Aluminium Hydroxide+Magnesium Hydroxide

Pharmacologic Category

Antacid

Dosing: Adult

Antacid: Oral: Liquid: Aluminum hydroxide 200 mg/magnesium hydroxide 200 mg per 5 mL: 10 to 20 mL 4 times daily; maximum: 80 mL per 24 hours.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling; aluminum and/or magnesium may accumulate in renal impairment.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Pediatric

Note: Chronic antacid therapy not recommended for management of GERD in pediatric patients (AAP [Lightdale 2013]; Vandenplas 2009).

Antacid: Aluminum hydroxide 200 mg and magnesium hydroxide 200 mg per 5 mL:

Children <12 years: Limited data available: Short-term therapy only: Oral: 0.5 to 1 mL/kg/dose after meals and at bedtime; maximum dose: 20 mL/dose (Orenstein 1988)

Children ≥12 years and Adolescents: Oral: 10 to 20 mL 4 times daily; maximum daily dose: 80 mL per 24 hours

Dosing: Renal Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; aluminum and/or magnesium may accumulate in renal impairment.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Use: Labeled Indications

Antacid: Relief of heartburn, acid indigestion, sour stomach and GI upset associated with these symptoms

Administration: Oral

Shake well before use; administer between meals and at bedtime (4 times daily)

Administration: Pediatric

Oral: Shake well before use; administer 1 to 2 hours after meals (Orenstein 1988)

Dietary Considerations

Should be taken between meals. Some products may contain sodium.

Storage/Stability

Store at room temperature; avoid freezing.

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

• It is used to treat heartburn and upset stomach.

• It may be given to you for other reasons. Talk with the doctor.

Frequently reported side effects of this drug

• Constipation

• Diarrhea

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

• A significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Warnings/Precautions

Concerns related to adverse effects:

• Hypophosphatemia: Prolonged antacid therapy may result in hypophosphatemia; aluminum in antacid may form insoluble complexes with phosphate leading to decreased phosphate absorption in the GI tract. Rarely, severe hypophosphatemia can lead to anorexia, muscle weakness, malaise, and osteomalacia.

Disease-related concerns:

• Renal impairment: Hypermagnesemia or aluminum intoxication may occur in patients with renal impairment, particularly with prolonged use. Aluminum intoxication may lead to osteomalacia or dialysis encephalopathy.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Dosage form specific issues:

• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Zar 2007).

Other warnings/precautions:

• Self-medication (OTC use): When used for self-medication, patients should be instructed to consult their health care prescriber prior to using if they are on a magnesium and/or sodium restricted diet. Do not take the maximum dose for >14 days.

Geriatric Considerations

Elderly, due to disease or drug therapy, may be predisposed to diarrhea or constipation. Diarrhea may result in electrolyte imbalance. Decreased renal function (CrCl <30 mL/minute) may result in toxicity of aluminum or magnesium. Drug interactions must be considered. If possible, administer antacid 1-2 hours apart from other drugs. When treating ulcers, consider buffer capacity (mEq/mL) to calculate dose of antacid.

Warnings: Additional Pediatric Considerations

Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Shehab 2009).

Absorption of aluminum has been reported in infants receiving both short-term and long-term antacid therapy; use with caution; consider monitoring serum aluminum concentrations to monitor for toxicity (Tsou 1991; Woodard-Knight 1992)

Pregnancy Considerations

Most aluminum- and magnesium-containing antacids are considered low risk during pregnancy (Mahadevan 2006).

Breast-Feeding Considerations

Most aluminum- and magnesium-containing antacids are considered low risk in nursing women (Mahadevan 2006).

Adverse Reactions

Frequency not defined.

Central nervous system: Calcium or chalky taste

Endocrine & metabolic: Hypermagnesemia (rare), hypophosphatemia (rare)

Gastrointestinal: Abdominal cramps, constipation, fecal discoloration (white speckles), fecal impaction, nausea, vomiting

Toxicology

• Magnesium

Metabolism/Transport Effects

None known.

Drug Interactions Open Interactions

Acalabrutinib: Antacids may decrease the serum concentration of Acalabrutinib. Management: Separate administration of acalabrutinib from the administration of any antacids by at least 2 hours in order to minimize the potential for a significant interaction. Risk D: Consider therapy modification

Allopurinol: Aluminum Hydroxide may decrease the serum concentration of Allopurinol. Management: Consider administering allopurinol 3 hours prior to aluminum hydroxide. Risk D: Consider therapy modification

Alpha-Lipoic Acid: Magnesium Salts may decrease the absorption of Alpha-Lipoic Acid. Alpha-Lipoic Acid may decrease the absorption of Magnesium Salts. Management: Separate administration of alpha-lipoic acid from that of any magnesium-containing compounds by several hours. If alpha-lipoic acid is given 30 minutes before breakfast, then administer oral magnesium-containing products at lunch or dinner. Risk D: Consider therapy modification

Amphetamines: Antacids may decrease the excretion of Amphetamines. Risk C: Monitor therapy

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. Management: In patients with severe renal dysfunction, consider avoiding this combination. Administering agents at least 2 hours apart may help minimize effects. Monitor for toxic effects of aluminum (from antacid) if ascorbic acid is coadministered. Risk D: Consider therapy modification

Atazanavir: Antacids may decrease the absorption of Atazanavir. Management: Administer antacids 1 hour before or 2 hours after atazanavir to minimize the risk of a clinically significant interaction. Risk D: Consider therapy modification

Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Risk X: Avoid combination

Bictegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Bictegravir. Management: Administer bictegravir under fasting conditions at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended. 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. Management: Antacids should not be used within 1 hour before bisacodyl administration. Risk D: Consider therapy modification

Bismuth Subcitrate: Antacids may diminish the therapeutic effect of Bismuth Subcitrate. Management: Avoid administration of antacids within 30 minutes of bismuth subcitrate (tripotassium bismuth dicitrate) administration. Risk D: Consider therapy modification

Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification

Bosutinib: Antacids may decrease the serum concentration of Bosutinib. Management: Administer antacids more than 2 hours before or after bosutinib. Risk D: Consider therapy modification

Bromperidol: Antacids may decrease the absorption of Bromperidol. Risk C: Monitor therapy

Calcium Channel Blockers: May enhance the adverse/toxic effect of Magnesium Salts. Magnesium Salts may enhance the hypotensive effect of Calcium Channel Blockers. Risk C: Monitor therapy

Calcium Polystyrene Sulfonate: Laxatives (Magnesium Containing) may enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. More specifically, concomitant use of calcium polystyrene sulfonate with magnesium-containing laxatives may result in metabolic alkalosis or with sorbitol may result in intestinal necrosis. Management: Avoid concomitant use of calcium polystyrene sulfonate (rectal or oral) and magnesium-containing laxatives. Risk X: Avoid combination

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

Cefditoren: Antacids may decrease the serum concentration of Cefditoren. Management: Concomitant use of cefditoren with antacids is not recommended. Consider alternative methods to control acid reflux (eg, diet modification) or alternative antimicrobial therapy. If antacid therapy can not be avoided, separate dosing by several hours. Risk D: Consider therapy modification

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

Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Management: Administer cefuroxime axetil at least 1 hour before or 2 hours after the administration of short-acting antacids. Risk D: Consider therapy modification

Chenodiol: Aluminum Hydroxide may decrease the serum concentration of Chenodiol. Management: Consider administration of chenodiol 2 hours before or 6 hours after aluminum-containing antacid products to prevent adsorption in the gastrointestinal tract. Risk D: Consider therapy modification

Chloroquine: Antacids may decrease the serum concentration of Chloroquine. Management: Separate the administration of antacids and chloroquine by at least 4 hours to minimize any potential negative impact of antacids on chloroquine bioavailability. Risk D: Consider therapy modification

Cholic Acid: Aluminum Hydroxide may decrease the absorption of Cholic Acid. Management: Administer cholic acid at least 1 hour before or 4 to 6 hours after administration of any aluminum hydroxide-containing products to minimize the potential for a significant interaction. Risk D: Consider therapy modification

Citric Acid Derivatives: May increase the absorption of Aluminum Hydroxide. Risk C: Monitor therapy

Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Management: Consider separating doses by 2 or more hours. Budesonide enteric coated tablets could dissolve prematurely if given with drugs that lower gastric acid, with unknown impact on budesonide therapeutic effects. Risk D: Consider therapy modification

Cysteamine (Systemic): Antacids may diminish the therapeutic effect of Cysteamine (Systemic). Risk C: Monitor therapy

Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Management: Dabigatran etexilate Canadian product labeling recommends avoiding concomitant use with antacids for 24 hours after surgery. In other situations, administer dabigatran etexilate 2 hours prior to antacids. Monitor clinical response to dabigatran therapy. Risk D: Consider therapy modification

Dasatinib: Antacids may decrease the serum concentration of Dasatinib. Management: Simultaneous administration of dasatinib and antacids should be avoided. Administer antacids 2 hours before or 2 hours after dasatinib. Risk D: Consider therapy modification

Deferasirox: Aluminum Hydroxide may diminish the therapeutic effect of Deferasirox. Risk X: Avoid combination

Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Risk D: Consider therapy modification

Delavirdine: Antacids may decrease the serum concentration of Delavirdine. Management: Separate doses of delavirdine and antacids by at least 1 hour. Monitor for decreased delavirdine therapeutic effects with this combination. Risk D: Consider therapy modification

Dexmethylphenidate: Antacids may increase the absorption of Dexmethylphenidate. Specifically, antacids may interfere with the normal release of drug from the extended-release capsules (Focalin XR brand), which could result in both increased absorption (early) and decreased delayed absorption. Risk C: Monitor therapy

Diacerein: Antacids may decrease the absorption of Diacerein. Risk C: Monitor therapy

Dichlorphenamide: Laxatives may enhance the hypokalemic effect of Dichlorphenamide. Risk C: Monitor therapy

Dolutegravir: Aluminum Hydroxide may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral aluminum hydroxide. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral aluminum hydroxide. Risk D: Consider therapy modification

Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Risk D: Consider therapy modification

Elvitegravir: Antacids may decrease the serum concentration of Elvitegravir. Management: Separate administration of aluminum and magnesium containing antacids and elvitegravir-containing products by at least 2 hours in order to minimize the risk for an interaction. Risk D: Consider therapy modification

Erdafitinib: Serum Phosphate Level-Altering Agents may diminish the therapeutic effect of Erdafitinib. Management: Avoid coadministration of serum phosphate level-altering agents with erdafitinib before initial dose increase period based on serum phosphate levels (Days 14 to 21). 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 serum concentration of Ethambutol. Management: Avoid concurrent administration of ethambutol and aluminum hydroxide. If coadministration cannot be avoided administer ethambutol first and then wait at least 4 hours before administering aluminum hydroxide-containing products. Risk D: Consider therapy modification

Fexofenadine: Antacids may decrease the serum concentration of Fexofenadine. Management: Separate the administration of fexofenadine and aluminum- or magnesium-containing antacids. Risk D: Consider therapy modification

Fosinopril: Antacids may decrease the serum concentration of Fosinopril. Management: The US and Canadian fosinopril manufacturer labels recommend separating the doses of antacids and fosinopril by 2 hours. Risk D: Consider therapy modification

Gabapentin: Aluminum Hydroxide may decrease the serum concentration of Gabapentin. Management: Administer gabapentin at least 2 hours after administration of antacids containing aluminum hydroxide or magnesium hydroxide. Risk D: Consider therapy modification

Gefitinib: Antacids may decrease the serum concentration of Gefitinib. Management: Administer gefitinib at least 6 hours before or 6 hours after administration of an antacid, and closely monitor clinical response to gefitinib. Risk D: Consider therapy modification

Hyoscyamine: Antacids may decrease the serum concentration of Hyoscyamine. Management: Administer immediate release hyoscyamine before meals and antacids after meals when these agents are given in combination. Risk D: Consider therapy modification

Iron Preparations: Antacids may decrease the absorption of Iron Preparations. Management: Separate dosing of oral iron preparations and antacids as much as possible to avoid decreased efficacy of iron preparation. If coadministered with antacids, monitor for decreased therapeutic effects of iron preparations. Exceptions: Ferric Carboxymaltose; Ferric Citrate; Ferric Derisomaltose; Ferric Gluconate; Ferric Hydroxide Polymaltose Complex; Ferric Pyrophosphate Citrate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk D: Consider therapy modification

Itraconazole: Antacids may decrease the serum concentration of Itraconazole. Antacids may increase the serum concentration of Itraconazole. Management: Administer Sporanox brand itraconazole at least 2 hours before or 2 hours after administration of any antacids. Exposure to Tolsura brand itraconazole may be increased by antacids; consider itraconazole dose reduction. Risk D: Consider therapy modification

Ketoconazole (Systemic): Antacids may decrease the serum concentration of Ketoconazole (Systemic). Management: Administer oral ketoconazole at least 2 hours prior to use of any antacid product. Monitor patients closely for signs of inadequate clinical response to ketoconazole. Risk D: Consider therapy modification

Lanthanum: Antacids may diminish the therapeutic effect of Lanthanum. Risk D: Consider therapy modification

Ledipasvir: Antacids may decrease the serum concentration of Ledipasvir. Management: Separate the administration of ledipasvir and antacids by 4 hours. Risk D: Consider therapy modification

Levothyroxine: Aluminum Hydroxide may decrease the serum concentration of Levothyroxine. Management: Separate administration of oral levothyroxine and aluminum hydroxide by at least 4 hours. Risk D: Consider therapy modification

Mequitazine: Aluminum Hydroxide may decrease the absorption of Mequitazine. Management: Administer mequitazine at least 2 hours before or 2 hours after administration of any aluminum hydroxide-containing products to minimize the potential for a significant interaction. Risk D: Consider therapy modification

Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with sustained-release mesalamine products. Separating antacid and mesalamine administration, and/or using lower antacid doses may be adequate means of avoiding this interaction. Risk D: Consider therapy modification

Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Management: Consider avoiding this combination if possible. Antacids may decrease the therapeutic effects of methenamine; sodium bicarbonate is of most concern. If coadministering methenamine and antacids, monitor for decreased methenamine efficacy. Risk D: Consider therapy modification

Methylphenidate: Antacids may increase the absorption of Methylphenidate. Specifically, antacids may interfere with the normal release of drug from the extended-release capsules (Ritalin LA brand), which could result in both increased absorption (early) and decreased delayed absorption. Risk C: Monitor therapy

MiSOPROStol: Antacids may enhance the adverse/toxic effect of MiSOPROStol. More specifically, concomitant use with magnesium-containing antacids may increase the risk of diarrhea. Management: Avoid concomitant use of misoprostol and magnesium-containing antacids. In patients requiring antacid therapy, employ magnesium-free preparations. Monitor for increased adverse effects (e.g., diarrhea, dehydration). Risk X: Avoid combination

Multivitamins/Fluoride (with ADE): May increase the serum concentration of Aluminum Hydroxide. Aluminum Hydroxide may decrease the serum concentration of Multivitamins/Fluoride (with ADE). Specifically, aluminum hydroxide may impair fluoride absorption. Management: Avoid administration of aluminum hydroxide within at least 1-2 hours of fluoride administration. In patients with severe renal dysfunction, consider avoiding this combination altogether. Risk D: Consider therapy modification

Multivitamins/Minerals (with ADEK, Folate, Iron): May increase the serum concentration of Aluminum Hydroxide. Management: In patients with severe renal dysfunction, consider avoiding this combination of agents. Administering agents at least 2 hours apart may help minimize the interaction(s). Risk D: Consider therapy modification

Multivitamins/Minerals (with AE, No Iron): May increase the serum concentration of Aluminum Hydroxide. Specifically, vitamin C may enhance aluminum absorption. Management: In patients with severe renal dysfunction, consider avoiding this combination of agents. Administering agents at least 2 hours apart may help minimize the interaction(s). Risk D: Consider therapy modification

Mycophenolate: Antacids may decrease the absorption of Mycophenolate. Management: Separate doses of mycophenolate and antacids by at least 2 hours. Monitor for reduced effects of mycophenolate if taken concomitant with antacids. Risk D: Consider therapy modification

Mycophenolate: Magnesium Salts may decrease the serum concentration of Mycophenolate. Management: Separate doses of mycophenolate and oral magnesium salts. Monitor for reduced effects of mycophenolate if taken concomitant with oral magnesium salts. Risk D: Consider therapy modification

Neratinib: Antacids may decrease the serum concentration of Neratinib. Specifically, antacids may reduce neratinib absorption. Management: Separate the administration of neratinib and antacids by giving neratinib at least 3 hours after the antacid. Risk D: Consider therapy modification

Neuromuscular-Blocking Agents: Magnesium Salts may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Nilotinib: Antacids may decrease the serum concentration of Nilotinib. Management: Separate the administration of nilotinib and any antacid by at least 2 hours whenever possible in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification

PAZOPanib: Antacids may decrease the serum concentration of PAZOPanib. Management: Avoid the use of antacids in combination with pazopanib whenever possible. Separate doses by several hours if antacid treatment is considered necessary. The impact of dose separation has not been investigated. Risk D: Consider therapy modification

PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Risk D: Consider therapy modification

Pexidartinib: Antacids may decrease the serum concentration of Pexidartinib. Management: Administer pexidartinib 2 hours before or after antacids. Risk D: Consider therapy modification

Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate administration. Separating administer of oral phosphate supplements from antacid administration by as long as possible may minimize the interaction. Exceptions: Sodium Glycerophosphate Pentahydrate. Risk D: Consider therapy modification

Phosphate Supplements: Magnesium Salts may decrease the serum concentration of Phosphate Supplements. Management: Administer oral phosphate supplements as far apart from the administration of an oral magnesium salt as possible to minimize the significance of this interaction. Exceptions: Sodium Glycerophosphate Pentahydrate. Risk D: Consider therapy modification

Potassium Phosphate: Antacids may decrease the serum concentration of Potassium Phosphate. Management: Consider separating administration of antacids and oral potassium phosphate by at least 2 hours to decrease risk of a significant interaction. Risk D: Consider therapy modification

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

Quinolones: Antacids may decrease the absorption of Quinolones. Of concern only with oral administration of quinolones. Management: Avoid concurrent administration of quinolones and antacids to minimize the impact of this interaction. Recommendations for optimal dose separation vary by specific quinolone. Exceptions: LevoFLOXacin (Oral Inhalation). Risk D: Consider therapy modification

Quinolones: Magnesium Salts may decrease the serum concentration of Quinolones. Management: Administer oral quinolones several hours before (4 h for moxi/pe/spar-, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome/pe-, 3 h for gemi-, and 2 h for levo-, nor-, or ofloxacin or nalidixic acid) oral magnesium salts. Exceptions: LevoFLOXacin (Oral Inhalation). Risk D: Consider therapy modification

Raltegravir: Aluminum Hydroxide may decrease the serum concentration of Raltegravir. Management: Avoid the use of oral / enteral aluminum hydroxide with raltegravir. No dose separation schedule has been established that adequately reduces the magnitude of interaction. Risk X: Avoid combination

Rilpivirine: Antacids may decrease the serum concentration of Rilpivirine. Management: Administer antacids at least 2 hours before or 4 hours after rilpivirine when used with most rilpivirine products. However, administer antacids at least 6 hours before or 4 hours after the rilpivirine/dolutegravir combination product. Risk D: Consider therapy modification

Riociguat: Antacids may decrease the serum concentration of Riociguat. Management: Separate the administration of antacids and riociguat by at least 1 hour in order to minimize any potential interaction. Risk D: Consider therapy modification

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

Sodium Polystyrene Sulfonate: Laxatives (Magnesium Containing) may enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. More specifically, concomitant use of sodium polystyrene sulfonate with magnesium-containing laxatives may result in metabolic alkalosis or with sorbitol may result in intestinal necrosis. Management: Avoid concomitant use of sodium polystyrene sulfonate (rectal or oral) and magnesium-containing laxatives. Risk X: Avoid combination

Sotalol: Antacids may decrease the serum concentration of Sotalol. Management: Avoid simultaneous administration of sotalol and antacids. Administer antacids 2 hours after sotalol. Risk D: Consider therapy modification

Strontium Ranelate: Aluminum Hydroxide may decrease the serum concentration of Strontium Ranelate. Management: Separate administration of strontium ranelate and aluminum hydroxide by at least 2 hours whenever possible in order to minimize this interaction. Risk D: Consider therapy modification

Strontium Ranelate: Magnesium Hydroxide may decrease the serum concentration of Strontium Ranelate. Management: Separate administration of strontium ranelate and magnesium hydroxide by at least 2 hours whenever possible in order to minimize this interaction. Risk D: Consider therapy modification

Sulpiride: Antacids may decrease the serum concentration of Sulpiride. Management: Separate administration of antacids and sulpiride by at least 2 hours in order to minimize the impact of antacids on sulpiride absorption. Risk D: Consider therapy modification

Tetracyclines: Antacids may decrease the absorption of Tetracyclines. Management: Separate administration of antacids and oral tetracycline derivatives by several hours when possible to minimize the extent of this potential interaction. Exceptions: Eravacycline. Risk D: Consider therapy modification

Tetracyclines: Magnesium Salts may decrease the absorption of Tetracyclines. Only applicable to oral preparations of each agent. Management: Avoid coadministration of oral magnesium salts and oral tetracyclines. If coadministration cannot be avoided, administer oral magnesium at least 2 hours before, or 4 hours after, oral tetracyclines. Monitor for decreased tetracycline therapeutic effects. Exceptions: Eravacycline. Risk D: Consider therapy modification

Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant administration of trientine and oral products that contain polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. If other oral polyvalent cations are needed, separate administration by 1 hour. Risk D: Consider therapy modification

Ursodiol: Aluminum Hydroxide may decrease the serum concentration of Ursodiol. Management: Consider administration of ursodiol 2 hours before or 6 hours after aluminum-containing antacid products to prevent adsorption in the gastrointestinal tract. Risk D: Consider therapy modification

Velpatasvir: Antacids may decrease the serum concentration of Velpatasvir. Management: Separate administration of velpatasvir and antacids by at least 4 hours. Risk D: Consider therapy modification

Vitamin D Analogs: May increase the serum concentration of Aluminum Hydroxide. Specifically, the absorption of aluminum may be increased, leading to increased serum aluminum concentrations. Risk X: Avoid combination

Advanced Practitioners Physical Assessment/Monitoring

See individual agents.

Nursing Physical Assessment/Monitoring

See individual agents.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Liquid, oral:

Mag-Al: Aluminum hydroxide 200 mg and magnesium hydroxide 200 mg per 5 mL (30 mL) [dye free, ethanol free, sugar free; contains propylene glycol, sodium 4 mg/5 mL; peppermint flavor]

Generic Available (US)

No

Pharmacodynamics/Kinetics

Duration: Dependent on gastric emptying time: Fasting state: 20-60 minutes; 1 hour after meals: May be up to 3 hours

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Chalky taste. Aluminum and magnesium ions prevent GI absorption of tetracycline by forming a large ionized chelated molecule with the tetracyclines in the stomach. Aluminum hydroxide prevents GI absorption of ketoconazole and itraconazole by increasing the pH in the GI tract. Any of these drugs should be administered at least 1 hour before aluminum hydroxide.

Effects on Bleeding

No information available to require special precautions

Related Information

• Aluminum Hydroxide
• Magnesium Hydroxide

Index Terms

Magnesium Hydroxide and Aluminum Hydroxide

References

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Mag-Al Suspension (aluminum hydroxide/magnesium hydroxide) [prescribing information]. Greenville, SC: Pharmaceuticals Associates; May 2019.

Mahadevan U, Kane S. American Gastroenterological Association institute medical position statement on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006;131(1):278-282.[PubMed 16831610]

Nord KS, "Peptic Ulcer Disease in the Pediatric Population," Pediatr Clin North Am, 1988, 35(1):117-40.[PubMed 3124068]

Orenstein SR and Orenstein DM, "Gastroesophageal Reflux and Respiratory Disease in Children," J Pediatr, 1988, 112(6):847-58.[PubMed 3286854]

Shehab N, Lewis CL, Streetman DD, Donn SM. Exposure to the pharmaceutical excipients benzyl alcohol and propylene glycol among critically ill neonates. Pediatr Crit Care Med. 2009;10(2):256-259.[PubMed 19188870]

Sutphen JL, Dillard VL, and Pipan ME, "Antacid and Formula Effects on Gastric Acidity in Infants With Gastroesophageal Reflux," Pediatrics, 1986, 78(1):55-7.[PubMed 3725503]

Tsou VM, Young RM, Hart MH, Vanderhoof JA. Elevated plasma aluminum levels in normal infants receiving antacids containing aluminum. Pediatrics. 1991;87(2):148-151.[PubMed 1987526 ]

Vandenplas Y, Rudolph CD, Di Lorenzo C, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009;49(4):498-547.[PubMed 19745761 ]

Woodard-Knight L, Fudge A, Teubner J, Simmer K. Aluminium absorption and antacid therapy in infancy. J Paediatr Child Health. 1992;28(3):257-259.[PubMed 1605980 ]

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Brand Names: International

Aluta (TH); Antasida Doen (ID); Carelox (AE); Fanta (TW); Lederscan (HK); Maalox (AT, BB, BH, BS, CZ, DE, FR, GB, GR, HN, IE, IL, IT, JM, JO, KW, LB, LT, MT, NL, PE, PH, PL, PY, QA, RO, TH, TT, TZ, UY, VN, ZW); Maalox Plus (PE); Medacid (QA); Medalox (SY); Moxal (BH, ET, QA); Omacid (BH); Rialox (QA); Varogel S (VN)

Last Updated 5/2/20