SUNGEL SUSPENSION

Indications

• Dyspepsia
• Gastroesophageal reflux disease
• Peptic ulcer disease
• Vaccination as an adjuvant

Dosage

Children: Refer to specific product guidelines for dosing; pediatric dosing varies based on age, weight, and formulation.

Adults: Refer to specific product guidelines for dosing; generally, aluminium antacids are taken as needed, with doses determined by the severity of symptoms.

Mechanism of action

Aluminium compounds exert their effects primarily by neutralizing gastric acid, which increases the pH of stomach contents. This activity reduces gastric acidity, providing symptomatic relief from heartburn and indigestion. In the context of vaccines, aluminium salts act as immunological adjuvants, enhancing the body's immune response to the antigen present in the vaccine.

Pharmacodynamics

The pharmacodynamic effects of aluminium include the neutralization of gastric acids and the enhancement of the immune response. The antacid effect decreases the acidity of gastric secretions, leading to increased comfort in patients with acid-related disorders. As an adjuvant in vaccines, it improves the body's immunogenic response, resulting in a more effective long-term immunity.

Pharmacokinetics

Aluminium compounds are not significantly absorbed from the gastrointestinal tract when used as antacids, and their systemic bioavailability is low. In the case of parenterally administered aluminium (e.g., in vaccines), the absorption can vary, but the majority of the aluminium is eventually excreted via the kidneys. The half-life of aluminium in the body depends on various factors, including the form of aluminium, the route of administration, and individual patient factors such as renal function.

Contra-indications

• Hypersensitivity to aluminium or any of its components
• Severe renal impairment

Adverse effects

• Constipation
• Diarrhea
• Abdominal pain
• Nausea
• Vomiting
• Headache
• Electrolyte imbalances
• Aluminium toxicity (with chronic use or in patients with renal impairment)

Interactions

• Antacids may interfere with the absorption of certain medications
• Phosphate supplements may be less effective when taken with aluminium-containing products

Precautions

• Use with caution in patients with renal impairment
• Monitor for signs of aluminium toxicity in long-term use
• Assess dietary phosphorus levels in patients taking aluminium-containing medications

Pregnancy

Aluminium is generally considered safe during pregnancy when used as directed, but excessive exposure should be avoided.

Breast-feeding

Aluminium is excreted in breast milk but is not expected to cause harm in nursing infants when used appropriately.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Formulations

• Aluminium hydroxide gel
• Aluminium carbonate
• Aluminium phosphate

Dosage

Children: Refer to specific guidelines for pediatric dosing; consult the BNF for Children for accurate dosage information.

Adults: Refer to specific guidelines for use; dosage may vary based on the context of use.

Mechanism of action

Hydroxide ions act primarily as bases, neutralizing acids to form water and salts. They participate in various biochemical pathways, including selenium metabolism and the degradation of reactive oxygen species. Hydroxide can influence enzyme activity and stability by altering the pH of the environment, thereby affecting metabolic reactions.

Pharmacodynamics

Hydroxide ions can impact biological processes by changing the local pH, which influences enzyme activity, ion transport, and the solubility of other compounds. Their ability to neutralize acids can help regulate physiological pH, contributing to homeostasis in living organisms.

Pharmacokinetics

As an inorganic ion, hydroxide does not undergo traditional pharmacokinetic processes like absorption, distribution, metabolism, or excretion. Instead, it is rapidly equilibrated in biological fluids and participates in acid-base reactions, having immediate effects on the local environment.

Pregnancy

There is limited information regarding the use of hydroxide during pregnancy. Consult a healthcare professional for advice.

Breast-feeding

Limited data is available on the excretion of hydroxide in breast milk. Consult a healthcare professional before use.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Indications

• Gastroesophageal reflux disease (GERD)
• Peptic ulcer disease
• Indigestion
• Heartburn
• Constipation

Dosage

Children: For children, dosing should be based on age and weight, and it is recommended to consult the BNF for Children for specific doses and formulations.

Adults: For antacid use, typically 5 to 15 mL of a liquid preparation is taken up to four times per day as needed. For constipation, the usual dose is 30 to 60 mL of the liquid preparation taken at bedtime. Refer to specific product guidelines for exact dosing.

Mechanism of action

Magnesium hydroxide acts as a weak base that reacts with hydrochloric acid in the stomach to form magnesium chloride and water, thereby neutralizing gastric acidity. The resultant increase in osmotic pressure in the intestines leads to water retention and promotes peristalsis, which helps in alleviating constipation.

Pharmacodynamics

The antacid effect of magnesium hydroxide occurs when it neutralizes gastric acid, leading to a rise in the gastric pH. This can help reduce symptoms associated with hyperacidity, such as pain and discomfort. Additionally, its laxative effect is mediated through osmotic action, increasing water content in the stool and promoting bowel movement.

Pharmacokinetics

Magnesium hydroxide is not significantly absorbed from the gastrointestinal tract. Its action is primarily local, and it acts in the lumen of the stomach and intestines. The onset of action for its antacid effect is usually within minutes, while the laxative effect may take several hours to manifest. The duration of action can vary based on the individual’s gastrointestinal transit time.

Contra-indications

• Hypersensitivity to magnesium compounds
• Severe renal impairment
• Heart block

Adverse effects

• Diarrhea
• Nausea
• Vomiting
• Abdominal cramping
• Hypotension
• Respiratory depression

Interactions

• Increased risk of neuromuscular blockade with neuromuscular blocking agents
• Antibiotics (tetracyclines and fluoroquinolones) may have reduced absorption when taken with magnesium
• May interfere with the absorption of other medications

Precautions

• Use with caution in patients with renal impairment
• Monitor patients on concurrent medications that can affect renal function
• Use cautiously in patients with cardiac disease

Pregnancy

Magnesium is generally considered safe during pregnancy when used appropriately, but high doses should be avoided unless specifically indicated.

Breast-feeding

Magnesium is excreted in breast milk but is not expected to cause adverse effects in nursing infants at normal dietary levels.

Storage

Store in a cool, dry place away from light. Keep out of reach of children.

Formulations

• Oral tablets
• Oral suspension
• Intravenous solution

Indications

• Flatulence
• Bloating
• Gastroesophageal reflux disease
• Functional dyspepsia

Dosage

Children: For children, refer to the BNF for Children for specific dosing recommendations.

Adults: The usual adult dose is 40 to 125 mg taken after meals and at bedtime, as needed.

Mechanism of action

Simethicone is a surfactant that decreases the surface tension of gas bubbles in the gastrointestinal tract, facilitating their expulsion. It acts by forming a film of low surface tension that promotes the coalescence of mucus-surrounded gas bubbles, allowing for easier passage of gas.

Pharmacodynamics

Simethicone decreases the surface tension of gas bubbles in the gastrointestinal tract, facilitating their expulsion. Its effects are generally short-lived, as it is typically administered as needed. The therapeutic index is wide since it is not absorbed systemically, making it safe for use in various patient populations.

Pharmacokinetics

Simethicone is not systemically absorbed following oral administration, which contributes to its safety profile. Due to its lack of systemic absorption, specific pharmacokinetic parameters such as half-life, clearance, and volume of distribution are not applicable.

Pregnancy

Simethicone can be used during pregnancy as there are no known risks associated with its use.

Breast-feeding

Simethicone is considered safe to use during breastfeeding, as it is not absorbed systemically.

Storage

Store in a cool, dry place, away from direct sunlight. Keep out of reach of children.

Formulations

• Oral suspension
• Chewable tablets
• Soft gels

Mechanism of action

Simethicone is a surfactant that decreases the surface tension of gas bubbles in the gastrointestinal tract, more easily allowing gas to exit the body. The clinical use of simethicone is based on its antifoam properties. Silicone antifoams spread on the surface of aqueous liquids, forming a film of low surface tension and thus causing collapse of foam bubbles. Simethicone reportedly allows mucus-surrounded gas bubbles in the GI tract to coalesce and be expelled.

Pharmacodynamics

Simethicone decreases the surface tension of gas bubbles in the gastrointestinal tract, facilitating their expulsion. It has a short duration of action as it is generally given as needed, and a wide therapeutic index as it is not systemically absorbed.