calcium carbonate/magnesium hydroxide (OTC)

Brand and Other Names:Rolaids Extra Strength, Rolaids Regular Strength, more...Rolaids Regular Strength Liquid, Rolaids Ultra Strength, Rolaids Ultra Strength Liquid, Mylanta Supreme
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Dosing & Uses

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Dosage Forms & Strengths

calcium carbonate/magnesium hydroxide

chewable tablet

  • 550mg/110mg (Rolaids Regular Strength)
  • 675mg/135mg (Rolaids Extra Strength)
  • 1000mg/200mg (Rolaids Ultra Strength)

oral suspension

  • (400mg/135mg)/5mL (Mylanta Supreme)
  • (550mg/110mg)/5mL (Rolaids Regular Strength Liquid)
  • (1000mg/200mg)/5mL (Rolaids Ultra Strength Liquid)
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Heartburn & Indigestion

Antacid: Typical dose 800-3,000 mg of calcium carbonate PO prn for symptoms

Tablet: Chew 2-4 tabs PO prn

Suspension: 10-20 mL PO prn

Tablet and suspension strength varies; not to exceed ~7 g of calcium carbonate/day

Dosing Considerations

Calcium carbonate (elemental calcium equivalent)

  • 400 mg (160 mg)
  • 550 mg (220 mg)
  • 675 mg (270 mg)
  • 1000 mg (400 mg)

Magnesium hydroxide (elemental magnesium equivalent)

  • 110 mg (45 mg)
  • 135 mg (55 mg)
  • 200 mg (85 mg)

Administration

Avoid taking drugs whose absorption is affected by antacids within 1 hr of administration

Suspension: Shake well before using, protect from freezing

Tablets: Chew thoroughly

Safety and efficacy not established

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Interactions

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and calcium carbonate/magnesium hydroxide

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            Adverse Effects

            Frequency Not Defined

            Calcium carbonate

            • Anorexia
            • Constipation
            • Flatulence
            • Nausea
            • Vomiting
            • Hypercalcemia
            • Hypophosphatemia
            • Xerostomia
            • Acid rebound
            • Milk-alkali syndrome

            Magnesium hydroxide

            • Nausea
            • Constipation
            • Vomiting
            • Hypotension
            • Respiratory depression
            • Diarrhea
            • Abdominal crampin
            • Electrolyte imbalance
            • Muscle weakness
            • Parageusia
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            Warnings

            Contraindications

            Calcium carbonate

            • Hypersensitivity
            • Hypercalciuria
            • Renal calculi
            • Hypophosphatemia
            • Hypercalcemia
            • Suspected digoxin toxicity

            Magnesium hydroxide

            • Hypersensitivity
            • Renal failure
            • Existing electrolyte imbalance
            • Appendicitis symptoms
            • Acute surgical abdomen
            • Myocardial damage
            • Heart block
            • Fecal impaction
            • Rectal fissures
            • Intestinal obstruction or perforation

            Cautions

            OTC use: Do not use the maximum dosage for >2 weeks; if symptoms persist, discontinue and contact a health care provider

            Magnesium hydroxide: Caution with neuromuscular disease (eg, myasthenia gravis) and renal insufficiency

            Calcium carbonate: Caution with a history of kidney stones; Ca oxalate formation may increase risk

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            Pregnancy & Lactation

            Pregnancy Category: C (calcium carbonate); B (magnesium hydroxide)

            Calcium and magnesium both cross the placenta; antacids containing calcium or magnesium are considered to be low risk during pregnancy, however avoid excessive use

            Supplement calcium and magnesium during pregnancy and lactation according to recommended daily allowance

            Lactation: Calcium and magnesium both appear in breast milk, use in nursing mothers appears to be safe

            Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Antacid: Neutralizes gastric secretions resulting in increased gastric pH

            Absorption

            Onset of antacid action dependent on gastric emptying time

            Bioavailability: 25-35% (calcium carbonate); 15-30% (magnesium hydroxide)

            Distribution

            Protein bound: 45% (calcium carbonate)

            Elimination

            Excretion

            • Calcium carbonate: 80% as unabsorbed calcium in feces, 20% via urine
            • Magnesium hydroxide: Primarily via urine
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            Images

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