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Aluminum hydroxide and magnesium carbonate

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U.S. BRAND NAMES — Acid Gone Extra Strength [OTC]; Acid Gone [OTC]; Alenic Alka [OTC] [DSC]; 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: 15-30 mL 4 times/day after meals

Tablet (Gaviscon® Extra Strength): 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. [DSC] = Discontinued product

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] [DSC] 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], 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

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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
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

Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy

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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

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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 Phospha
te 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

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

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

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