aluminum hydroxide/magnesium hydroxide/simethicone (OTC)

Brand and Other Names:Mylanta, Mygel, more...DiGel, Gelusil, Rulox
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aluminum hydroxide/magnesium hydroxide/simethicone

liquid

  • (200mg/200mg/20mg)/5mL
  • (400mg/400mg/40mg)/5mL

suspension

  • (225mg/200mg/25mg)/5mL

tablet, chewable

  • 200mg/200mg/25mg (Gelusil)

Dyspepsia, Abdominal Bloating

10-20 mL PO q4-6hr taken 1 hour before or 3 hours after meals, OR

Chew 2-4 tablets q4-6hr; not to exceed 12 tablets/24 hr

Safety & efficacy not established

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Interactions

Interaction Checker

and aluminum hydroxide/magnesium hydroxide/simethicone

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            Contraindicated (2)

            • pazopanib

              aluminum hydroxide will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Contraindicated. Avoid coadministration of pazopanib with drugs that raise gastric pH; may use short-acting antacids in place of PPIs and H2 antagonists, but separate antacid and pazopanib dosing by several hours

            • raltegravir

              aluminum hydroxide decreases levels of raltegravir by cation binding in GI tract. Contraindicated. Not recommended with or without dose separation.

            Serious - Use Alternative (14)

            • atazanavir

              aluminum hydroxide will decrease the level or effect of atazanavir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Atazanavir solubility decreases as pH increases. Reduced plasma concentrations of atazanavir are expected if antacids or buffered medications are coadministered. Administer atazanavir 2 hr before or 1 hr after these medications.

            • baloxavir marboxil

              aluminum hydroxide will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. Avoid or Use Alternate Drug. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Human studies not conducted.

              magnesium hydroxide will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. Avoid or Use Alternate Drug. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Human studies not conducted.

            • ciprofloxacin

              aluminum hydroxide decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • demeclocycline

              magnesium hydroxide decreases levels of demeclocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • dapsone

              aluminum hydroxide will decrease the level or effect of dapsone by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • dasatinib

              aluminum hydroxide will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • demeclocycline

              aluminum hydroxide decreases levels of demeclocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • digoxin

              aluminum hydroxide will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • doxycycline

              magnesium hydroxide decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              aluminum hydroxide decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • eltrombopag

              magnesium hydroxide decreases levels of eltrombopag by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Separate by at least 4 hours.

              aluminum hydroxide decreases levels of eltrombopag by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Separate by at least 4 hours.

            • fleroxacin

              aluminum hydroxide decreases levels of fleroxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • infigratinib

              simethicone will decrease the level or effect of infigratinib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer infigratinib 2 hr before and after administration of a locally-acting antacid.

              magnesium hydroxide will decrease the level or effect of infigratinib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer infigratinib 2 hr before and after administration of a locally-acting antacid.

            • gemifloxacin

              aluminum hydroxide decreases levels of gemifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • sotorasib

              simethicone will decrease the level or effect of sotorasib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer sotorasib 4 hr before or 10 hr after administration of a locally-acting antacid.

            Monitor Closely (131)

            • acalabrutinib

              aluminum hydroxide decreases levels of acalabrutinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Acalabrutinib solubility decreases with increasing gastric pH. Separate dosing by at least 2 hr between administration of antacids and acalabrutinib.

            • acebutolol

              aluminum hydroxide decreases levels of acebutolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • alendronate

              aluminum hydroxide decreases levels of alendronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • allopurinol

              aluminum hydroxide decreases levels of allopurinol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • atenolol

              aluminum hydroxide decreases levels of atenolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • azithromycin

              aluminum hydroxide decreases levels of azithromycin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • bearberry

              aluminum hydroxide will increase the level or effect of bearberry by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • benazepril

              aluminum hydroxide decreases effects of benazepril by unspecified interaction mechanism. Use Caution/Monitor. May decrease absorption.

            • benzphetamine

              aluminum hydroxide will increase the level or effect of benzphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • betaxolol

              aluminum hydroxide decreases levels of betaxolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • bictegravir

              aluminum hydroxide will decrease the level or effect of bictegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Bictegravir can be taken under fasting conditions 2 hr before antacids containing Al, Mg, or Ca. Routine administration of bictegravir simultaneously with, or 2 hr after, antacids containing Al, Mg, or Ca is not recommended.

              magnesium hydroxide will decrease the level or effect of bictegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Bictegravir can be taken under fasting conditions 2 hr before antacids containing Al, Mg, or Ca. Routine administration of bictegravir simultaneously with, or 2 hr after, antacids containing Al, Mg, or Ca is not recommended.

            • bisoprolol

              aluminum hydroxide decreases levels of bisoprolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • cabotegravir

              magnesium hydroxide will decrease the level or effect of cabotegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Administer antacid products at least 2 hr before or 4 hr after taking oral cabotegravir.

            • bosutinib

              aluminum hydroxide decreases levels of bosutinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Bosutinib displays pH-dependent solubility; may use short-acting antacids with administration separated by 2 hr.

            • budesonide

              aluminum hydroxide decreases effects of budesonide by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Enteric-coated budesonide dissolves at pH >5.5. Also, dissolution of extended-release budesonide tablets is pH dependent. Coadministration with drugs that increase gastric pH may cause these budesonide products to prematurely dissolve, and possibly affect release properties and absorption of the drug in the duodenum.

            • cabotegravir

              aluminum hydroxide will decrease the level or effect of cabotegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Administer antacid products at least 2 hr before or 4 hr after taking oral cabotegravir.

            • capecitabine

              aluminum hydroxide increases levels of capecitabine by enhancing GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • captopril

              aluminum hydroxide decreases effects of captopril by unspecified interaction mechanism. Use Caution/Monitor. Aluminum hydroxide may decrease absorption of captopril.

            • carbonyl iron

              aluminum hydroxide will decrease the level or effect of carbonyl iron by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • carvedilol

              aluminum hydroxide decreases levels of carvedilol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • cefdinir

              aluminum hydroxide will decrease the level or effect of cefdinir by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • cefditoren

              aluminum hydroxide will decrease the level or effect of cefditoren by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • cefpodoxime

              aluminum hydroxide will decrease the level or effect of cefpodoxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • cefuroxime

              aluminum hydroxide will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • celecoxib

              aluminum hydroxide decreases levels of celecoxib by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • celiprolol

              aluminum hydroxide decreases levels of celiprolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • chenodiol

              aluminum hydroxide decreases levels of chenodiol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • chloroquine

              aluminum hydroxide will decrease the level or effect of chloroquine by cation binding in GI tract. Use Caution/Monitor. Separate doses by at least 4 hr

              magnesium hydroxide will decrease the level or effect of chloroquine by Mechanism: inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate doses by at least 4 hr

              aluminum hydroxide will decrease the level or effect of chloroquine by Mechanism: inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely.

            • cholic acid

              aluminum hydroxide will decrease the level or effect of cholic acid by drug binding in GI tract. Use Caution/Monitor. Take cholic acid at least 1 hr before or 4-6 hr (or as great an interval as possible) after a aluminum-based antacid.

            • ciprofloxacin

              magnesium hydroxide decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

            • crizotinib

              magnesium hydroxide decreases levels of crizotinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that elevate the gastric pH may decrease the solubility of crizotinib and subsequently reduce its bioavailability. However, no formal studies have been conducted. .

              aluminum hydroxide decreases levels of crizotinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that elevate the gastric pH may decrease the solubility of crizotinib and subsequently reduce its bioavailability. However, no formal studies have been conducted. .

            • cyclosporine

              aluminum hydroxide decreases levels of cyclosporine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • deferiprone

              magnesium hydroxide decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.

            • dabrafenib

              aluminum hydroxide will decrease the level or effect of dabrafenib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that alter upper GI tract pH (eg, PPIs, H2-blockers, antacids) may decrease dabrafenib solubility and reduce its bioavailability

            • deferasirox

              aluminum hydroxide will decrease the level or effect of deferasirox by Other (see comment). Use Caution/Monitor. Avoid combination. Although deferasirox has a lower affinity for aluminum than for iron, do not administer deferasirox with aluminum-containing antacid preparations.

            • deferiprone

              aluminum hydroxide decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.

            • deferoxamine

              deferoxamine decreases levels of aluminum hydroxide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron; its affinity for other minerals is unknown.

            • deflazacort

              magnesium hydroxide and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • delafloxacin

              aluminum hydroxide will decrease the level or effect of delafloxacin by cation binding in GI tract. Modify Therapy/Monitor Closely. Oral delafloxacin form chelates with alkaline earth and transition metal cations. Administer oral delafloxacin at least 2 hr before or 6 hr after these agents.

            • dextroamphetamine

              aluminum hydroxide will increase the level or effect of dextroamphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • dolutegravir

              magnesium hydroxide will decrease the level or effect of dolutegravir by cation binding in GI tract. Use Caution/Monitor. Administer dolutegravir 2 hr before or 6 hr after taking medications containing polyvalent cations; use alternative therapy if available

              aluminum hydroxide will decrease the level or effect of dolutegravir by cation binding in GI tract. Use Caution/Monitor. Administer dolutegravir 2 hr before or 6 hr after taking medications containing polyvalent cations; use alternative therapy if available

            • elvitegravir

              aluminum hydroxide will decrease the level or effect of elvitegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Elvitegravir plasma concentrations are lower with antacids due to the formation of ionic complexes in the GI tract and not due to changes in gastric pH; separate dose from antacid by at least 2 hr

            • fleroxacin

              magnesium hydroxide decreases levels of fleroxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              aluminum hydroxide decreases levels of elvitegravir/cobicistat/emtricitabine/tenofovir DF by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration from antacids by 2 hr.

            • enalapril

              aluminum hydroxide decreases effects of enalapril by unspecified interaction mechanism. Use Caution/Monitor.

            • ephedrine

              aluminum hydroxide will increase the level or effect of ephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • erythromycin base

              aluminum hydroxide increases levels of erythromycin base by unknown mechanism. Use Caution/Monitor.

            • erythromycin ethylsuccinate

              aluminum hydroxide increases levels of erythromycin ethylsuccinate by unknown mechanism. Use Caution/Monitor.

            • erythromycin lactobionate

              aluminum hydroxide increases levels of erythromycin lactobionate by unknown mechanism. Use Caution/Monitor.

            • erythromycin stearate

              aluminum hydroxide increases levels of erythromycin stearate by unknown mechanism. Use Caution/Monitor.

            • esmolol

              aluminum hydroxide decreases levels of esmolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • ethambutol

              aluminum hydroxide increases levels of ethambutol by cation binding in GI tract. Use Caution/Monitor. Avoid administering aluminum hydroxide containing antacids for at least 4 hr following ethambutol dose.

            • etidronate

              aluminum hydroxide decreases levels of etidronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • ferric maltol

              aluminum hydroxide will decrease the level or effect of ferric maltol by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • ferrous fumarate

              aluminum hydroxide will decrease the level or effect of ferrous fumarate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • ferrous gluconate

              aluminum hydroxide will decrease the level or effect of ferrous gluconate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • ferrous sulfate

              aluminum hydroxide will decrease the level or effect of ferrous sulfate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • flecainide

              aluminum hydroxide will increase the level or effect of flecainide by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • fosamprenavir

              aluminum hydroxide will decrease the level or effect of fosamprenavir by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • fosinopril

              aluminum hydroxide decreases effects of fosinopril by unspecified interaction mechanism. Use Caution/Monitor.

            • gabapentin

              aluminum hydroxide decreases levels of gabapentin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • gabapentin enacarbil

              aluminum hydroxide decreases levels of gabapentin enacarbil by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • gefitinib

              aluminum hydroxide decreases levels of gefitinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Separate gefitinib and antacid doses by at least 6 hr.

            • gemifloxacin

              magnesium hydroxide decreases levels of gemifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • glipizide

              aluminum hydroxide will increase the level or effect of glipizide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • glyburide

              aluminum hydroxide will increase the level or effect of glyburide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • ibandronate

              aluminum hydroxide decreases levels of ibandronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • imidapril

              aluminum hydroxide decreases effects of imidapril by unspecified interaction mechanism. Use Caution/Monitor.

            • iron dextran complex

              aluminum hydroxide will decrease the level or effect of iron dextran complex by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • iron sucrose

              aluminum hydroxide will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • isoniazid

              aluminum hydroxide decreases levels of isoniazid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • itraconazole

              aluminum hydroxide will decrease the level or effect of itraconazole by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer acid neutralizing medicines at least 2 hours before or 2 hours after itraconazole.

            • ketoconazole

              aluminum hydroxide decreases levels of ketoconazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • labetalol

              aluminum hydroxide decreases levels of labetalol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • lactulose

              aluminum hydroxide decreases effects of lactulose by pharmacodynamic antagonism. Use Caution/Monitor.

            • lanthanum carbonate

              lanthanum carbonate, magnesium hydroxide. cation binding in GI tract. Use Caution/Monitor. Administer antacid at least 2 hours before or after lanthanum. .

              lanthanum carbonate, aluminum hydroxide. cation binding in GI tract. Use Caution/Monitor. Administer antacid at least 2 hours before or after lanthanum. .

            • ledipasvir/sofosbuvir

              aluminum hydroxide decreases levels of ledipasvir/sofosbuvir by Other (see comment). Use Caution/Monitor. Comment: Ledipasvir solubility decreases as pH increases; drugs that increase gastric pH are expected to decrease levels of ledipasvir; separate antacid and ledipasivr/sofosbuvir administration by 4 hr.

            • levofloxacin

              magnesium hydroxide decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • lisdexamfetamine

              aluminum hydroxide will increase the level or effect of lisdexamfetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • lisinopril

              aluminum hydroxide decreases effects of lisinopril by unspecified interaction mechanism. Use Caution/Monitor.

            • memantine

              aluminum hydroxide will increase the level or effect of memantine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • methscopolamine

              aluminum hydroxide decreases levels of methscopolamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • methylphenidate

              aluminum hydroxide decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • metoprolol

              aluminum hydroxide decreases levels of metoprolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • mexiletine

              aluminum hydroxide will increase the level or effect of mexiletine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • moexipril

              aluminum hydroxide decreases effects of moexipril by unspecified interaction mechanism. Use Caution/Monitor.

            • moxifloxacin

              magnesium hydroxide decreases levels of moxifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • mycophenolate

              aluminum hydroxide will decrease the level or effect of mycophenolate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • nadolol

              aluminum hydroxide decreases levels of nadolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • nebivolol

              aluminum hydroxide decreases levels of nebivolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • neratinib

              aluminum hydroxide will decrease the level or effect of neratinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate antacid and neratinib dosing by 3 hr.

            • nilotinib

              aluminum hydroxide decreases levels of nilotinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Avoid this interaction by administering antacids 2 hr after or 2 hr before nilotinib.

            • nitrofurantoin

              aluminum hydroxide decreases levels of nitrofurantoin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • ofloxacin

              magnesium hydroxide decreases levels of ofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • omadacycline

              aluminum hydroxide will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

              magnesium hydroxide will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

            • pamidronate

              aluminum hydroxide decreases levels of pamidronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • pancrelipase

              magnesium hydroxide decreases effects of pancrelipase by pharmacodynamic antagonism. Use Caution/Monitor. Antacids may negate beneficial effects of enzymes.

            • penbutolol

              aluminum hydroxide decreases levels of penbutolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • penicillamine

              magnesium hydroxide decreases levels of penicillamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              aluminum hydroxide decreases levels of penicillamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • perindopril

              aluminum hydroxide decreases effects of perindopril by unspecified interaction mechanism. Use Caution/Monitor.

            • pexidartinib

              magnesium hydroxide will decrease the level or effect of pexidartinib by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate pexidartinib by 2 hr before or after taking a locally-acting antacid.

              simethicone will decrease the level or effect of pexidartinib by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate pexidartinib by 2 hr before or after taking a locally-acting antacid.

            • pexidartinib

              aluminum hydroxide will decrease the level or effect of pexidartinib by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate pexidartinib by 2 hr before or after taking a locally-acting antacid.

            • pindolol

              aluminum hydroxide decreases levels of pindolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • polysaccharide iron

              aluminum hydroxide will decrease the level or effect of polysaccharide iron by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • posaconazole

              aluminum hydroxide will decrease the level or effect of posaconazole by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • propranolol

              aluminum hydroxide decreases levels of propranolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • pseudoephedrine

              aluminum hydroxide will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor. Caution advised with frequent or high dose antacids

            • quinapril

              aluminum hydroxide decreases effects of quinapril by unspecified interaction mechanism. Use Caution/Monitor.

            • quinidine

              aluminum hydroxide will increase the level or effect of quinidine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • ramipril

              aluminum hydroxide decreases effects of ramipril by unspecified interaction mechanism. Use Caution/Monitor.

            • rifampin

              aluminum hydroxide will decrease the level or effect of rifampin by Other (see comment). Use Caution/Monitor. Concomitant antacid administration may reduce absorption of rifampin; daily doses of rifampin should be given at least 1 hr before ingestion of antacids

            • rilpivirine

              aluminum hydroxide decreases levels of rilpivirine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Coadministration of antacids with rilpivirine may cause significant decreases in rilpivirine plasma concentrations because of increased gastric pH. If antacids must be administered, they should be given at least 2 hr before or at least 4 hr after rilpivirine. For the combination product dolutegravir/rilpivirine, antacids should be given at least 4 hr before or at least 6 hr afterwards.

            • riociguat

              magnesium hydroxide decreases levels of riociguat by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration by at least 1 hour.

              aluminum hydroxide decreases levels of riociguat by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration by at least 1 hour.

            • risedronate

              aluminum hydroxide decreases levels of risedronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • sarecycline

              magnesium hydroxide will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

            • rose hips

              aluminum hydroxide will decrease the level or effect of rose hips by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • rosuvastatin

              aluminum hydroxide decreases levels of rosuvastatin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • sarecycline

              aluminum hydroxide will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

            • sodium phosphates, IV

              magnesium hydroxide decreases effects of sodium phosphates, IV by cation binding in GI tract. Modify Therapy/Monitor Closely. Magnesium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of aluminum hydroxide by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of aluminum hydroxide by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sofosbuvir/velpatasvir

              aluminum hydroxide will decrease the level or effect of sofosbuvir/velpatasvir by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Velpatasvir solubility decreases as gastric pH increases (practically insoluble at pH >5). Separate administration of sofosbuvir/velpatasvir from antacids by at least 4 hr.

            • sotalol

              aluminum hydroxide decreases levels of sotalol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • tiludronate

              aluminum hydroxide decreases levels of tiludronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • timolol

              aluminum hydroxide decreases levels of timolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • tolbutamide

              aluminum hydroxide will increase the level or effect of tolbutamide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • trandolapril

              aluminum hydroxide decreases effects of trandolapril by unspecified interaction mechanism. Use Caution/Monitor.

            • ursodiol

              aluminum hydroxide decreases effects of ursodiol by pharmacodynamic antagonism. Use Caution/Monitor.

            • vismodegib

              magnesium hydroxide will decrease the level or effect of vismodegib by Other (see comment). Use Caution/Monitor. Drugs that increase gastric pH alter vismodegib solubility and therefore reduce bioavailability; effect on efficacy unknown

              aluminum hydroxide will decrease the level or effect of vismodegib by Other (see comment). Use Caution/Monitor. Drugs that increase gastric pH alter vismodegib solubility and therefore reduce bioavailability; effect on efficacy unknown

            • vitamin D

              vitamin D increases levels of magnesium hydroxide by Other (see comment). Use Caution/Monitor. Comment: Vitamin D can increase serum magnesium concentrations, particularly in the presence of renal impairment. The combined use of vitamin D and magnesium-containing products should be avoided, if possible, in patients with chronic renal failure.

              vitamin D increases levels of aluminum hydroxide by Other (see comment). Use Caution/Monitor. Comment: Avoid coadministration. Chronic use of aluminum-containing antacids in conjunction with vitamin D can lead to aluminum retention and possible toxicity.

            • zoledronic acid

              aluminum hydroxide decreases levels of zoledronic acid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            Minor (59)

            • amikacin

              amikacin decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • amiloride

              amiloride increases levels of magnesium hydroxide by decreasing renal clearance. Minor/Significance Unknown.

            • amphotericin B deoxycholate

              amphotericin B deoxycholate decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • ascorbic acid

              ascorbic acid increases levels of aluminum hydroxide by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • aspirin

              aluminum hydroxide, aspirin. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • aspirin rectal

              aluminum hydroxide, aspirin rectal. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • aspirin/citric acid/sodium bicarbonate

              aluminum hydroxide, aspirin/citric acid/sodium bicarbonate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • balsalazide

              aluminum hydroxide, balsalazide. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • bazedoxifene/conjugated estrogens

              bazedoxifene/conjugated estrogens decreases levels of magnesium hydroxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

            • bendroflumethiazide

              bendroflumethiazide decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • blessed thistle

              blessed thistle decreases effects of aluminum hydroxide by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction.

            • bumetanide

              bumetanide decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • calcitonin salmon

              calcitonin salmon increases levels of magnesium hydroxide by decreasing renal clearance. Minor/Significance Unknown.

            • chlorothiazide

              chlorothiazide decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • chlorthalidone

              chlorthalidone decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • choline magnesium trisalicylate

              aluminum hydroxide, choline magnesium trisalicylate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • chromium

              aluminum hydroxide decreases levels of chromium by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Separate by 2 hours.

            • conjugated estrogens

              conjugated estrogens decreases levels of magnesium hydroxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

            • conjugated estrogens, vaginal

              conjugated estrogens, vaginal decreases levels of magnesium hydroxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

            • cyclopenthiazide

              cyclopenthiazide decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • devil's claw

              devil's claw decreases effects of aluminum hydroxide by pharmacodynamic antagonism. Minor/Significance Unknown.

            • dextrose

              dextrose decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • dextrose (Antidote)

              dextrose (Antidote) decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • diflunisal

              aluminum hydroxide, diflunisal. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • digoxin

              digoxin decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • doxercalciferol

              doxercalciferol increases levels of magnesium hydroxide by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • drospirenone

              drospirenone increases levels of magnesium hydroxide by decreasing renal clearance. Minor/Significance Unknown.

            • estradiol

              estradiol decreases levels of magnesium hydroxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

            • estrogens conjugated synthetic

              estrogens conjugated synthetic decreases levels of magnesium hydroxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

            • estrogens esterified

              estrogens esterified decreases levels of magnesium hydroxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

            • estropipate

              estropipate decreases levels of magnesium hydroxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

            • ethacrynic acid

              ethacrynic acid decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • furosemide

              furosemide decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • gentamicin

              gentamicin decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • glucagon intranasal

              glucagon intranasal increases levels of magnesium hydroxide by decreasing renal clearance. Minor/Significance Unknown.

            • hydrochlorothiazide

              hydrochlorothiazide decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • ibandronate

              magnesium hydroxide decreases levels of ibandronate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • indapamide

              indapamide decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • mannitol

              mannitol decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • mesalamine

              aluminum hydroxide, mesalamine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • mestranol

              mestranol decreases levels of magnesium hydroxide by Other (see comment). Minor/Significance Unknown. Comment: Magnesium shifted from blood to tissue storage.

            • methyclothiazide

              methyclothiazide decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • metolazone

              metolazone decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • neomycin PO

              neomycin PO decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • nitrofurantoin

              magnesium hydroxide decreases levels of nitrofurantoin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • paromomycin

              paromomycin decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • rose hips

              rose hips increases levels of aluminum hydroxide by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • salicylates (non-asa)

              aluminum hydroxide, salicylates (non-asa). Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • salsalate

              aluminum hydroxide, salsalate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • sodium polystyrene sulfonate

              sodium polystyrene sulfonate increases levels of magnesium hydroxide by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

            • spironolactone

              spironolactone increases levels of magnesium hydroxide by decreasing renal clearance. Minor/Significance Unknown.

            • streptomycin

              streptomycin decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • strontium ranelate

              aluminum hydroxide decreases levels of strontium ranelate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Separate by 2 hr when possible.

            • sucralfate

              sucralfate increases levels of aluminum hydroxide by pharmacodynamic synergism. Minor/Significance Unknown. Additive aluminum content.

            • sulfasalazine

              aluminum hydroxide, sulfasalazine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • tobramycin

              tobramycin decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • torsemide

              torsemide decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • triamterene

              triamterene increases levels of magnesium hydroxide by decreasing renal clearance. Minor/Significance Unknown.

            • willow bark

              aluminum hydroxide, willow bark. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

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            Adverse Effects

            Frequency Not Defined

            Aluminum hydroxide

            • Chalky taste
            • Constipation
            • Fecal impaction
            • Stomach cramps
            • Nausea
            • Vomiting
            • Rebound hyperacidity
            • Aluminum intoxication
            • Hypophosphatemia
            • Milk-alkali syndrome
            • Osteomalacia

            Magnesium hydroxide

            • Diarrhea
            • Hypermagnesemia

            Simethicone

            • Loose stools
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            Warnings

            Contraindications

            Hypersensitivity to any component of the formulation

            Cautions

            Caution in renal failure

            May increase or decrease rate &/or degree of absorption of concomitantly administered oral drugs by changing GI transit time or by binding the drug

            Mg-restricted diet

            Similar Trade Names may have different compositions

            Do not use combination product for hyperphosphatemia

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: excretion in milk unknown

            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

            Aluminum hydroxide: Neutralizes stomach hydrochloride to form AlCl3 salt plus water; increases gastric pH

            Magnesium hydroxide: Promotes bowel evacuation by causing osmotic retention of fluid, which causes the colon to distend with increased peristaltic activity; forms magnesium chloride when reacts with hydrochloric acid

            Simethicone: Disperses and prevents gas pockets in the GI system by decreasing surface tension of gas bubbles

            Elimination

            Excretion

            • Aluminum hydroxide: Absorbed Al ions are eliminated in the urine (0.1-0.5 mg of Al in aluminum-containing antacid is absorbed from standard daily doses of antacid); Insoluble or poorly absorbed Al salts in the intestines are excreted in feces
            • Magnesium hydroxide: Absorbed Mg ions (up to 30%) are eliminated in urine, unabsorbed drug is excreted in feces
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            Images

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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.