aluminum hydroxide/magnesium hydroxide

Action and Spectrum

Actions and Spectrum: 

• aluminum hydroxide: It acts as an antacid by neutralizing excess stomach acid. It reacts with hydrochloric acid in the stomach to form water and aluminum chloride, reducing the acidity of gastric contents. 
• magnesium hydroxide: It also works as an antacid by neutralizing stomach acid. magnesium hydroxide reacts with hydrochloric acid to form water and magnesium chloride, thus raising the pH of gastric contents. 

Spectrum of activity: 

• Acid-neutralizing effect: Both aluminum hydroxide and magnesium hydroxide have a similar spectrum of activity, primarily targeting excessive gastric acidity. They can relieve symptoms associated with heartburn, acid indigestion, and upset stomach by reducing the acidity of gastric contents. 

Drug Interaction

Adverse Reaction

Frequency defined 

>10% 

Aluminum oxide 

Constipation 

Stomach cramps 

Chalky taste 

Fecal impaction  

Frequency Not Defined 

Aluminum oxide 

Vomiting 

Osteomalacia 

Nausea 

Aluminum intoxication 

Hypophosphatemia 

Magnesium oxide 

Hypermagnesemia 

Diarrhea 

Black Box Warning

Black box warning: 

None 

Contraindication / Caution

Contraindications/caution: 

Contraindications: 

Hyoersensitivity 

Caution: 

• Renal impairment: Both aluminum hydroxide and magnesium hydroxide can be absorbed and may accumulate in individuals with impaired renal function.  
• Electrolyte imbalance: aluminum hydroxide and magnesium hydroxide can affect electrolyte levels, particularly magnesium.  
• Drug interactions: aluminum hydroxide and magnesium hydroxide can interact with certain medications. They may reduce the absorption and effectiveness of other drugs if taken simultaneously.  
• Gastrointestinal disorders: Use caution in individuals with gastrointestinal disorders such as constipation or bowel obstruction, as aluminum and magnesium can contribute to these conditions. Adequate fluid intake and dietary fiber should be ensured to prevent constipation. 

Pregnancy / Lactation

Pregnancy consideration: C 

Lactation: Excretion of the drug in human breast milk is unknown 

Pregnancy category: 

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 

Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

When used together in antacid formulations, the pharmacology of aluminum hydroxide and magnesium hydroxide primarily relates to their actions as acid-neutralizing agents. 

• Acid-neutralizing effect: aluminum hydroxide and magnesium hydroxide work as antacids by neutralizing excess stomach acid. aluminum hydroxide reacts with hydrochloric acid in the stomach to form water and aluminum chloride, while magnesium hydroxide reacts with hydrochloric acid to form water and magnesium chloride. This neutralization process helps raise the pH level in the stomach, reducing gastric acidity and relieving symptoms of heartburn, acid indigestion, and upset stomach. 
• Magnesium supplementation: In addition to their antacid properties, magnesium hydroxide provides a supplemental source of magnesium. magnesium is an essential mineral in various physiological processes, including nerve function, muscle contraction, and maintenance of normal heart rhythm.  

Pharmacokinetics: 

Absorption 

aluminum hydroxide is poorly absorbed from the gastrointestinal tract. Only a tiny amount of aluminum may be absorbed systemically. magnesium hydroxide is also poorly absorbed from the gastrointestinal tract. It has limited systemic absorption.  

Distribution 

Any absorbed aluminum can distribute to various tissues in the body, including bone, brain, and other organs. However, the extent of systemic distribution is generally limited due to the poor absorption of aluminum hydroxide. magnesium, when absorbed as magnesium ions, is distributed throughout the body and is involved in various physiological processes. 

Metabolism 

aluminum hydroxide is not significantly metabolized in the body. It remains in its original form as aluminum hydroxide until it is excreted. magnesium hydroxide does not undergo significant metabolism and is excreted as unchanged magnesium ions. 

Elimination and Excretion 

Most of the absorbed aluminum is excreted via the kidneys. Individuals with normal kidney function can efficiently eliminate aluminum. When absorbed as magnesium ions, magnesium is primarily excreted through the kidneys. It can also be excreted in feces. 

Adminstartion

Administration: 

aluminum hydroxide and magnesium hydroxide are typically taken by mouth with water or as directed. They are available in various forms, such as tablets, chewable tablets, suspensions, or powders. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: aluminum hydroxide/magnesium hydroxide 

Why do we use aluminum hydroxide/magnesium hydroxide? 

aluminum hydroxide and magnesium hydroxide, when used in combination as antacids, are primarily indicated for the following uses: 

• Relief of Heartburn and Acid Indigestion: aluminum hydroxide and magnesium hydroxide work together to neutralize excess stomach acid, relieving symptoms such as heartburn, acid indigestion, and upset stomach. They help alleviate the discomfort caused by stomach acid reflux into the esophagus. 
• Gastroesophageal Reflux Disease (GERD): GERD is a chronic condition characterized by the recurrent reflux of stomach acid into the esophagus. aluminum hydroxide and magnesium hydroxide can be used as part of the management plan for GERD, along with lifestyle modifications and other medications, to reduce gastric acidity and alleviate associated symptoms. 
• Peptic Ulcer Disease: Peptic ulcers are open sores that develop in the stomach lining or the small intestine’s upper part. aluminum hydroxide and magnesium hydroxide can help neutralize stomach acid, promote healing of the ulcers, and relieve symptoms associated with peptic ulcer disease when combined with other medications, such as antibiotics and proton pump inhibitors. 
• Hyperphosphatemia: aluminum hydroxide can also be used to manage high levels of phosphate in the blood, known as hyperphosphatemia.