Dyspepsia and Gastro-oesophageal reflux disease

Dyspepsia and Gastro-oesophageal reflux disease

First choice antacid:    CO-MAGALDROX 
First choice alginate:   PEPTAC®

 

Co-magaldrox available as Maalox® and Mucogel® (sugar-free suspension) is the formulary choice simple antacid. This is an effective combination of aluminium hydroxide and magnesium hydroxide with a low sodium content (less than 1mmol per 10mL dose).

Peptac® (sugar-free suspension containing sodium alginate, sodium bicarbonate and calcium carbonate) is only recommended for the treatment of gastric reflux as it is less effective as an antacid than co-magaldrox. It has a high sodium content (6.2mmol per 10mL dose).

SPECIAL INDICATIONS

Gaviscon® Advance (sugar-free suspension containing sodium alginate, potassium bicarbonate and calcium carbonate) is an alternative to Peptac® for the treatment of gastric reflux only in patients where the lower sodium content may be considered advantageous. It has a lower standard dose (5mL) and contains 2.3mmol sodium and 1mmol potassium per 5mL dose. It is also available as a tablet (containing sodium alginate and potassium bicarbonate).

Co-simalcite available as Altacite Plus® (sugar-free suspension containing activated dimethicone and hydrotalcite) is used for the treatment of biliary gastritis and is initiated in hospital.

Citrate antacid mixture is used pre-op in patients undergoing elective caesarean section.
PRESCRIBING POINTS FOR DYSPEPSIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE

• Liquid preparations are more effective than tablets.
• Antacids are best given when symptoms occur or are expected, usually between meals and at bedtime - four or more times daily.
• Antacids, taken at the same time as other drugs, may impair their absorption. They may also damage enteric coatings designed to prevent irritant drugs from dissolving in the stomach.

PAEDIATRIC NOTES - DYSPEPSIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE


 Aluminium hydroxide mixture is a suitable general antacid. In young children, it should only be used as a short course for gastritis due to potential toxicity. Where chronic use is required an H2-receptor antagonist like ranitidine should be considered. 


Carobel, Instant®, Vitaquick®, (feed thickeners), or Gaviscon® Infant are all effective for gastric regurgitation in bottle-fed babies. Vitaquick® should not be prescribed for children under 1 except in cases of failure to thrive. 


Gaviscon® liquid (100mL bottles) may be used in breast-fed infants although it is not licensed for infants.