Note: Chronic antacid therapy not recommended for management of gastroesophageal reflux disease (GERD) in pediatric patients (Ref). Approved ages and uses for products may vary; consult product labeling for specific information.
Heartburn/Indigestion:
Oral suspension:
Regular strength (aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL): Children ≥12 years and Adolescents: Oral: 15 to 30 mL 4 times daily after meals and at bedtime as needed; maximum daily dose: 120 mL per 24 hours.
Extra strength (aluminum hydroxide 254 mg and magnesium carbonate 237.5 mg per 5 mL): Children ≥12 years and Adolescents: Oral: 10 to 20 mL 4 times daily after meals and at bedtime as needed; maximum daily dose: 80 mL per 24 hours.
Tablet, chewable (aluminum hydroxide 160 mg and magnesium carbonate 105 mg per tablet): Children ≥12 years and Adolescents: Oral: 2 to 4 tablets 4 times daily after meals and at bedtime as needed; maximum daily dose: 16 tablets per 24 hours.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling; aluminum and/or magnesium may accumulate in renal impairment; avoid use due to risk of aluminum toxicity (Ref).
There are no dosage adjustments provided in the manufacturer's labeling.
(For additional information see "Aluminum hydroxide and magnesium carbonate: Drug information")
Antacid: Oral:
Chewable tablet: Aluminum hydroxide 160 mg and magnesium carbonate 105 mg per tablet: Chew 2 to 4 tablets 4 times daily; maximum: 16 tablets per 24 hours.
Liquid:
Regular strength (aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL): 15 to 30 mL 4 times daily; maximum: 120 mL per 24 hours.
Extra strength (aluminum hydroxide 254 mg and magnesium carbonate 237.5 mg per 5 mL): 10 to 20 mL 4 times daily; maximum: 80 mL per 24 hours.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer’s labeling; aluminum and/or magnesium may accumulate in renal impairment.
There are no dosage adjustments provided in the manufacturer’s labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%:
Endocrine & metabolic: Hypermagnesemia, hypophosphatemia
Gastrointestinal: Constipation, diarrhea
Neuromuscular & skeletal: Osteomalacia
Miscellaneous: Aluminum toxicity (prolonged use and concomitant renal failure)
Concerns related to adverse effects:
• Laxative effect: May occur.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP 1997; CDC 1982); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer’s labeling.
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 or if they have renal impairment. Do not take the maximum dose for >14 days.
Absorption of aluminum has been reported in infants receiving both short-term and long-term antacid therapy (Tsou 1991; Woodard-Knight 1992); use of aluminum antacids is not recommended in infants or in pediatric patients with kidney impairment (NASPGHAN/ESPGHAN [Rosen 2018]).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Suspension, Oral:
Acid Gone: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL (355 mL) [contains edetate (edta) disodium, fd&c blue #1 (brilliant blue), quinoline yellow (d&c yellow #10), saccharin sodium; spearmint flavor]
Gavis-Care: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL (355 mL [DSC]) [contains benzyl alcohol, edetate (edta) disodium, fd&c blue #1 (brilliant blue), quinoline yellow (d&c yellow #10), saccharin sodium]
Gaviscon: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL (177 mL, 355 mL) [contains benzyl alcohol, edetate (edta) disodium, fd&c blue #1 (brilliant blue), quinoline yellow (d&c yellow #10), saccharin sodium; cool mint flavor]
Gaviscon Extra Relief Formula: Aluminum hydroxide 254 mg and magnesium carbonate 237.5 mg per 5 mL (355 mL) [cool mint flavor]
Gaviscon Extra Strength: Aluminum hydroxide 254 mg and magnesium carbonate 237.5 mg per 5 mL (355 mL) [contains edetate (edta) disodium, saccharin sodium; cherry flavor]
Tablet Chewable, Oral:
Acid Gone: Aluminum hydroxide 160 mg and magnesium carbonate 105 mg
Gaviscon Extra Strength: Aluminum hydroxide 160 mg and magnesium carbonate 105 mg
Gaviscon Extra Strength: Aluminum hydroxide 160 mg and magnesium carbonate 105 mg [cherry flavor]
May be product dependent
Chewable (Acid Gone Oral)
160-105 mg (per each): $0.05
Chewable (Gaviscon Extra Strength Oral)
160-105 mg (per each): $0.09
Suspension (Acid Gone Oral)
95-358 mg/15 mL (per mL): $0.01
Suspension (Gaviscon Extra Relief Formula Oral)
508-475 mg/10 mL (per mL): $0.03
Suspension (Gaviscon Extra Strength Oral)
254-237.5 mg/5 mL (per mL): $0.03
Suspension (Gaviscon Oral)
95-358 mg/15 mL (per mL): $0.02
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral: Administer after meals and at bedtime (4 times daily).
Chewable tablets: Chew thoroughly, then follow with at least 1/2 glass of water or other liquid; do not swallow tablets whole.
Oral suspension: Shake suspension well before use. Administer with an accurate measuring device; do not use a household teaspoon (overdosage may occur).
Administer after meals and at bedtime (4 times daily) with water or other liquid. Shake liquid well before use. Do not swallow chewable tablets whole.
Store up to 25°C (77°F). Avoid freezing.
Temporary relief of heartburn, acid indigestion, or sour stomach, and GI upset associated with these symptoms (OTC FDA approved in ages ≥12 years and adults). Note: Approved ages and uses for products may vary; consult product labeling for specific information.
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs (pediatric liquid medications requiring measurement) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Community/Ambulatory Care Settings).
Remegel [Netherlands] may be confused with Renagel brand name for sevelamer [U.S., Canada, and multiple international markets]
Remegel: Brand name for aluminum hydroxide and magnesium carbonate [Netherlands], but also the brand name for calcium carbonate [Great Britain, Hungary, and Ireland]
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Acalabrutinib: Antacids may decrease the serum concentration of Acalabrutinib. Management: Separate administration of acalabrutinib capsules from the administration of any antacid by at least 2 hours in order to minimize the potential for a significant interaction. Acalabrutinib tablets are not expected to interact with antacids. Risk D: Consider therapy modification
Alfacalcidol: May increase the serum concentration of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving alfacalcidol. If magnesium-containing products must be used with alfacalcidol, serum magnesium concentrations should be monitored closely. 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
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 to 2 hours 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
Belumosudil: Antacids may decrease the serum concentration of Belumosudil. Management: Consider separating administration of belumosudil and antacids by 2 hours and monitor for reduced belumosudil efficacy. Risk D: Consider therapy modification
Bictegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Bictegravir. Management: Administer bictegravir 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. 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
Cabotegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Cabotegravir. Management: Administer polyvalent cation containing products at least 2 hours before or 4 hours after oral cabotegravir. Risk D: Consider therapy modification
Calcitriol (Systemic): May increase the serum concentration of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving calcitriol. If magnesium-containing products must be used with calcitriol, serum magnesium concentrations should be monitored closely. Risk D: Consider therapy modification
Calcium Polystyrene Sulfonate: May enhance the adverse/toxic effect of Aluminum Hydroxide. More specifically, concomitant use of these agents may increase the risk for intestinal obstruction. Management: Monitor for signs/symptoms of intestinal obstruction with concomitant use of calcium polystyrene sulfonate and aluminum hydroxide. Adequate fluid intake, laxative use, alternative antacid agents, and/or limiting duration of therapy may help reduce risks. Risk D: Consider therapy modification
Captopril: Antacids may decrease the serum concentration of Captopril. Risk C: Monitor therapy
Cefdinir: Antacids may decrease the absorption of Cefdinir. Management: Administer cefdinir 2 hours before or 2 hours after aluminum- or magnesium-containing antacids. Risk D: Consider therapy modification
Cefditoren: Antacids may decrease the serum concentration of Cefditoren. Risk X: Avoid combination
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. Taking cefuroxime with food may lessen the magnitude of this interaction. Risk D: Consider therapy modification
Chenodiol: Aluminum Hydroxide may decrease the serum concentration of Chenodiol. Risk C: Monitor therapy
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
Diacerein: Antacids may decrease the absorption of Diacerein. 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
Doxercalciferol: May enhance the hypermagnesemic effect of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving doxercalciferol. If magnesium-containing products must be used with doxercalciferol, serum magnesium concentrations should be monitored closely. 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 and sublingual oral hyoscyamine before meals, and antacids after meals, when these agents are given in combination. Risk D: Consider therapy modification
Infigratinib: Antacids may decrease serum concentrations of the active metabolite(s) of Infigratinib. Antacids may decrease the serum concentration of Infigratinib. Management: Avoid coadministration of infigratinib with antacids or other gastric acid-lowering agents. If antacids cannot be avoided, administer infigratinib 2 hours before or after administration of antacids. Risk D: Consider therapy modification
Iron Preparations: Antacids may decrease the absorption of Iron Preparations. Management: No action is likely necessary for the majority of patients who only use antacids intermittently or occasionally. Consider separating doses of oral iron and antacids in patients who require chronic use of both agents and monitor for reduced iron efficacy. Risk D: Consider therapy modification
Isoniazid: Antacids may decrease the absorption of Isoniazid. Risk C: Monitor therapy
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 antacids at least 1 hour prior to, or 2 hours after, ketoconazole. Additionally, administer ketoconazole with an acidic beverage (eg, non-diet cola) and 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. Management: Administer antacid products at least 2 hours before or after 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
Levoketoconazole: Antacids may decrease the absorption of Levoketoconazole. Management: Advise patients to take antacids at least 2 hours after taking levoketoconazole. Risk D: Consider therapy modification
Levonadifloxacin: Magnesium Salts may decrease the serum concentration of Levonadifloxacin. Risk X: Avoid combination
Levonadifloxacin: Antacids may decrease the serum concentration of Levonadifloxacin. Risk X: Avoid combination
Levothyroxine: Magnesium Salts may decrease the serum concentration of Levothyroxine. Management: Separate administration of oral levothyroxine and oral magnesium salts 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 the Apriso brand of mesalamine extended-release capsules. The optimal duration of dose separation is unknown. Other mesalamine products do not contain this interaction warning. Risk D: Consider therapy modification
Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Management: Consider avoiding the concomitant use of medications that alkalinize the urine, such as antacids, and methenamine. Monitor for decreased therapeutic effects of methenamine if used concomitant with antacids. Risk D: Consider therapy modification
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
Moxifloxacin (Systemic): Aluminum Hydroxide may decrease the absorption of Moxifloxacin (Systemic). Management: Administer moxifloxacin at least 4 hours before or 8 hours after aluminum hydroxide. Risk D: Consider therapy modification
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). If combined, monitor for toxic effects of aluminum. 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). If coadministered, monitor for toxic effects of aluminum. Risk D: Consider therapy modification
Mycophenolate: Aluminum Hydroxide may decrease the serum concentration of Mycophenolate. Management: Simultaneous administration of aluminum hydroxide antacids with the Myfortic brand of mycophenolic acid is not recommended. Administrater aluminum hydroxide at least 2 hours after a dose of the Cellcept brand of mycophenolate mofetil. 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
Nirogacestat: Antacids may decrease the serum concentration of Nirogacestat. Management: If acid-reducing therapy is required, separate nirogacestat administration from antacids by 2 hours. Risk D: Consider therapy modification
Octreotide: Antacids may decrease the serum concentration of Octreotide. Risk C: Monitor therapy
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 at least 2 hours before or 2 hours 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 administration of oral phosphate supplements from antacid administration by as long as possible may minimize the interaction. 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. 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
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; see full monograph for details. 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/enox-, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome/pe/enox-, 3 h for gemi-, and 2 h for levo-, nor-, or ofloxacin or nalidixic acid) oral magnesium salts. 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 oral 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. Monitor clinical response to riociguat more closely in patients using this combination. Risk D: Consider therapy modification
Rosuvastatin: Antacids may decrease the serum concentration of Rosuvastatin. Risk C: Monitor therapy
Roxadustat: Polyvalent Cation Containing Products may decrease the serum concentration of Roxadustat. Management: Administer roxadustat at least 1 hour after the administration of oral polyvalent cation containing products. Risk D: Consider therapy modification
Selpercatinib: Antacids may decrease the serum concentration of Selpercatinib. Management: Coadministration of selpercatinib and antacids should be avoided. If coadministration cannot be avoided, selpercatinib should be administered 2 hours before or 2 hours after antacids. Risk D: Consider therapy modification
Sodium Polystyrene Sulfonate: Antacids may enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. Specifically, the risk of metabolic alkalosis may be increased. Antacids may diminish the therapeutic effect of Sodium Polystyrene Sulfonate. Risk C: Monitor therapy
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
Sotorasib: Antacids may decrease the serum concentration of Sotorasib. Management: Avoid coadministration of sotorasib and antacids. If use of a gastric acid suppressing medication cannot be avoided, administer sotorasib 4 hours before or 10 hours after oral antacid administration. Risk D: Consider therapy modification
Sparsentan: Antacids may decrease the serum concentration of Sparsentan. Management: Administer sparsentan 2 hours before or 2 hours after antacids. 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 when possible, in order to minimize this interaction. Risk D: Consider therapy modification
Sucralfate: Antacids may diminish the therapeutic effect of Sucralfate. Management: Consider separating the administration of antacids and sucralfate by at least 30 minutes. 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
Tacrolimus (Systemic): Aluminum Hydroxide may decrease the serum concentration of Tacrolimus (Systemic). Particularly, maximum concentration may decrease. Aluminum Hydroxide may increase the serum concentration of Tacrolimus (Systemic). Risk C: Monitor therapy
Taurursodiol: Aluminum Hydroxide may decrease the absorption of Taurursodiol. Risk X: Avoid combination
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. Monitor for decreased therapeutic effects of tetracyclines. 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. Risk D: Consider therapy modification
Thyroid Products: Antacids may decrease the absorption of Thyroid Products. Risk C: Monitor therapy
Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant use of trientine and polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. For other oral polyvalent cations, give trientine 1 hour before, or 1 to 2 hours after the polyvalent cation. Risk D: Consider therapy modification
Unithiol: May diminish the therapeutic effect of Polyvalent Cation Containing Products. Risk X: Avoid combination
Ursodiol: Aluminum Hydroxide may decrease the serum concentration of Ursodiol. Management: Separate administration of ursodiol and 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. Management: Consider avoiding chronic use of aluminum and aluminum-containing products in patients who are also taking active vitamin D analogs. If coadministered, monitor aluminum status and for signs and symptoms of aluminum-related toxicities. Risk D: Consider therapy modification
Should be taken after meals with water or other liquid. Some products may contain sodium.
Refer to individual monographs.
GI complaints, stool frequency.
Aluminum hydroxide neutralizes hydrochloride in the stomach to form Al (Cl)3 salt + H2O, resulting in increased gastric pH and inhibition of pepsin activity (Weberg, 1998). Magnesium salts have a similar mechanism. Alginic acid is a natural polysaccharide polymer that precipitates into a low-density viscous gel of near-neutral pH within minutes of contacting gastric acid. The change in pH triggers the sodium bicarbonate in the formulation to release carbon dioxide, which becomes trapped in the alginate gel, causing it to float to the top of the gastric contents. (Rohof 2013).
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