MEDICATION SAFETY ISSUES
Sound-alike/look-alike issues:
Maalox® may be confused with Maox®, Monodox®
Mylanta® may be confused with Mynatal®
Maalox® is a different formulation than Maalox® Total Stomach Relief®
U.S. BRAND NAMES — Alamag Plus [OTC]; Aldroxicon I [OTC]; Aldroxicon II [OTC]; Almacone Double Strength® [OTC]; Almacone® [OTC]; Gelusil® [OTC]; Maalox® Max [OTC]; Maalox® [OTC]; Mi-Acid Maximum Strength [OTC]; Mi-Acid [OTC]; Mintox Extra Strength [OTC]; Mintox Plus [OTC]; Mylanta® Liquid [OTC]; Mylanta® Maximum Strength Liquid [OTC]
PHARMACOLOGIC CATEGORY
Antacid
Antiflatulent
DOSING: ADULTS — Dyspepsia, abdominal bloating: Oral: 10-20 mL or 2-4 tablets 4-6 times/day between meals and at bedtime; may be used every hour for severe symptoms
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum and/or magnesium may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL); aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Aldroxicon I: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (30 mL)
Aldroxicon II: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (30 mL)
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Almacone Double Strength®: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Maalox®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL, 770 mL) [lemon and mint flavors]
Maalox® Max: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL, 770 mL) [cherry, vanilla creme, and wild berry flavors]
Mi-Acid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Mi-Acid Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Mintox Extra Strength: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL (360 mL) [lemon creme flavor]
Mylanta®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, and mint flavors]
Mylanta® Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, orange creme, and mint flavors]
Suspension (Alamag Plus): Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL (360 mL)
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [cherry flavor]
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg [peppermint flavor]
Gelusil®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [peppermint flavor]
Mintox Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
DOSAGE FORMS: CONCISE
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL; aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Aldroxicon I [OTC], Almacone® [OTC], Maalox® [OTC], Mi-Acid [OTC], Mylanta® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL
Aldroxicon II [OTC], Almacone Double Strength [OTC], Maalox® Max® [OTC], Mi-Acid Maximum Strength [OTC], Mylanta® Maximum Strength [OTC]: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Mintox Extra Strength [OTC]: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL
Suspension:
Alamag Plus [OTC]: Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus [OTC], Gelusil® [OTC], Mintox Plus [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Almacone® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg
GENERIC EQUIVALENT AVAILABLE — Yes
ADMINISTRATION — Administer 1-2 hours apart from oral drugs.
USE — Temporary relief of hyperacidity associated with gas; may also be used for indications associated with other antacids
ADVERSE REACTIONS SIGNIFICANT
>10%: Gastrointestinal: Chalky taste, stomach cramps, constipation, bowel motility decreased, fecal impaction, hemorrhoids
1% to 10%: Gastrointestinal: Nausea, vomiting, discoloration of feces (white speckles)
<1% (Limited to important or life-threatening): Dehydration or fluid restriction, hypomagnesemia, hypophosphatemia
DRUG INTERACTIONS
ACE Inhibitors: Antacids may decrease the serum concentration of ACE Inhibitors. Risk C: Monitor therapy
Allopurinol: Antacids may decrease the absorption of Allopurinol. Risk D: Consider therapy modification
Alpha-/Beta-Agonists: Antacids may decrease the excretion of Alpha-/Beta-Agonists. Exceptions: Dipivefrin. Risk C: Monitor therapy
Amphetamines: Antacids may decrease the excretion of Amphetamines. Risk C: Monitor therapy
Anticonvulsants (Hydantoin): Antacids may decrease the serum concentration of Anticonvulsants (Hydantoin). Risk C: Monitor therapy
Antifungal Agents (Azole Derivatives, Systemic): Antacids may decrease the absorption of Antifungal Agents (Azole Derivatives, Systemic). Exceptions: Fluconazole; Miconazole; Voriconazole. Risk D: Consider therapy modification
Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor therapy
Ascorbic Acid: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Atazanavir: Antacids may decrease the absorption of Atazanavir. Risk D: Consider therapy modification
Bisacodyl: Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Antacids may decrease the absorption of Bisphosphonate Derivatives. Antacids containing aluminum, calcium, or magnesium are of specific concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Magnesium Salts may decrease the absorption of Bisphosphonate Derivatives. Only oral magnesium salts are of concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Calcitriol: May increase the serum concentration of Magnesium Salts. Risk D: Consider therapy modification
Calcium Channel Blockers: May enhance the adverse/toxic effect of Magnesium Salts. Magnesium Salts may enhance the hypotensive effect of Calcium Channel Blockers. Risk C: Monitor therapy
Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy
Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Risk C: Monitor therapy
Citric Acid Derivatives: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Risk D: Consider therapy modification
CycloSPORINE: Antacids may decrease the serum concentration of CycloSPORINE. Specifically when cyclosporine is administered orally. Risk C: Monitor therapy
Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Risk C: Monitor therapy
Dasatinib: Antacids may decrease the absorption of Dasatinib. Risk D: Consider therapy modification
Deferasirox: Aluminum Hydroxide may diminish the therapeutic effect of Deferasirox. Risk D: Consider therapy modification
Delavirdine: Antacids may decrease the absorption of Delavirdine. Risk D: Consider therapy modification
Eltrombopag: Aluminum Hydroxide may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., aluminum-containing products) by at least 4 hours. Risk D: Consider therapy modification
Eltrombopag: Magnesium Salts may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., magnesium-containing products) by at least 4 hours. Risk D: Consider therapy modification
Erlotinib: Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification
Ethambutol: Aluminum Hydroxide may decrease the absorption of Ethambutol. Risk D: Consider therapy modification
Fexofenadine: Antacids may decrease the serum concentration of Fexofenadine. Management: No specific recommendations concerning the time required between their administration are provided. Separate administration of each agent by as much time as possible to decrease the risk of an interaction. Risk D: Consider therapy modification
Iron Salts: Antacids may decrease the absorption of Iron Salts. Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk D: Consider therapy modification
Isoniazid: Antacids may decrease the absorption of Isoniazid. Risk D: Consider therapy modification
Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with sustained-release mesalamine products. Separating antacid and mesalamine administration, and/or using lower antacid doses may be adequate means of avoiding this interaction. Risk D: Consider therapy modification
Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Risk D: Consider therapy modification
Mycophenolate: Antacids may decrease the absorption of Mycophenolate. Risk D: Consider therapy modification
Mycophenolate: Magnesium Salts may decrease the absorption of Mycophenolate. This only applies to oral magnesium salts. Risk D: Consider therapy modification
Neuromuscular-Blocking Agents: Magnesium Salts may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Only of concern in patients with increased serum magnesium concentrations. Risk C: Monitor therapy
Penicillamine: Antacids may decrease the serum concentration of Penicillamine. Risk D: Consider therapy modification
Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Phosphate Supplements: Magnesium Salts may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Protease Inhibitors: Antacids may decrease the absorption of Protease Inhibitors. Exceptions: Darunavir. Risk C: Monitor therapy
QuiNIDine: Antacids may decrease the excretion of QuiNIDine. Risk C: Monitor therapy
QuiNINE: Antacids may decrease the serum concentration of QuiNINE. Risk X: Avoid combination
Quinolone Antibiotics: Antacids may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of quinolones. Risk D: Consider therapy modification
Quinolone Antibiotics: Magnesium Salts may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of both agents. Risk D: Consider therapy modification
Sodium Polystyrene Sulfonate: May enhance the adverse/toxic effect of Antacids. The combined use of these two agents may result in metabolic alkalosis. Risk D: Consider therapy modification
Tetracycline Derivatives: Antacids may decrease the absorption of Tetracycline Derivatives. Risk D: Consider therapy modification
Tetracycline Derivatives: Magnesium Salts may decrease the absorption of Tetracycline Derivatives. Only applicable to oral preparations of each agent. Risk D: Consider therapy modification
Tocainide: Antacids may increase the serum concentration of Tocainide. Risk C: Monitor therapy
Trientine: Antacids may decrease the absorption of Trientine. Risk D: Consider therapy modification
Trientine: May decrease the serum concentration of Magnesium Salts. Magnesium Salts may decrease the serum concentration of Trientine. Risk D: Consider therapy modification
PREGNANCY RISK FACTOR — C (show table)
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals.
PRICING — (data from drugstore.com)
Suspension (Mylanta)
200-200-20 mg/5 mL (355): $7.99
200-200-20 mg/5 mL (355): $9.12
200-200-20 mg/5 mL (710): $8.80
Suspension (Mylanta Double-Strength)
400-400-40 mg/5 mL (355): $7.99
400-400-40 mg/5 mL (710): $10.15
CANADIAN BRAND NAMES — Diovol Plus®; Gelusil®; Mylanta® Double Strength; Mylanta® Extra Strength; Mylanta® Regular Strength
INTERNATIONAL BRAND NAMES — Diovol Plus (CA); Gelusil (CA); Mylanta Double Strength (CA); Mylanta Extra Strength (CA); Mylanta Regular Strength (CA)
Showing posts with label and simethicon. Show all posts
Showing posts with label and simethicon. Show all posts
Wednesday, June 16, 2010
Aluminum hydroxide, magnesium hydroxide, and simethicon
MEDICATION SAFETY ISSUES
Sound-alike/look-alike issues:
Maalox® may be confused with Maox®, Monodox®
Mylanta® may be confused with Mynatal®
Maalox® is a different formulation than Maalox® Total Stomach Relief®
U.S. BRAND NAMES — Alamag Plus [OTC]; Aldroxicon I [OTC]; Aldroxicon II [OTC]; Almacone Double Strength® [OTC]; Almacone® [OTC]; Gelusil® [OTC]; Maalox® Max [OTC]; Maalox® [OTC]; Mi-Acid Maximum Strength [OTC]; Mi-Acid [OTC]; Mintox Extra Strength [OTC]; Mintox Plus [OTC]; Mylanta® Liquid [OTC]; Mylanta® Maximum Strength Liquid [OTC]
PHARMACOLOGIC CATEGORY
Antacid
Antiflatulent
DOSING: ADULTS — Dyspepsia, abdominal bloating: Oral: 10-20 mL or 2-4 tablets 4-6 times/day between meals and at bedtime; may be used every hour for severe symptoms
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum and/or magnesium may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL); aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Aldroxicon I: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (30 mL)
Aldroxicon II: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (30 mL)
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Almacone Double Strength®: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Maalox®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL, 770 mL) [lemon and mint flavors]
Maalox® Max: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL, 770 mL) [cherry, vanilla creme, and wild berry flavors]
Mi-Acid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Mi-Acid Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Mintox Extra Strength: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL (360 mL) [lemon creme flavor]
Mylanta®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, and mint flavors]
Mylanta® Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, orange creme, and mint flavors]
Suspension (Alamag Plus): Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL (360 mL)
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [cherry flavor]
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg [peppermint flavor]
Gelusil®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [peppermint flavor]
Mintox Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
DOSAGE FORMS: CONCISE
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL; aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Aldroxicon I [OTC], Almacone® [OTC], Maalox® [OTC], Mi-Acid [OTC], Mylanta® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL
Aldroxicon II [OTC], Almacone Double Strength [OTC], Maalox® Max® [OTC], Mi-Acid Maximum Strength [OTC], Mylanta® Maximum Strength [OTC]: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Mintox Extra Strength [OTC]: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL
Suspension:
Alamag Plus [OTC]: Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus [OTC], Gelusil® [OTC], Mintox Plus [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Almacone® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg
GENERIC EQUIVALENT AVAILABLE — Yes
ADMINISTRATION — Administer 1-2 hours apart from oral drugs.
USE — Temporary relief of hyperacidity associated with gas; may also be used for indications associated with other antacids
ADVERSE REACTIONS SIGNIFICANT
>10%: Gastrointestinal: Chalky taste, stomach cramps, constipation, bowel motility decreased, fecal impaction, hemorrhoids
1% to 10%: Gastrointestinal: Nausea, vomiting, discoloration of feces (white speckles)
<1% (Limited to important or life-threatening): Dehydration or fluid restriction, hypomagnesemia, hypophosphatemia
DRUG INTERACTIONS
ACE Inhibitors: Antacids may decrease the serum concentration of ACE Inhibitors. Risk C: Monitor therapy
Allopurinol: Antacids may decrease the absorption of Allopurinol. Risk D: Consider therapy modification
Alpha-/Beta-Agonists: Antacids may decrease the excretion of Alpha-/Beta-Agonists. Exceptions: Dipivefrin. Risk C: Monitor therapy
Amphetamines: Antacids may decrease the excretion of Amphetamines. Risk C: Monitor therapy
Anticonvulsants (Hydantoin): Antacids may decrease the serum concentration of Anticonvulsants (Hydantoin). Risk C: Monitor therapy
Antifungal Agents (Azole Derivatives, Systemic): Antacids may decrease the absorption of Antifungal Agents (Azole Derivatives, Systemic). Exceptions: Fluconazole; Miconazole; Voriconazole. Risk D: Consider therapy modification
Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor therapy
Ascorbic Acid: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Atazanavir: Antacids may decrease the absorption of Atazanavir. Risk D: Consider therapy modification
Bisacodyl: Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Antacids may decrease the absorption of Bisphosphonate Derivatives. Antacids containing aluminum, calcium, or magnesium are of specific concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Magnesium Salts may decrease the absorption of Bisphosphonate Derivatives. Only oral magnesium salts are of concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Calcitriol: May increase the serum concentration of Magnesium Salts. Risk D: Consider therapy modification
Calcium Channel Blockers: May enhance the adverse/toxic effect of Magnesium Salts. Magnesium Salts may enhance the hypotensive effect of Calcium Channel Blockers. Risk C: Monitor therapy
Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy
Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Risk C: Monitor therapy
Citric Acid Derivatives: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Risk D: Consider therapy modification
CycloSPORINE: Antacids may decrease the serum concentration of CycloSPORINE. Specifically when cyclosporine is administered orally. Risk C: Monitor therapy
Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Risk C: Monitor therapy
Dasatinib: Antacids may decrease the absorption of Dasatinib. Risk D: Consider therapy modification
Deferasirox: Aluminum Hydroxide may diminish the therapeutic effect of Deferasirox. Risk D: Consider therapy modification
Delavirdine: Antacids may decrease the absorption of Delavirdine. Risk D: Consider therapy modification
Eltrombopag: Aluminum Hydroxide may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., aluminum-containing products) by at least 4 hours. Risk D: Consider therapy modification
Eltrombopag: Magnesium Salts may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., magnesium-containing products) by at least 4 hours. Risk D: Consider therapy modification
Erlotinib: Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification
Ethambutol: Aluminum Hydroxide may decrease the absorption of Ethambutol. Risk D: Consider therapy modification
Fexofenadine: Antacids may decrease the serum concentration of Fexofenadine. Management: No specific recommendations concerning the time required between their administration are provided. Separate administration of each agent by as much time as possible to decrease the risk of an interaction. Risk D: Consider therapy modification
Iron Salts: Antacids may decrease the absorption of Iron Salts. Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk D: Consider therapy modification
Isoniazid: Antacids may decrease the absorption of Isoniazid. Risk D: Consider therapy modification
Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with sustained-release mesalamine products. Separating antacid and mesalamine administration, and/or using lower antacid doses may be adequate means of avoiding this interaction. Risk D: Consider therapy modification
Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Risk D: Consider therapy modification
Mycophenolate: Antacids may decrease the absorption of Mycophenolate. Risk D: Consider therapy modification
Mycophenolate: Magnesium Salts may decrease the absorption of Mycophenolate. This only applies to oral magnesium salts. Risk D: Consider therapy modification
Neuromuscular-Blocking Agents: Magnesium Salts may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Only of concern in patients with increased serum magnesium concentrations. Risk C: Monitor therapy
Penicillamine: Antacids may decrease the serum concentration of Penicillamine. Risk D: Consider therapy modification
Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Phosphate Supplements: Magnesium Salts may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Protease Inhibitors: Antacids may decrease the absorption of Protease Inhibitors. Exceptions: Darunavir. Risk C: Monitor therapy
QuiNIDine: Antacids may decrease the excretion of QuiNIDine. Risk C: Monitor therapy
QuiNINE: Antacids may decrease the serum concentration of QuiNINE. Risk X: Avoid combination
Quinolone Antibiotics: Antacids may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of quinolones. Risk D: Consider therapy modification
Quinolone Antibiotics: Magnesium Salts may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of both agents. Risk D: Consider therapy modification
Sodium Polystyrene Sulfonate: May enhance the adverse/toxic effect of Antacids. The combined use of these two agents may result in metabolic alkalosis. Risk D: Consider therapy modification
Tetracycline Derivatives: Antacids may decrease the absorption of Tetracycline Derivatives. Risk D: Consider therapy modification
Tetracycline Derivatives: Magnesium Salts may decrease the absorption of Tetracycline Derivatives. Only applicable to oral preparations of each agent. Risk D: Consider therapy modification
Tocainide: Antacids may increase the serum concentration of Tocainide. Risk C: Monitor therapy
Trientine: Antacids may decrease the absorption of Trientine. Risk D: Consider therapy modification
Trientine: May decrease the serum concentration of Magnesium Salts. Magnesium Salts may decrease the serum concentration of Trientine. Risk D: Consider therapy modification
PREGNANCY RISK FACTOR — C (show table)
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals.
PRICING — (data from drugstore.com)
Suspension (Mylanta)
200-200-20 mg/5 mL (355): $7.99
200-200-20 mg/5 mL (355): $9.12
200-200-20 mg/5 mL (710): $8.80
Suspension (Mylanta Double-Strength)
400-400-40 mg/5 mL (355): $7.99
400-400-40 mg/5 mL (710): $10.15
CANADIAN BRAND NAMES — Diovol Plus®; Gelusil®; Mylanta® Double Strength; Mylanta® Extra Strength; Mylanta® Regular Strength
INTERNATIONAL BRAND NAMES — Diovol Plus (CA); Gelusil (CA); Mylanta Double Strength (CA); Mylanta Extra Strength (CA); Mylanta Regular Strength (CA)
Sound-alike/look-alike issues:
Maalox® may be confused with Maox®, Monodox®
Mylanta® may be confused with Mynatal®
Maalox® is a different formulation than Maalox® Total Stomach Relief®
U.S. BRAND NAMES — Alamag Plus [OTC]; Aldroxicon I [OTC]; Aldroxicon II [OTC]; Almacone Double Strength® [OTC]; Almacone® [OTC]; Gelusil® [OTC]; Maalox® Max [OTC]; Maalox® [OTC]; Mi-Acid Maximum Strength [OTC]; Mi-Acid [OTC]; Mintox Extra Strength [OTC]; Mintox Plus [OTC]; Mylanta® Liquid [OTC]; Mylanta® Maximum Strength Liquid [OTC]
PHARMACOLOGIC CATEGORY
Antacid
Antiflatulent
DOSING: ADULTS — Dyspepsia, abdominal bloating: Oral: 10-20 mL or 2-4 tablets 4-6 times/day between meals and at bedtime; may be used every hour for severe symptoms
DOSING: ELDERLY — Refer to adult dosing.
DOSING: RENAL IMPAIRMENT — Aluminum and/or magnesium may accumulate in renal impairment.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL); aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Aldroxicon I: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (30 mL)
Aldroxicon II: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (30 mL)
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Almacone Double Strength®: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Maalox®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL, 770 mL) [lemon and mint flavors]
Maalox® Max: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL, 770 mL) [cherry, vanilla creme, and wild berry flavors]
Mi-Acid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (360 mL)
Mi-Acid Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL)
Mintox Extra Strength: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL (360 mL) [lemon creme flavor]
Mylanta®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, and mint flavors]
Mylanta® Maximum Strength: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (180 mL, 360 mL, 720 mL) [original, cherry, orange creme, and mint flavors]
Suspension (Alamag Plus): Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL (360 mL)
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [cherry flavor]
Almacone®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg [peppermint flavor]
Gelusil®: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg [peppermint flavor]
Mintox Plus: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
DOSAGE FORMS: CONCISE
Liquid: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL; aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Aldroxicon I [OTC], Almacone® [OTC], Maalox® [OTC], Mi-Acid [OTC], Mylanta® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg per 5 mL
Aldroxicon II [OTC], Almacone Double Strength [OTC], Maalox® Max® [OTC], Mi-Acid Maximum Strength [OTC], Mylanta® Maximum Strength [OTC]: Aluminum hydroxide 400 mg, magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL
Mintox Extra Strength [OTC]: Aluminum hydroxide 500 mg, magnesium hydroxide 450 mg, and simethicone 40 mg per 5 mL
Suspension:
Alamag Plus [OTC]: Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and simethicone 25 mg per 5 mL
Tablet, chewable: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Alamag Plus [OTC], Gelusil® [OTC], Mintox Plus [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 25 mg
Almacone® [OTC]: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and simethicone 20 mg
GENERIC EQUIVALENT AVAILABLE — Yes
ADMINISTRATION — Administer 1-2 hours apart from oral drugs.
USE — Temporary relief of hyperacidity associated with gas; may also be used for indications associated with other antacids
ADVERSE REACTIONS SIGNIFICANT
>10%: Gastrointestinal: Chalky taste, stomach cramps, constipation, bowel motility decreased, fecal impaction, hemorrhoids
1% to 10%: Gastrointestinal: Nausea, vomiting, discoloration of feces (white speckles)
<1% (Limited to important or life-threatening): Dehydration or fluid restriction, hypomagnesemia, hypophosphatemia
DRUG INTERACTIONS
ACE Inhibitors: Antacids may decrease the serum concentration of ACE Inhibitors. Risk C: Monitor therapy
Allopurinol: Antacids may decrease the absorption of Allopurinol. Risk D: Consider therapy modification
Alpha-/Beta-Agonists: Antacids may decrease the excretion of Alpha-/Beta-Agonists. Exceptions: Dipivefrin. Risk C: Monitor therapy
Amphetamines: Antacids may decrease the excretion of Amphetamines. Risk C: Monitor therapy
Anticonvulsants (Hydantoin): Antacids may decrease the serum concentration of Anticonvulsants (Hydantoin). Risk C: Monitor therapy
Antifungal Agents (Azole Derivatives, Systemic): Antacids may decrease the absorption of Antifungal Agents (Azole Derivatives, Systemic). Exceptions: Fluconazole; Miconazole; Voriconazole. Risk D: Consider therapy modification
Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor therapy
Ascorbic Acid: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Atazanavir: Antacids may decrease the absorption of Atazanavir. Risk D: Consider therapy modification
Bisacodyl: Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Antacids may decrease the absorption of Bisphosphonate Derivatives. Antacids containing aluminum, calcium, or magnesium are of specific concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Magnesium Salts may decrease the absorption of Bisphosphonate Derivatives. Only oral magnesium salts are of concern. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Calcitriol: May increase the serum concentration of Magnesium Salts. Risk D: Consider therapy modification
Calcium Channel Blockers: May enhance the adverse/toxic effect of Magnesium Salts. Magnesium Salts may enhance the hypotensive effect of Calcium Channel Blockers. Risk C: Monitor therapy
Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy
Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Risk C: Monitor therapy
Citric Acid Derivatives: May increase the absorption of Aluminum Hydroxide. Risk D: Consider therapy modification
Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Risk D: Consider therapy modification
CycloSPORINE: Antacids may decrease the serum concentration of CycloSPORINE. Specifically when cyclosporine is administered orally. Risk C: Monitor therapy
Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Risk C: Monitor therapy
Dasatinib: Antacids may decrease the absorption of Dasatinib. Risk D: Consider therapy modification
Deferasirox: Aluminum Hydroxide may diminish the therapeutic effect of Deferasirox. Risk D: Consider therapy modification
Delavirdine: Antacids may decrease the absorption of Delavirdine. Risk D: Consider therapy modification
Eltrombopag: Aluminum Hydroxide may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., aluminum-containing products) by at least 4 hours. Risk D: Consider therapy modification
Eltrombopag: Magnesium Salts may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., magnesium-containing products) by at least 4 hours. Risk D: Consider therapy modification
Erlotinib: Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification
Ethambutol: Aluminum Hydroxide may decrease the absorption of Ethambutol. Risk D: Consider therapy modification
Fexofenadine: Antacids may decrease the serum concentration of Fexofenadine. Management: No specific recommendations concerning the time required between their administration are provided. Separate administration of each agent by as much time as possible to decrease the risk of an interaction. Risk D: Consider therapy modification
Iron Salts: Antacids may decrease the absorption of Iron Salts. Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk D: Consider therapy modification
Isoniazid: Antacids may decrease the absorption of Isoniazid. Risk D: Consider therapy modification
Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with sustained-release mesalamine products. Separating antacid and mesalamine administration, and/or using lower antacid doses may be adequate means of avoiding this interaction. Risk D: Consider therapy modification
Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Risk D: Consider therapy modification
Mycophenolate: Antacids may decrease the absorption of Mycophenolate. Risk D: Consider therapy modification
Mycophenolate: Magnesium Salts may decrease the absorption of Mycophenolate. This only applies to oral magnesium salts. Risk D: Consider therapy modification
Neuromuscular-Blocking Agents: Magnesium Salts may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Only of concern in patients with increased serum magnesium concentrations. Risk C: Monitor therapy
Penicillamine: Antacids may decrease the serum concentration of Penicillamine. Risk D: Consider therapy modification
Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Phosphate Supplements: Magnesium Salts may decrease the absorption of Phosphate Supplements. Risk D: Consider therapy modification
Protease Inhibitors: Antacids may decrease the absorption of Protease Inhibitors. Exceptions: Darunavir. Risk C: Monitor therapy
QuiNIDine: Antacids may decrease the excretion of QuiNIDine. Risk C: Monitor therapy
QuiNINE: Antacids may decrease the serum concentration of QuiNINE. Risk X: Avoid combination
Quinolone Antibiotics: Antacids may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of quinolones. Risk D: Consider therapy modification
Quinolone Antibiotics: Magnesium Salts may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of both agents. Risk D: Consider therapy modification
Sodium Polystyrene Sulfonate: May enhance the adverse/toxic effect of Antacids. The combined use of these two agents may result in metabolic alkalosis. Risk D: Consider therapy modification
Tetracycline Derivatives: Antacids may decrease the absorption of Tetracycline Derivatives. Risk D: Consider therapy modification
Tetracycline Derivatives: Magnesium Salts may decrease the absorption of Tetracycline Derivatives. Only applicable to oral preparations of each agent. Risk D: Consider therapy modification
Tocainide: Antacids may increase the serum concentration of Tocainide. Risk C: Monitor therapy
Trientine: Antacids may decrease the absorption of Trientine. Risk D: Consider therapy modification
Trientine: May decrease the serum concentration of Magnesium Salts. Magnesium Salts may decrease the serum concentration of Trientine. Risk D: Consider therapy modification
PREGNANCY RISK FACTOR — C (show table)
DIETARY CONSIDERATIONS — Should be taken 1-3 hours after meals.
PRICING — (data from drugstore.com)
Suspension (Mylanta)
200-200-20 mg/5 mL (355): $7.99
200-200-20 mg/5 mL (355): $9.12
200-200-20 mg/5 mL (710): $8.80
Suspension (Mylanta Double-Strength)
400-400-40 mg/5 mL (355): $7.99
400-400-40 mg/5 mL (710): $10.15
CANADIAN BRAND NAMES — Diovol Plus®; Gelusil®; Mylanta® Double Strength; Mylanta® Extra Strength; Mylanta® Regular Strength
INTERNATIONAL BRAND NAMES — Diovol Plus (CA); Gelusil (CA); Mylanta Double Strength (CA); Mylanta Extra Strength (CA); Mylanta Regular Strength (CA)
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