Part II: Gastric Medication

PART II: GASTRIC MEDICATION

In Part I of Gastric Medication, we have discussed about the definition and possible causes of gastric as a brief understanding for everyone. If you would like to refer back, kindly click into the following link: https://storyofdrugs.blogspot.my/2016/07/part-i-understanding-gastric.html.

Now, here in Part II, we would like to convey some important information on gastric medications. Currently, there are 3 main classes of gastric medication, ranging from fast-acting antacids to a mild agent of histamine H₂ blockers, and the strongest gastric medication, proton pump inhibitors (PPI).

Three main classes of gastric medication: Antacids, H2 blockers and Proton Pump Inhibitors (PPIs).

ANTACIDS

• Available over-the-counter for fast, short-term relief of gastric pain.
• May used alone or together with other gastric medication (H₂ blockers and PPI)
• Available in liquid & tablets. Liquid antacids work faster than tablets.
• Mechanism of Action: It neutralizes gastric hydrochloric acid by forming salt and water; decreases amount of gastric acid; decreases pepsin activity through inactivation from alkaline conditions.
• There are various antacids available in the market. The following are some examples of products containing antacids.

Maalox Plus

Maalox plus contains a balanced mixture of 2 antacids (Aluminium hydroxide, Magnesium hydroxide) and an anti-flatulent, simethicone. Antacids (Aluminium and magnesium salts) are effective to neutralize our stomach acid, hence help with heartburn and indigestion. Aluminium salts may cause constipation, but the effect is balanced by magnesium salts which may cause diarrhea when used in combination. Besides, the salts are not well absorbed by our guts, hence it minimizes the possible systemic side effects. Simethicone is added to breaks up gas bubbles in the gut, therefore it solves the problem of flatulence and hiccup.

Mechanism of Action of antacids

Maalox Plus is available in both tablets and liquid bottle, as well as in liquid sachet form.

Tablets: Chew 2-4 tablets, 30 minutes after each meals and at bedtime (maximum 4 tablets 4 times a day).

Liquid bottle: Take 5-10ml 30 minutes after each meal and at bedtime.

Liquid sachet: 1-2 sachets (10-20ml) after each meal and at bedtime (maximum 4 times a day)

                              

Take note…

• Do not use more than 2 weeks. Long-term use may cause calcium loss.
• Wait at least 1 hour before taking Maalox Plus if you are taking other medication.
• Do not store Maalox in the freezer.
• Not recommended for kidney failure patients (easily develop toxicity to brain and heart), pregnant women (safety not established), and children (table should not be given to children below 12 years old, a maximum of 5ml liquid 3 times a day should be given only on medical advice).
• Minimal amount of antacids will be excreted in breast milk, but there are no expected side effects on breastfed infants.

Gaviscon Peppermint

Gaviscon Double Action

Gaviscon Advance

Gaviscon is a combination of antacids and alginate. Sodium bicarbonate and calcium carbonate are antacids that provide rapid action. Calcium carbonate provides longer duration of action compared to sodium bicarbonate. The side effect of these antacids is belching. The additional ingredient of alginate forms a protective barrier on the surface of stomach contents which helps to prevent acid reflux.

There are 3 types of Gaviscon with their respective contents:

Peppermint: Alginic acid with antacids (aluminium hydroxide, magnesium trisilicate, sodium bicarbonate)

Double Action: Sodium alginate with antacids (sodium bicarbonate, calcium carbonate)

Advance: Sodium alginate and antacid (potassium hydrogen carbonate)

Gaviscon is available in tablets, liquid sachets, and liquid bottles.

Tablets: Chew 2-4 tablets, 30 minutes after each meals and at bedtime (maximum 4 tablets 4 times a day).

Liquid sachet: 1-2 sachets (10-20ml) after each meals and at bedtime (maximum 4 times a day)

Liquid bottle: Take 5-10ml 30 minutes after each meals and at bedtime.

Take note…

• Gaviscon are highly effective and suitable to use during pregnancy and whilst breast feeding. These include Gaviscon Original, Gaviscon Double Action and Gaviscon Advance in both liquid and tablet form. This is because they act physically rather than entering the bloodstream. Gavilast however is not suitable for use during pregnancy. *Medicines can affect the unborn baby. Always talk to your doctor or pharmacist before taking any medicine in pregnancy.*
• Not recommended for patient with kidney failure (side effect more severe especially when taken with milk which known as milk-alkali syndrome), heart failure, hypertensive patient (sodium salts), and children (below 12 years old).
• Long-term use may cause alkalosis, with the symptoms of numbness and nausea. If experience dizziness and difficulty in breathing, please seek for medical help immediately.
• Liquid bottle can store up to 6 months after opening. It should not be stored in the refrigerator.

Dentinox Colic Drops; Woodwards GripeWater

These are simethicone with or without antacid-containing products for infants who have gastric reflux and wind problem. The summary is shown as below:

If there is any allergy reaction on the infants, stop using the product immediately and seek for medical advice from your physician or pharmacist. Other than medications, you can take note on the feeding pattern of the milk for your infant. It is recommended to feed frequently, by administering small volume of the milk. You can always opt for special milk formulation for wind and gastric problem too.

I guess that you must be tired reading this article. Hope that you enjoy our informative blog and have a good rest. To be continued…

Author:

Lok Ker Yee

BPharm (Hons) (IMU)

Editors:

Chang Jen Nee

BPharm (Hons) (IMU)

Grace Ho Mee Yan

BPharm (Hons) (IMU)