29.9 mg	2–4 tabs (16 tabs)		b, g, h
Alka-Mints Tablets USP (Chewable) [U.S.]		Calcium carbonate 850 mg			15.9 mEq	Sodium <0.5 mg	1–2 tabs (9 tabs)		b, g
Alkets Tablets USP (Chewable) [U.S.]		Calcium carbonate 500 mg				Sodium £2 mg	1–2 tabs (16 tabs)		b, g
Alkets Extra Strength Tablets USP (Chewable) [U.S.]		Calcium carbonate 750 mg				Sodium £2 mg	1–2 tabs (10 tabs)		b, e, g
Almacone Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 200 mg		Magnesium hydroxide 200 mg	Simethicone 20 mg	10 mEq	Sodium 0.75 mg	5–10 mL (120 mL)	‡	b, c, d, e
Tablets USP (Chewable) [U.S.]	Aluminum hydroxide (dried gel) 200 mg		Magnesium hydroxide 200 mg	Simethicone 20 mg			1–2 tabs (24 tabs)		b, g
Almacone II Oral Suspension USP [U.S.]	Aluminum hydroxide 400 mg		Magnesium hydroxide 400 mg	Simethicone 40 mg	20 mEq	Sodium 1.5 mg	5–10 mL (60 mL)	‡	b, c, d, e
Almagel 200 Oral Suspension USP [Canada]	Aluminum hydroxide (equiv. to dried gel) 200 mg		Magnesium hydroxide 200 mg				5–20 mL		b, c, d, e
AlternaGEL Gel USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 600 mg			Simethicone	16 mEq	Sodium <2.5 mg Sugar free	5–10 mL (90 mL). See also General Dosing Information for other doses.	‡	b, c, d, e
Alu-Cap Capsules USP [U.S.]	Aluminum hydroxide (dried gel) 400 mg				8.5 mEq		3 caps (9 caps)		a
Aludrox Oral Suspension USP [U.S.]	Aluminum hydroxide gel 307 mg		Magnesium hydroxide 103 mg	Simethicone 5 mg	12 mEq	Sodium 2 mg	10 mL (60 mL)	‡	b, c, d, e
Alugel Gel USP [Canada]	Aluminum hydroxide gel 320 mg						10 mL (80 mL)		b, c, d, e
Alumina and Magnesia * Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 240 mg		Magnesium hydroxide 210 mg		13.3 mEq		5–20 mL (80 mL)		b, c, d, e
Oral Suspension USP [Canada]	Aluminum hydroxide (equiv. to dried gel) 225 mg		Magnesium hydroxide 200 mg			Sugar free	10–20 mL (80 mL)		b, c, d, e
Alumina, Magnesia, and Simethicone * Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 213 mg		Magnesium hydroxide 200 mg	Simethicone 20 mg	12.7 mEq		5–10 mL (120 mL)		b, c, d, e
Oral Suspension USP [Canada]	Aluminum hydroxide (equiv. to dried gel) 225 mg		Magnesium hydroxide 200 mg	Simethicone 25 mg		Sugar free	10–20 mL (80 mL)		b, c, d, e
Aluminum Hydroxide Gel * USP [U.S./Canada]	Aluminum hydroxide gel 320 mg Aluminum hydroxide gel 450 mg Aluminum hydroxide gel 600 mg Aluminum hydroxide gel 675 mg						600 mg–1.2 grams. See also General Dosing Information for other doses.	‡	b, c, d, e
Aluminum Hydroxide Gel, Dried * Tablets USP [U.S./Canada]	Aluminum hydroxide (dried gel) 500 mg Aluminum hydroxide (dried gel) 600 mg						600 mg–1.2 grams. See also General Dosing Information for other doses.		a, g
Alu-Tab Tablets USP [U.S.]	Aluminum hydroxide (dried gel) 500 mg				10.6 mEq		3 tabs (9 tabs)		a
Tablets USP [Canada]	Aluminum hydroxide (dried gel) 600 mg					Film-coated Tartrazine free	1–2 tabs		a
Amitone Tablets USP (Chewable) [U.S.]		Calcium carbonate 350 mg			7 mEq	Sodium <2 mg	2 tabs (22 tabs)		b, g
Amphojel Gel USP [U.S./Canada]	Aluminum hydroxide gel 320 mg				10 mEq	Sodium <2.3 mg (peppermint)	10 mL (60 mL)		b, c, d, e
Tablets USP [U.S./Canada]	Aluminum hydroxide (dried gel) 300 mg				8 mEq	Sodium 1.4 mg	2 tabs (12 tabs)		a, f, h
	Aluminum hydroxide (dried gel) 600 mg				16 mEq	Sodium 2.8 mg	1 tab (6 tabs)		a, g, h
Amphojel 500 Oral Suspension USP [Canada]	Aluminum hydroxide 500 mg		Magnesium hydroxide 500 mg		37 mEq	Sodium 3 mg Tartrazine free Sugar free	5–10 mL (40 mL)	‡	b, c, d, e
Amphojel Plus Oral Suspension USP [Canada]	Aluminum hydroxide 300 mg		Magnesium hydroxide 300 mg	Simethicone 25 mg		Sodium 7 mg Sugar free Tartrazine free	5–10 mL (40 mL)	‡	b, c, d, e
Chewable Tablets [Canada]			Magnesium hydroxide 300 mg	Aluminum hydroxide and magnesium carbonate co-dried gel 300 mg, Simethicone 25 mg		Sodium 10 mg Sugar free Tartrazine free	1–2 tabs (8 tabs)		a, g
Antacid Gelcaps Tablets USP [U.S.]		Calcium carbonate 311 mg	Magnesium carbonate 232 mg				2–4 tabs (24 tabs)		b
Antacid Liquid Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 200 mg		Magnesium hydroxide 200 mg	Simethicone 20 mg		Sodium <1.25mg	10–20 mL (120 mL)		b, c, d, e
Antacid Liquid Double strength Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 400 mg		Magnesium hydroxide 400 mg	Simethicone 40 mg		Sodium <1.25mg	10–20 mL (60 mL)		b, c, d, e
Basaljel Capsules [U.S.]	Dried basic aluminum carbonate gel equiv. to 500 mg of aluminum hydroxide or 608 mg of dried aluminum hydroxide gel				12 mEq	Sodium 2.76 mg	2 caps q 2 hr (24 caps) See also General Dosing Information for other doses.		a, h
Capsules [Canada]	Aluminum hydroxide (dried gel) 500 mg					Sodium <2 mg Tartrazine free	2–3 caps (12 caps)		a, h
Oral Suspension [U.S.]	Basic aluminum carbonate gel equiv. to 400 mg of aluminum hydroxide			Simethicone 5 mg	11.5 mEq	Sodium 3 mg	10 mL q 2 hr (120 mL)	‡	b, c, d, h
Tablets [U.S.]	Dried basic aluminum carbonate gel equiv. to 500 mg of aluminum hydroxide or 608 mg of dried aluminum hydroxide gel				12.5 mEq	Sodium 2.76 mg	2 tabs q 2 hr (24 tabs)		a, h
Calcium Carbonate * Oral Suspension USP [U.S.]		Calcium carbonate 1250 mg					5 mL		b, c, e
Tablets USP [U.S.]		Calcium carbonate 500 mg Calcium carbonate 600 mg Calcium carbonate 650 mg Calcium carbonate 1250 mg					1–2 tabs See also General Dosing Information for other doses.		b, h
Tablets USP (Chewable) [U.S.]		Calcium carbonate 500 mg Calcium carbonate 750 mg					1–2 tabs		b, g
Calglycine Tablets USP (Chewable) [U.S.]		Calcium carbonate 420 mg		Glycine 150 mg		Sugar free	2 tabs (19 tabs)		b, f, i
Chooz Chewing Gum [U.S.]		Calcium carbonate 500 mg			10 mEq	Sodium <5 mg	1–2 tabs q 2–4 hr (14 tabs)	6–12 yrs: 1 tab q 2–4 hr (8 tabs)	a
Dicarbosil Tablets USP (Chewable) [U.S.]		Calcium carbonate 500 mg			10 mEq	Sodium <2 mg	2 tabs (16 tabs)		b, g, i
Di-Gel Oral Suspension USP [U.S.]	Aluminum hydroxide (dried gel) 200 mg		Magnesium hydroxide 200 mg	Simethicone 20 mg	³9 mEq	Sodium £5 mg Sugar free	10–20 mL q 2 hr (100 mL)		b, c, d, e
Diovol Oral Suspension [Canada]	Aluminum hydroxide 165 mg		Magnesium hydroxide 200 mg	Simethicone	11.9 mEq	Alcohol 1% Sodium <1 mg Sugar free Tartrazine free	10–20 mL (80 mL)		b, c, d, e
Chewable Tablets [Canada]			Magnesium hydroxide 100 mg	Aluminum hydroxide and magnesium carbonate co-dried gel 300 mg	10 mEq	Sodium 1 mg Sugar free Tartrazine free	2–4 tabs (16 tabs)		a, g
Diovol Caplets Tablets [Canada]	Aluminum hydroxide (equiv. to dried gel) 200 mg		Magnesium hydroxide 200 mg			Sugar free Tartrazine free	2–4 tabs (16 tabs)		a
Diovol Ex Oral Suspension [Canada]	Aluminum hydroxide 494 mg		Magnesium hydroxide 300 mg		25 mEq	Alcohol 1% Sodium <1 mg Sugar free Tartrazine free	5–10 mL (40 mL)	‡	b,c,d,e
Tablets (Chewable) [Canada]	Aluminum hydroxide (equiv. to dried gel) 600 mg		Magnesium hydroxide 300 mg		24.6 mEq	Sodium 1 mg Sugar free Tartrazine free	1–2 tabs (8 tabs)		b, g
Diovol Plus Oral Suspension [Canada]	Aluminum hydroxide 165 mg		Magnesium hydroxide 200 mg	Simethicone 25 mg	11.9 mEq	Alcohol <1% Sodium <1 mg Sugar free Tartrazine free	10–20 mL (80 mL)	‡	b, c, d, e
Chewable Tablets [Canada]			Magnesium hydroxide 100 mg	Aluminum hydroxide and magnesium carbonate co-dried gel 300 mg, Simethicone 25 mg	10 mEq	Sodium 1 mg Sugar free Tartrazine free	2–4 tabs (16 tabs)		a, g, i
Diovol Plus AF Oral Suspension [Canada]		Calcium carbonate 200 mg	Magnesium hydroxide 200 mg	Simethicone 25 mg	9.8 mEq	Alcohol 1% Sodium 1 mg Sugar free Tartrazine free	10–20 mL (80 mL)		b, c, d
Chewable Tablets [Canada]		Calcium carbonate 200 mg	Magnesium hydroxide 200 mg	Simethicone 25 mg	10 mEq	Sodium 1 mg Sugar free Tartrazine free	2–4 tabs (16 tabs)		a, g
Equilet Tablets USP (Chewable) [U.S.]		Calcium carbonate 500 mg				Sodium 0.3 mg	2 tabs		b, g
Foamicon Tablets USP (Chewable) [U.S.]	Aluminum hydroxide 80 mg		Magnesium trisilicate 20 mg	Alginic acid, Sodium bicarbonate		Sodium 18.4 mg	2–4 tabs (16 tabs)		a, g, h
Gasmas Chewable Tablets [Canada]			Magnesium hydroxide 100 mg	Aluminum hydroxide and magnesium carbonate co-dried gel 300 mg, Simethicone 25 mg			2 tabs		a, g
Gaviscon Oral Suspension USP [U.S.]	Aluminum hydroxide 31.7 mg		Magnesium carbonate 119.3 mg	Sodium alginate	2.5–4.3 mEq	Sodium 13 mg	15–30 mL (120 mL)	‡	b, c, d, e, h
Tablets USP (Chewable) [U.S.]	Aluminum hydroxide (dried gel) 80 mg		Magnesium trisilicate 20 mg	Alginic acid, Sodium bicarbonate	0.5 mEq	Sodium 18.4 mg	2–4 tabs (16 tabs)		a, g, h
Gaviscon-2 Tablets USP (Chewable) [U.S.]	Aluminum hydroxide (dried gel) 160 mg		Magnesium trisilicate 40 mg	Alginic acid, Sodium bicarbonate	1 mEq	Sodium 36.8 mg	1–2 tabs (8 tabs)		a, g, h
Gaviscon Acid Plus Gas Relief Oral Suspension [Canada]		Calcium carbonate 660 mg	Magnesium hydroxide 145 mg	Simethicone 30 mg			10–20 mL (60 mL)		b, d
Tablets USP (Chewable) [Canada]		Calcium carbonate 585 mg	Magnesium hydroxide 120 mg	Simethicone 30 mg			2–4 tabs (13 tabs)		b, g
Gaviscon Acid Relief Oral Suspension [Canada]		Calcium carbonate 660 mg	Magnesium hydroxide 145 mg				10–20 mL (60 mL)		b, d
Tablets USP (Chewable) [Canada]		Calcium carbonate 585 mg	Magnesium hydroxide 120 mg				2–4 tabs (13 tabs)		b, g
Gaviscon Extra Strength Acid Relief Oral Suspension [Canada]		Calcium carbonate 1 gram	Magnesium hydroxide 250 mg				10–15 mL (40 mL)		b, d
Gaviscon Extra Strength Relief Formula Oral Suspension USP [U.S.]	Aluminum hydroxide 254 mg		Magnesium carbonate 238 mg	Sodium alginate, Simethicone emulsion	14.3 mEq	Sodium 20.7 mg	10–20 mL (80 mL)		b, c, d, e, h
Tablets USP (Chewable) [U.S.]	Aluminum hydroxide 160 mg		Magnesium carbonate 105 mg	Alginic acid, Sodium bicarbonate	5–7.5 mEq	Sodium 29.9 mg	2–4 tabs (16 tabs)		b, g, h
Gaviscon Heartburn Relief Oral Suspension USP [Canada]	Aluminum hydroxide (dried gel) 100 mg			Sodium alginate 250 mg		Sodium 30 mg Alcohol free Sugar free Tartrazine free	10–20 mL (100 mL)		b, d, e
Oral Suspension [Canada]			Magnesium carbonate 100 mg	Sodium alginate 250 mg, Calcium carbonate, Sodium bicarbonate			10–20 mL (100 mL)		b, d
Tablets USP (Chewable) [Canada]	Aluminum hydroxide (dried gel) 80 mg			Alginic acid 200 mg		Sodium 22 mg Tartrazine free	2–4 tabs (20 tabs)		a, g
Chewable Tablets [Canada]			Magnesium carbonate 40 mg	Alginic acid 200 mg, Sodium bicarbonate			2–4 tabs (20 tabs)		a, g
Gaviscon Heartburn Relief Extra Strength Tablets USP (Chewable) [Canada]	Aluminum hydroxide (dried gel) 160 mg			Alginic acid 400 mg		Tartrazine free	2 tabs (10 tabs)		a, g
Gelusil Oral Suspension USP [Canada]	Aluminum hydroxide (equiv. to dried gel) 200 mg		Magnesium hydroxide 200 mg			Sodium 0.84 mg Sugar free Tartrazine free	10–20 mL 4 times/day		b, c, d, e
Tablets USP (Chewable) [U.S.]	Aluminum hydroxide 200 mg		Magnesium hydroxide 200 mg	Simethicone 25 mg	11 mEq	Sodium <5 mg	2–4 tabs (12 tabs)		b, g
Tablets USP (Chewable) [Canada]	Aluminum hydroxide (equiv. to dried gel) 200 mg		Magnesium hydroxide 200 mg			Sodium 1.1 mg Tartrazine free	2–4 tabs 4 times/day		b, g
Gelusil Extra Strength Oral Suspension USP [Canada]	Aluminum hydroxide (equiv. to dried gel) 650 mg		Magnesium hydroxide 350 mg			Sodium 1.4 mg Sugar free Tartrazine free	10 mL 4 times/day		b, c, d, e
Tablets USP (Chewable) [Canada]	Aluminum hydroxide (equiv. to dried gel) 400 mg		Magnesium hydroxide 400 mg			Sodium 1.6 mg Tartrazine free	2–4 tabs 4 times/day		b, g, h
Genaton Oral Suspension USP [U.S.]	Aluminum hydroxide 31.7 mg		Magnesium carbonate 137.3 mg	Sodium alginate		Sodium 13 mg	15–30 mL (120 mL)		b, c, d, e, h
Tablets USP (Chewable) [U.S.]	Aluminum hydroxide 80 mg		Magnesium trisilicate 20 mg	Alginic acid, Sodium bicarbonate		Sodium 18.4 mg	2–4 tabs (16 tabs)		a, g, h
Genaton Extra Strength Tablets USP (Chewable) [U.S.]	Aluminum hydroxide 160 mg		Magnesium carbonate 105 mg	Alginic acid, Sodium bicarbonate		Sodium 35 mg	2–4 tabs (16 tabs)		b, e, g, h
Kudrox Double Strength Oral Suspension USP [U.S.]	Aluminum hydroxide 500 mg		Magnesium hydroxide 450 mg	Simethicone 40 mg	25 mEq	Sodium <5 mg	10–20 mL (60 mL)		b, c, d, e
Life Antacid Oral Suspension USP [Canada]	Aluminum hydroxide (dried gel) 228 mg		Magnesium hydroxide 200 mg			Sugar free	10–20 mL (80 mL)		b, c, d, e
Life Antacid Plus Oral Suspension USP [Canada]	Aluminum hydroxide (dried gel) 228 mg		Magnesium hydroxide 200 mg	Simethicone 25 mg		Sugar free	10–20 mL (80 mL)		b, c, d, e
Tablets USP (Chewable) [Canada]	Aluminum hydroxide (dried gel) 200 mg		Magnesium hydroxide 200 mg	Simethicone 25 mg			1–4 tabs		b, g
Losopan Oral Suspension USP [U.S.]				Magaldrate 540 mg		Sodium <5 mg	5–10 mL (90 mL)		b, c, d, e
Losopan Plus Oral Suspension USP [U.S.]				Magaldrate 540 mg, Simethicone 40 mg		Sodium <5 mg	5–10 mL (90 mL)		b, c, d, e
Lowsium Plus Oral Suspension USP [U.S.]				Magaldrate 540 mg, Simethicone 40 mg		Sodium <5 mg	5–10 mL (90 mL)	‡	b, c, d, e
Maalox Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 225 mg		Magnesium hydroxide 200 mg		13.3 mEq	Sodium <1.5 mg Sugar free	10–20 mL (80 mL)	‡	b, c, d
Oral Suspension USP [Canada]	Aluminum hydroxide (equiv. to dried gel) 225 mg		Magnesium hydroxide 200 mg		13.3 mEq	Sodium 0.92 mg Sugar free Tartrazine free	10–20 mL (80 mL)	‡	b, c, d
Original Tablets USP (Chewable) [U.S.]	Aluminum hydroxide (dried gel) 200 mg		Magnesium hydroxide 200 mg		9.7 mEq	Sodium 0.7 mg Sugar free	2–4 tabs (16 tabs)		b, e, g
Tablets USP (Chewable) [Canada]	Aluminum hydroxide (equiv. to dried gel) 400 mg		Magnesium hydroxide 400 mg			Sodium 0.93 mg Tartrazine free	1–2 tabs (8 tabs)		b, g, h
Maalox Antacid Caplets Tablets USP [U.S./Canada]		Calcium carbonate 311 mg	Magnesium carbonate 232 mg				2–4 tabs (24 tabs)		b
Maalox Heartburn Relief Formula Oral Suspension [U.S.]			Magnesium carbonate 175 mg	Aluminum hydroxide- magnesium carbonate co-dried gel 140 mg	8.5 mEq	Sodium <1.5 mg Tartrazine	10–20 mL (80 mL)		b, c, d, e
Maalox HRF Oral Suspension [Canada]			Magnesium alginate 250 mg, Magnesium carbonate 175 mg	Aluminum hydroxide- magnesium carbonate codried gel 140 mg		Sodium <5 mg Sugar free Tartrazine free	10–20 mL (80 mL)		b, c, d
Tablets (Chewable) [Canada]			Magnesium alginate 250 mg, Magnesium carbonate 160 mg	Aluminum hydroxide- magnesium carbonate codried gel 180 mg		Sodium <3 mg Tartrazine free	2–4 tabs (16 tabs)		a, g, h
Maalox Plus Oral Suspension USP [Canada]	Aluminum hydroxide (equiv. to dried gel) 225 mg		Magnesium hydroxide 200 mg	Simethicone 25 mg	13.35 mEq	Sodium 0.92 mg Sugar free Tartrazine free	10–20 mL (80 mL)		b, c, d, e
Tablets USP (Chewable) [U.S.]	Aluminum hydroxide (equiv. to dried gel) 200 mg		Magnesium hydroxide 200 mg	Simethicone 25 mg	10.65 mEq	Sodium £1 mg	1–4 tabs (16 tabs)		b, g
Tablets USP (Chewable) [Canada]	Aluminum hydroxide (dried gel) 200 mg		Magnesium hydroxide 200 mg	Simethicone 25 mg		Sodium 1 mg (lemon) 0.94 mg (mint) Tartrazine free	2–4 tabs (16 tabs)		a, g, h
Maalox Plus, Extra Strength Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 500 mg		Magnesium hydroxide 450 mg	Simethicone 40 mg	26.1 mEq	Sodium <1 mg Sugar free	10–20 mL (60 mL)		b, c, d, e
Oral Suspension USP [Canada]	Aluminum hydroxide (equiv. to dried gel) 500 mg		Magnesium hydroxide 450 mg	Simethicone 40 mg		Sodium 1.2 mg Sugar free Tartrazine free	10–20 mL (60 mL)		b, c, d, e
Tablets USP (Chewable) [U.S./Canada]	Aluminum hydroxide (dried gel) 350 mg		Magnesium hydroxide 350 mg	Simethicone 30 mg	16.7 mEq	Sodium 1.4 mg Sugar 0.72 gram	1–3 tabs (12 tabs)		b, g
Maalox TC Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 600 mg		Magnesium hydroxide 300 mg		27.2 mEq	Sodium <1 mg Sugar free	5–10 mL (40 mL)		b, c, d, e
Oral Suspension USP [Canada]	Aluminum hydroxide (equiv. to dried gel) 600 mg		Magnesium hydroxide 300 mg			Sodium 0.95 mg Sugar free Tartrazine free	5–10 mL (40 mL)		b, c, d, e
Tablets USP (Chewable) [Canada]	Aluminum hydroxide (dried gel) 600 mg		Magnesium hydroxide 300 mg		28 mEq	Sodium 0.98 mg Tartrazine free	1–2 tabs (8 tabs)		b, g
Magaldrate * Oral Suspension USP [U.S.]				Magaldrate 540 mg		Sodium free Sugar free Dye free	5–10 mL (100 mL)	‡	b, c, d
Magaldrate and Simethicone * Oral Suspension USP [U.S.]				Magaldrate 540 mg, Simethicone 20 mg			5–10 mL (100 mL)	‡	b, c, d, e
Magnalox Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 225 mg		Magnesium hydroxide 200 mg	Simethicone		Sugar free	10–20 mL (80 mL)		b, c, d, e
Magnalox Plus Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 500 mg		Magnesium hydroxide 450 mg	Simethicone 40 mg			10–20 mL (60 mL)		b, c, d, e
Magnesium Hydroxide * Magnesia Tablets USP (Chewable) [Canada]			Magnesium hydroxide 385 mg			Sugar free	2–4 tabs (16 tabs)		b, f, h
Milk of Magnesia USP * [U.S.]			Magnesium hydroxide 400 mg		14 mEq		5–15 mL (60 mL)	‡	b, c, d, e
Milk of Magnesia USP * [Canada]			Magnesium hydroxide 440 mg			Sugar free	10–20 mL		b, c, d, e
Mag-Ox 400 Tablets USP [U.S.]			Magnesium oxide 400 mg		20 mEq		1–2 tabs/day (2 tabs)		a
Mallamint Tablets USP (Chewable) [U.S.]		Calcium carbonate 420 mg				Sodium <0.1 mg Sugar free	2 tabs		a, g
Maox 420 Tablets USP [U.S.]			Magnesium oxide 420 mg		21 mEq	Tartrazine	1 tab/day		a
Marblen Oral Suspension [U.S.]		Calcium carbonate 520 mg	Magnesium carbonate 400 mg		18 mEq	Sugar free	5–10 mL (60 mL)		c, d, e
Tablets USP [U.S.]		Calcium carbonate 520 mg	Magnesium carbonate 400 mg		18 mEq	Sugar free	1–2 tabs (12 tabs)		g, i
Mi-Acid Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 200 mg		Magnesium hydroxide 200 mg	Simethicone 20 mg		Sodium <5 mg	10–20 mL (120 mL)	‡	b, c, d, e
Tablets USP [U.S.]		Calcium carbonate 311 mg	Magnesium carbonate 232 mg				2–4 tabs (24 tabs)		a
Mi-Acid Double Strength Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 400 mg		Magnesium hydroxide 400 mg	Simethicone 40 mg		Sodium <5 mg	10–20 mL (60 mL)		b, c, d, e
Mintox Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 225 mg		Magnesium hydroxide 200 mg			Sodium 1.38 mg	10–20 mL (80 mL)	‡	b, c, d, e
Tablets USP (Chewable) [U.S.]	Aluminum hydroxide 200 mg		Magnesium hydroxide 200 mg				2 tabs		a, g
Mintox Extra Strength Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 500 mg		Magnesium hydroxide 450 mg	Simethicone 40 mg		Sodium <5 mg	10–20 mL (60 mL)		b, c, d, e
Tablets USP (Chewable) [U.S.]	Aluminum hydroxide 200 mg		Magnesium hydroxide 200 mg	Simethicone 25 mg			1–2 tabs		b, g
Mygel Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 200 mg		Magnesium hydroxide 200 mg	Simethicone 20 mg		Sodium 1.38 mg	10–20 mL (120 mL)	‡	b, c, d, e
Mygel II Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 400 mg		Magnesium hydroxide 400 mg	Simethicone 40 mg		Sodium 1.3 mg	10–20 mL (60 mL)	‡	b, c, d, e
Mylanta Lozenges [U.S.]		Calcium carbonate 600 mg			11.4 mEq		1–2 lozenges (12 lozenges)		a
Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 200 mg		Magnesium hydroxide 200 mg	Simethicone 20 mg	12.7 mEq	Sodium 0.68 mg Sugar free	10–20 mL (120 mL)	‡	b, c, d, e
Oral Suspension USP [Canada]	Aluminum hydroxide (equiv. to dried gel) 200 mg		Magnesium hydroxide 200 mg	Simethicone 20 mg		Sodium 3.2 mg Sugar free Tartrazine free	10–20 mL 4 times/day		b, c, d, e
Tablets USP (Chewable) [U.S.]		Calcium carbonate 350 mg	Magnesium hydroxide 150 mg		12 mEq	Sodium 0.3 mg	2–4 tabs (20 tabs)		b, g
Tablets USP (Chewable) [Canada]	Aluminum hydroxide (dried gel) 200 mg		Magnesium hydroxide 200 mg	Simethicone 20 mg		Sodium 0.9 mg Tartrazine free	2–4 tabs 4 times/day		a, g, i
Mylanta Double Strength Oral Suspension USP [U.S.]	Aluminum hydroxide 400 mg		Magnesium hydroxide 400 mg	Simethicone 40 mg	25.4 mEq	Sodium 1.14 mg Sugar free	10–20 mL (60 mL)	‡	b, c, d, e
Tablets USP (Chewable) [U.S.]		Calcium carbonate 700 mg	Magnesium hydroxide 300 mg		24 mEq	Sodium 0.6 mg	2–4 tabs (10 tabs)		b, g
Tablets USP (Chewable) [Canada]	Aluminum hydroxide (equiv. to dried gel) 400 mg		Magnesium hydroxide 400 mg	Simethicone 30 mg		Sodium 1.5 mg Tartrazine free	2–4 tabs 4 times/day		b, g
Mylanta Double Strength Plain Oral Suspension USP [Canada]	Aluminum hydroxide (equiv. to dried gel) 400 mg		Magnesium hydroxide 400 mg			Sodium 10 mg Sugar free Tartrazine free	5–10 mL 4 times/day		b, c, d, e
Mylanta Extra Strength Oral Suspension USP [Canada]	Aluminum hydroxide (equiv. to dried gel) 650 mg		Magnesium hydroxide 350 mg	Simethicone 30 mg		Sodium 1.8 mg Sugar free Tartrazine free	5–10 mL 4 times/day		b, c, d, e
Mylanta Gelcaps Tablets [U.S.]		Calcium carbonate 550 mg	Magnesium hydroxide 125 mg		11.5 mEq	Benzyl alcohol, Sodium 2.5 mg	2–4 tabs (24 tabs)		a
Nephrox Oral Suspension [U.S.]	Aluminum hydroxide gel 320 mg			Mineral oil 10%	9 mEq	Sugar free	10 mL (60 mL)		c, d, e
Neutralca-S Oral Suspension USP [Canada]	Aluminum hydroxide (equiv. to dried gel) 200 mg		Magnesium hydroxide 200 mg			Sodium 0.6 mg Sugar free	5–15 mL	‡	b, c, d
Tablets USP (Chewable) [Canada]	Aluminum hydroxide (dried gel) 400 mg		Magnesium hydroxide 400 mg			Sodium 1.01 mg Scored	1–2 tabs		b, g
Phillips" Magnesia Tablets USP (Chewable) [Canada]			Magnesium hydroxide 311 mg			Low sodium Sucrose 195 mg	2–4 tabs (16 tabs)	7–14 yrs: 1 tab (4 tabs)	b, e, g
Milk of Magnesia USP [U.S.]			Magnesium hydroxide 400 mg				5–15 mL (60 mL)		b, c, d, e
Milk of Magnesia USP [Canada]			Magnesium hydroxide 400 mg			Alcohol free Sodium <2.2 mg Sugar free (plain and mint)	5–15 mL (60 mL)	1–12 yrs: 1–10 mL	b, c, d, e
Phillips" Chewable Magnesia Tablets USP (Chewable) [U.S.]			Magnesium hydroxide 311 mg				2–4 tabs (16 tabs)	7–14 yrs: 1 tab (4 tabs)	b, g
Phillips" Concentrated Double-strength Milk of Magnesia USP [U.S.]			Magnesium hydroxide 800 mg				2.5–7.5 mL (30 mL)		b, c, d, e
PMS Alumina, Magnesia, and Simethicone Oral suspension USP [Canada]	Aluminum hydroxide 200 mg		Magnesium hydroxide 200 mg	Simethicone 25 mg		Sugar free	10–20 mL 4 times/day (80 mL)		b, c, d, e
Rafton Oral Suspension [Canada]	Aluminum hydroxide 100 mg			Calcium carbonate, Sodium bicarbonate, Sodium alginate 250 mg		Alcohol free Sodium 30 mg Sugar free Tartrazine free	10–20 mL 1–4 times/day (80 mL)		b, c, d, e, h
Chewable tablets [Canada]	Aluminum hydroxide (equiv. to dried gel) 80 mg			Alginic acid 200 mg, Sodium bicarbonate		Sodium 22 mg Sucrose 1.2 grams Tartrazine free	2–4 tabs 1–4 times/day (16 tabs)		a, g, h
Riopan Oral Suspension USP [U.S.]				Magaldrate 540 mg	15 mEq	Sodium <0.3 mg	5–10 mL (80 mL)	‡	b, c, d, e
Oral Suspension USP [Canada]				Magaldrate 480 mg		Alcohol free Sodium <0.7 mg Sugar free Tartrazine free	10–20 mL	‡	b, c, d, e
Tablets USP (Chewable) [Canada]				Magaldrate 480 mg		Sodium 0.7 mg Tartrazine free	1–4 tabs		a, g
Riopan Extra Strength Oral Suspension USP [Canada]				Magaldrate 1080 mg		Alcohol free Sodium 0.3 mg Sugar free Tartrazine free	5–10 mL		b, c, d, e
Riopan Plus Oral Suspension USP [U.S.]				Magaldrate 540 mg, Simethicone 40 mg	15 mEq	Sodium <0.3 mg	5–10 mL (60 mL)	‡	b, c, d, e
Oral Suspension USP [Canada]				Magaldrate 480 mg, Simethicone 20 mg	13.5 mEq	Alcohol free Sodium 0.7 mg Sugar free Tartrazine free	10–20 mL		b, c, d, e
Tablets USP (Chewable) [U.S./Canada]				Magaldrate 480 mg, Simethicone 20 mg	13.5 mEq	Sodium 0.1 mg	2–4 tabs (25 tabs)		b, g
Riopan Plus Double Strength Oral Suspension USP [U.S.]				Magaldrate 1080 mg, Simethicone 40 mg		Sodium £0.3 mg	5–10 mL (60 mL)	‡	b, c, d, e
Tablets USP (Chewable) [U.S.]				Magaldrate 1080 mg, Simethicone 20 mg	30 mEq	Sodium £0.5 mg	2–4 tabs (25 tabs)		b, g
Riopan Plus Extra Strength Oral Suspension USP [Canada]				Magaldrate 1080 mg, Simethicone 30 mg		Sodium 0.3 mg Sugar free Tartrazine free	5–10 mL		b, c, d, e
Rolaids Tablets USP (Chewable) [U.S.]		Calcium carbonate 550 mg	Magnesium hydroxide 110 mg		14.8 mEq	Sodium <0.1 mg	1–4 tabs (12 tabs)		b, g
Tablets USP (Chewable) [Canada]		Calcium carbonate 317 mg	Magnesium hydroxide 64 mg			Sodium <1 mg Tartrazine free	1–2 tabs (12 tabs)		b, g
Rolaids Extra Strength Tablets USP (Chewable) [Canada]		Calcium carbonate 750 mg	Magnesium hydroxide 64 mg			Sodium <1 mg Tartrazine free	1–2 tabs (10 tabs)		b, g
Rulox Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 225 mg		Magnesium hydroxide 200 mg		12 mEq	Sodium <1 mg	10–20 mL (80 mL)	‡	b, c, d, e
Rulox No. 1 Tablets USP (Chewable) [U.S.]	Aluminum hydroxide (dried gel) 200 mg		Magnesium hydroxide 200 mg				1–2 tabs (16 tabs)		b, e, g, h
Rulox No. 2 Tablets USP (Chewable) [U.S.]	Aluminum hydroxide (dried gel) 400 mg		Magnesium hydroxide 400 mg				1–2 tabs (8 tabs)		b, e, g, h
Rulox Plus Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 500 mg		Magnesium hydroxide 450 mg	Simethicone 40 mg			10–20 mL (80 mL)		b, c, d, e
Simaal Gel Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 200 mg		Magnesium hydroxide 200 mg	Simethicone 20 mg		Sodium 1.4 mg Sugar free	10–20 mL (120 mL)		b, c, d, e
Simaal 2 Gel Oral Suspension USP [U.S.]	Aluminum hydroxide (equiv. to dried gel) 400 mg		Magnesium hydroxide 400 mg	Simethicone 40 mg		Sodium 1.84 mg Sugar free	10–20 mL (60 mL)	‡	b, c, d, e
Tempo Tablets USP (Chewable) [U.S.]	Aluminum hydroxide 133 mg	Calcium carbonate 414 mg	Magnesium hydroxide 81 mg	Simethicone 20 mg	14 mEq	Sodium 3 mg	1 tab (12 tabs)		b, g
Titralac Tablets USP (Chewable) [U.S.]		Calcium carbonate 420 mg		Glycine 183 mg	7.5 mEq	Sodium 1.1 mg Sugar free	2 tabs (19 tabs)		b, f, i
Titralac Extra Strength Tablets USP (Chewable) [U.S.]		Calcium carbonate 750 mg		Glycine 321 mg		Sodium 1.1 mg Sugar free	1–2 tabs (10 tabs)		b, f, h, i
Titralac Plus Oral Suspension [U.S.]		Calcium carbonate 500 mg		Simethicone 20 mg		Sodium 2.5 mg Sugar free	10 mL (80 mL)		b, c, d
Chewable Tablets [U.S.]		Calcium carbonate 420 mg		Glycine 173 mg Simethicone 21 mg		Sodium 1.1 mg Sugar free	2 tabs (19 tabs)		b, f, i
Trial Tablets USP (Chewable) [Canada]		Calcium carbonate 420 mg					1–2 tabs (18 tabs)		a, g
Tums Tablets USP (Chewable) [U.S.]		Calcium carbonate 500 mg			10 mEq	Sodium <2 mg	2–4 tabs (16 tabs)		b, g, i
Tablets USP (Chewable) [Canada]		Calcium carbonate 500 mg			10 mEq	Sodium <2 mg	1–2 tabs (16 tabs)		b, g
Tums Anti-gas/ Antacid Chewable Tablets [U.S.]		Calcium carbonate 500 mg		Simethicone 20 mg	10 mEq	Sodium £2 mg	1–2 tabs (16 tabs)		a, g
Tums E-X Tablets USP (Chewable) [U.S.]		Calcium carbonate 750 mg			15 mEq	Sodium <2 mg	2–4 tabs (10 tabs)		b, g
Tums Extra Strength Tablets USP (Chewable) [Canada]		Calcium carbonate 750 mg			15 mEq	Sodium <2 mg	1–2 tabs (10 tabs)		b, g
Tums Ultra Tablets USP (Chewable) [U.S.]		Calcium carbonate 1 gram			20 mEq	Sodium £4 mg	2–3 tabs (8 tabs)		b, g
Tums Ultra Tablets USP (Chewable) [Canada]		Calcium carbonate 1 gram			20 mEq	Sodium £4 mg	1–2 tabs (8 tabs)		b, g
Univol Oral Suspension [Canada]	Aluminum hydroxide 165 mg		Magnesium hydroxide 200 mg			Alcohol 1% Sodium 1 mg Sugar free Tartrazine free	10–20 mL (80 mL)		b, c, d, e
Uro-Mag Capsules USP [U.S.]			Magnesium oxide 140 mg		7 mEq		3–4 caps/daily		a

^* Specific formulations may vary among the different manufacturers; check product labeling
^† In peptic ulcer disease, maximum therapeutic response may be obtained if taken 1 and 3 hours after meals and at bedtime. Severe symptoms may require more frequent dosing
^‡ Pediatric doses may range between 5 and 15 mL every 3 to 6 hours or 1 and 3 hours after meals and at bedtime, unless otherwise stated. However, these are general guidelines; proper diagnosis and dose individualization should precede the use of an antacid in a pediatric patient
^§ For appropriate Packaging and storage and Label information refer to designated letters as follows:

• a–Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a well-closed container, unless otherwise specified by manufacturer.


• b–Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.


• c–Protect from freezing.


• d–Auxiliary labeling: o Shake well.


• e–Auxiliary labeling: o Keep container tightly closed.


• f–Auxiliary labeling: o May be chewed or swallowed whole.


• g–Auxiliary labeling: o Chew tablets or wafers before swallowing.


• h–Auxiliary labeling: o Follow with 1/2 to 1 glass of water or other liquid.


• i–Auxiliary labeling: o May also be allowed to dissolve in mouth.

Revised: 07/18/1996

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12. Panel comment.
    

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54. Not used.
    

55. Not used.
    

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60. Not used.
    

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86. Reviewer comment, 1992.
    

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97. Reviewers' consensus on Gallium Nitrate monograph revision of 1992.
    

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101. Panel comment, 1993.
     

102. Panel comment, 1993.
     

103. Panel comments, 1993.
     

104. Reviewers' consensus on monograph revision of 1993.
     

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107. O'Connell M, Lindberg J, Peller T, et al. Gastrointestinal tolerance of oral calcium supplements. Clin Pharm 1989; 8: 425-7.
     

108. Reviewers' consensus on Pamidronate monograph revision of 1992.
     

109. Milk of Magnesia product label (Phillips—US), Rec 10/93.
     

110. Gelusil product labels (Warner-Lambert—Canada), Rec 2/95.
     

111. Phillips Milk of Magnesia product label (Bayer—Canada), Rec 10/3/94.
     

112. Milk of Magnesia product labels (Stanley—Canada), Rec 12/94.
     

113. Basaljel (Wyeth-Ayerst). In: PDR Physicians' desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 2649.
     

114. The United States pharmacopeia. The national formulary. USP XXII revision (January 1, 1990). NF XVIIth ed (January 1, 1990). Rockville, MD: The United States Pharmacopeial Convention, Inc., 1990: 8th supplement, 1993: 3218-9.
     

115. Amphojel (Wyeth-Ayerst). In: PDR Physicians' desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 2641.
     

116. Alu-Tab, Alu-Cap(3M). In: PDR Physicians' desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 1379.
     

117. Alu-Tab (3M). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 30th ed. Ottawa: Canadian Pharmaceutical Association, 1995: 52.
     

118. Tums (SmithKline Beecham). In: PDR Physicians' desk reference for nonprescription drugs. 15th ed. 1994. Montvale, NJ: Medical Economics Data Production Company, 1994: 720.
     

119. Alka-Mints(Miles). In: PDR Physicians' desk reference for nonprescription drugs. 15th ed. 1994. Montvale, NJ: Medical Economics Data Production Co, 1994: 600.
     

120. Maalox (Rhone-Poulenc Rorer). In: PDR Physicians' desk reference for nonprescription drugs. 15th ed. 1994. Montvale, NJ: Medical Economics Data Production Co, 1994: 651-6.
     

121. Tums product labels (SmithKline Beecham—US), Rec 10/94, 11/94.
     

122. Mylanta Lozenges product label (J&J-Merck—US), Rec 1/95.
     

123. Calcium Carbonate oral suspension product label (Roxane—US), Rev 5/91, Rec 10/94.
     

124. Uro-Mag, Mag-Ox 400 (Blaine). In: PDR Physicians' desk reference for nonprescription drugs. 15th ed. 1994. Montvale, NJ: Medical Economics Data Production Co, 1994: 508.
     

125. Magnalox product labels (Schein—US), Rec 11/94.
     

126. Titralac product labels (3M—US), Rec 11/94.
     

127. Mi-Acid product labels (Major—US), Rec 10/94.
     

128. Mylanta Gelcaps product label (J&J-Merck—US), Rec 1/95.
     

129. Alenic Alka product labels (Rugby—US), Rec 12/94.
     

130. Genaton product labels (Goldline—US), Rec 11/94.
     

131. Rulox tablets product labels (Rugby—US), Rec 12/94.
     

132. Maalox TC (Rhone-Poulenc Rorer). In: PDR Physicians' desk reference. 48th ed. 1994. Montvale, NJ: Medical Economics Data Production Company, 1994: 1868.
     

133. Mintox product labels (Major—US), Rec 10/94.
     

134. Rulox Plus suspension product label (Rugby—US), Rec 12/94.
     

135. Dioval product labels (Horner—Canada), Rec 1/95.
     

136. Gaviscon product labels (Sterling Health—Canada), Rec 11/94.
     

137. Maalox product labels (Rhone-Poulenc Rorer—Canada), Rec 1/95.
     

138. Mylanta product labels (Warner-Lambert—Canada), Rec 2/95.
     

139. Riopan (Whitehall-Robins). Carruthers-Czyzewski P, editor. Compendium of nonprescription products. Premier edition. Ottawa: Canadian Pharmaceutical Association, 1994: 150-1.
     

140. Amphojel (Wyeth-Ayerst). Carruthers-Czyzewski P, editor. Compendium of nonprescription products. Premier edition. Ottawa: Canadian Pharmaceutical Association, 1994: 14-5.
     

141. Di-Gel (Schering-Plough). In: PDR Physicians' desk reference for nonprescription drugs. 15th ed. 1994. Montvale, NJ: Medical Economics Data Production Co, 1994: 690.
     

142. Olin BR, editor. Drug facts and comparisons. St. Louis: Facts and Comparisons Inc, August 1994: 294c.
     

143. Tums product labels (SmithKline Beecham—Canada), Rec 11/94.
     

144. Rolaids (Adams Brands). Carruthers-Czyzewski P, editor. Compendium of nonprescription products. Premier edition. Ottawa: Canadian Pharmaceutical Association, 1994: 155.
     

145. Rolaids product labels (Warner-Lambert—US), Rec 11/94.
     

146. Alumina, Magnesia, Simethicone suspension product label (Roxane—US), Rev 6/94, Rec 10/94.
     

147. Olin BR, editor. Drug facts and comparisons. St. Louis: Facts and Comparisons Inc, August 1994: 293a.
     

148. Olin BR, editor. Drug facts and comparisons. St. Louis: Facts and Comparisons Inc, August 1994: 293b.
     

149. Alumina and Magnesia product label (Roxane—US), Rev 3/94, Rec 10/94.
     

150. Iosopan product labels (Goldline—US), Rec 11/94.
     

151. Mylagen product labels (Goldline—US), Rec 11/94.
     

152. Foamicon product label (Invamed—US), Rec 10/94.
     

153. Alamag product labels (Goldline—US), Rec 11/94.
     

154. Amitone product label (Menley & James—US), Rec 10/94.
     

155. Nephrox (Fleming). In: PDR Physicians' desk reference for nonprescription drugs. 15th ed. 1994. Montvale, NJ: Medical Economics Data Production Co, 1994: 562.
     

156. Tempo product label (Thompson—US), Rec 10/94.
     

157. Mygel product labels (Geneva—US), Rec 11/94.
     

158. Gaviscon product labels (SmithKline Beecham—US), Rec 10/94.
     

159. Simaal product labels (Schein—US), Rec 11/94.
     

160. Dicarbosil product label (Bira—US), Rec 11/94.
     

161. Kudrox product label (Schwarz Pharma—US), Rec 10/94.
     

162. Almagel product label (Atlas—Canada), Rec 10/94.
     

163. Alugel product label (Atlas—Canada), Rec 10/94.
     

164. Gasmas product label (Vachon—Canada), Rec 11/94.
     

165. Univol product label (Horner—Canada), Rec 11/94.
     

166. Alumina, Magnesia [and Simethicone] product labels (Drug Trading—Canada), Rec 11/94.
     

167. Alkets product label (Roberts—US), Rec 12/94.
     

168. Titralac product label (3M—Canada), Rec 12/94.
     

169. Calglycine product label (Rugby—US), Rec 12/94.
     

170. Lowsium Plus product label (Rugby—US), Rec 12/94.
     

171. Gastrocote product label (Stanley—Canada), Rec 12/94.
     

172. Life Antacid product labels (Stanley, KSL—Canada), Rec 12/94.
     

173. AlternaGEL product label (J&J-Merck), Rec 1/95.
     

174. Mylanta Calcium Rich tablets product labels (J&J-Merck—US), Rec 1/95.
     

175. Gas-Ban product label (Roberts—US), Rev 9/94, Rec 1/95.
     

176. Chooz (Schering-Plough). In: PDR Physicians' desk reference for nonprescription drugs. 15th ed. 1994. Montvale, NJ: Medical Economics Data Production Co, 1994: 688.
     

177. Riopan product labels (Whitehall-Robins—US), Rec 3/95.
     

178. Advanced Formula Di-Gel (Schering-Plough—US), 3/4/95.