Mag-Al Liquid
It is used to treat heartburn and upset stomach.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Antacid
Pharmacologic Class
Antacid (Neutralizing Agent)
Pregnancy Category
C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
This medicine is an antacid that helps relieve heartburn, sour stomach, acid indigestion, and upset stomach by neutralizing stomach acid. It contains two main ingredients: aluminum hydroxide, which can cause constipation, and magnesium hydroxide, which can cause diarrhea. When combined, they often balance each other's effects on the bowels.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, take it exactly as directed by your doctor. Carefully read all the information provided with your prescription, and follow the instructions closely. Take your medication after meals and at bedtime, or as instructed by your doctor. Before using the liquid form, shake the bottle well to ensure the medication is evenly mixed.
When measuring a liquid dose, use the measuring device that comes with the medication. If one is not provided, ask your pharmacist for a suitable measuring device to accurately measure your dose.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the bathroom. Do not freeze your medication. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist. If you have questions about disposing of your medication, consult your pharmacist, who may be aware of drug take-back programs in your area.
Missing a Dose
If you take your medication on a regular schedule and miss a dose, take it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses. If you take your medication as needed, do not take it more frequently than directed by your doctor.
To get the most benefit from your medication, take it exactly as directed by your doctor. Carefully read all the information provided with your prescription, and follow the instructions closely. Take your medication after meals and at bedtime, or as instructed by your doctor. Before using the liquid form, shake the bottle well to ensure the medication is evenly mixed.
When measuring a liquid dose, use the measuring device that comes with the medication. If one is not provided, ask your pharmacist for a suitable measuring device to accurately measure your dose.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the bathroom. Do not freeze your medication. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist. If you have questions about disposing of your medication, consult your pharmacist, who may be aware of drug take-back programs in your area.
Missing a Dose
If you take your medication on a regular schedule and miss a dose, take it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses. If you take your medication as needed, do not take it more frequently than directed by your doctor.
Lifestyle & Tips
- Shake the bottle well before each use.
- Take this medicine between meals and at bedtime for best results.
- Do not take other medications within 2 hours before or after taking this antacid, as it can interfere with their absorption.
- Avoid foods and drinks that trigger your symptoms (e.g., spicy foods, fatty foods, caffeine, alcohol, carbonated beverages).
- Eat smaller, more frequent meals.
- Avoid lying down immediately after eating.
- Elevate the head of your bed if you experience nighttime heartburn.
- If symptoms persist for more than 2 weeks or worsen, consult a doctor.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
10-20 mL (2-4 teaspoonfuls) orally, between meals, at bedtime, or as directed by a physician.
Dose Range:
10 - 20 mg
Condition-Specific Dosing:
heartburn:
10-20 mL as needed, up to 4 times daily.
acid indigestion:
10-20 mL as needed, up to 4 times daily.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established (use with caution and medical supervision)
Child:
6-12 years: 5-10 mL (1-2 teaspoonfuls) orally, as directed by a physician. Not recommended for children under 6 years without medical advice.
Adolescent:
12+ years: Same as adult dosing.
Dose Adjustments
Renal Impairment:
Mild:
Use with caution; monitor for hypermagnesemia and aluminum accumulation.
Moderate:
Avoid use or use with extreme caution; significant risk of hypermagnesemia and aluminum toxicity.
Severe:
Contraindicated due to risk of hypermagnesemia and aluminum toxicity.
Dialysis:
Contraindicated due to risk of hypermagnesemia and aluminum toxicity.
Hepatic Impairment:
Mild:
No specific adjustment needed, but monitor renal function if co-existing impairment.
Moderate:
No specific adjustment needed, but monitor renal function if co-existing impairment.
Severe:
No specific adjustment needed, but monitor renal function if co-existing impairment.
Pharmacology
Mechanism of Action
Aluminum hydroxide and magnesium hydroxide are inorganic salts that act as antacids. They neutralize gastric acid by reacting with hydrochloric acid in the stomach to form water and other salts, thereby increasing gastric pH. Aluminum hydroxide also has astringent and constipating properties, while magnesium hydroxide has laxative properties, which can help balance the bowel effects when combined.
Pharmacokinetics
Absorption:
Bioavailability:
Minimal systemic absorption for both aluminum and magnesium ions from the GI tract. However, small amounts of aluminum and magnesium can be absorbed.
Tmax:
Not applicable for systemic absorption; local effect is immediate.
FoodEffect:
Taking with food may prolong the duration of action by delaying gastric emptying.
Distribution:
Vd:
Not applicable; primarily acts locally in the GI tract. Absorbed ions distribute throughout the body.
ProteinBinding:
Not applicable for local action. Absorbed aluminum can bind to plasma proteins (e.g., transferrin).
CnssPenetration:
Limited for the compounds themselves. Absorbed aluminum can cross the blood-brain barrier, especially in renal impairment.
Elimination:
HalfLife:
Not applicable for the compounds. Absorbed aluminum and magnesium ions are renally excreted.
Clearance:
Renal clearance for absorbed ions.
ExcretionRoute:
Unabsorbed drug is excreted in feces. Absorbed aluminum and magnesium ions are excreted renally.
Unchanged:
Majority of administered dose is unabsorbed and excreted unchanged in feces.
Pharmacodynamics
OnsetOfAction:
Within minutes (rapid)
PeakEffect:
Within 20-60 minutes
DurationOfAction:
1-3 hours (depending on gastric emptying rate and presence of food)
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
If you experience any of the following symptoms, call your doctor immediately or seek emergency medical attention, as they may be signs of a severe and potentially life-threatening reaction:
- Signs of an allergic reaction, such as rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. Contact your doctor if you experience any of the following side effects or if they persist or bother you:
- Diarrhea
- Constipation
Reporting Side Effects
This list does not include all possible side effects. If you have questions or concerns about side effects, consult your doctor. For medical advice about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
If you experience any of the following symptoms, call your doctor immediately or seek emergency medical attention, as they may be signs of a severe and potentially life-threatening reaction:
- Signs of an allergic reaction, such as rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. Contact your doctor if you experience any of the following side effects or if they persist or bother you:
- Diarrhea
- Constipation
Reporting Side Effects
This list does not include all possible side effects. If you have questions or concerns about side effects, consult your doctor. For medical advice about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe constipation or diarrhea
- Black, tarry stools (may indicate bleeding)
- Vomiting blood or material that looks like coffee grounds
- Difficulty swallowing
- Unexplained weight loss
- Dizziness or lightheadedness (signs of hypermagnesemia)
- Muscle weakness or fatigue (signs of hypermagnesemia or hypophosphatemia)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
If you have kidney problems, as this may affect your ability to take this medication.
This list is not exhaustive, and it is crucial to discuss all your medications (including prescription and over-the-counter drugs, natural products, and vitamins) and health conditions with your doctor and pharmacist. They will help determine whether it is safe to take this medication in conjunction with your other medications and health issues.
Remember, do not start, stop, or modify the dosage of any medication without first consulting your doctor to ensure your safety.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
If you have kidney problems, as this may affect your ability to take this medication.
This list is not exhaustive, and it is crucial to discuss all your medications (including prescription and over-the-counter drugs, natural products, and vitamins) and health conditions with your doctor and pharmacist. They will help determine whether it is safe to take this medication in conjunction with your other medications and health issues.
Remember, do not start, stop, or modify the dosage of any medication without first consulting your doctor to ensure your safety.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. If you are following a low-magnesium diet, consult with your doctor to discuss any potential interactions. Similarly, if you are on a low-sodium or sodium-free diet, talk to your doctor, as some formulations of this medication may contain sodium.
Do not exceed the prescribed duration of treatment with this medication. Take it only for the length of time specified by your doctor. Additionally, be aware that this drug may interfere with the absorption of other oral medications. If you are taking other medications by mouth, you may need to take them at a different time than this medication. Consult with your doctor to determine the best schedule for your medications.
This medication is not recommended for children under 12 years old unless advised by a doctor. If you are pregnant, planning to become pregnant, or are breastfeeding, inform your doctor. You and your doctor will need to discuss the potential benefits and risks of this medication to both you and your baby.
Do not exceed the prescribed duration of treatment with this medication. Take it only for the length of time specified by your doctor. Additionally, be aware that this drug may interfere with the absorption of other oral medications. If you are taking other medications by mouth, you may need to take them at a different time than this medication. Consult with your doctor to determine the best schedule for your medications.
This medication is not recommended for children under 12 years old unless advised by a doctor. If you are pregnant, planning to become pregnant, or are breastfeeding, inform your doctor. You and your doctor will need to discuss the potential benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe diarrhea (magnesium overdose)
- Severe constipation (aluminum overdose)
- Nausea
- Vomiting
- Abdominal pain
- Muscle weakness
- Drowsiness
- Dizziness
- Slowed heart rate
- Low blood pressure
- Confusion
- Coma (rare, severe cases, especially with renal impairment)
What to Do:
Discontinue use. For severe symptoms, seek immediate medical attention. Call 911 or Poison Control at 1-800-222-1222. Treatment may involve supportive care, IV fluids, and in severe hypermagnesemia, calcium gluconate or dialysis.
Drug Interactions
Contraindicated Interactions
- Sodium Polystyrene Sulfonate (Kayexalate) - risk of intestinal necrosis (with aluminum hydroxide)
Major Interactions
- Tetracyclines (e.g., doxycycline, minocycline) - decreased absorption
- Fluoroquinolones (e.g., ciprofloxacin, levofloxacin) - decreased absorption
- Digoxin - decreased absorption
- Iron salts (e.g., ferrous sulfate) - decreased absorption
- Thyroid hormones (e.g., levothyroxine) - decreased absorption
- Bisphosphonates (e.g., alendronate) - decreased absorption
- Mycophenolate mofetil - decreased absorption
- Azithromycin - decreased absorption
- Ketoconazole/Itraconazole - decreased absorption (due to increased gastric pH)
- Gabapentin - decreased absorption
Moderate Interactions
- H2-receptor antagonists (e.g., ranitidine, famotidine) - altered absorption due to pH change (less significant)
- Phenytoin - decreased absorption
- Warfarin - potential altered absorption (monitor INR)
- Salicylates (e.g., aspirin) - increased urinary excretion of salicylates
- Corticosteroids - potential for increased aluminum absorption with long-term use
- Phosphate binders (e.g., sevelamer) - additive effect on phosphate binding
Minor Interactions
- Benzodiazepines (e.g., diazepam) - altered absorption
- Sulfonylureas - altered absorption
Monitoring
Routine Monitoring
Symptom relief (heartburn, indigestion)
Frequency: Daily, as needed
Target: Resolution or significant reduction of symptoms
Action Threshold: If symptoms persist or worsen after 2 weeks of use, consult a physician.
Bowel habits (constipation/diarrhea)
Frequency: Daily, as needed
Target: Normal bowel function
Action Threshold: If severe constipation or diarrhea occurs, adjust dose or discontinue.
Serum Magnesium (for chronic/high-dose use, especially in renal impairment)
Frequency: Periodically, as clinically indicated
Target: 1.5-2.5 mg/dL
Action Threshold: If >2.5 mg/dL, reduce dose or discontinue. Monitor for signs of hypermagnesemia (e.g., muscle weakness, hypotension, bradycardia).
Serum Phosphate (for chronic/high-dose aluminum hydroxide use)
Frequency: Periodically, as clinically indicated
Target: 2.5-4.5 mg/dL
Action Threshold: If <2.5 mg/dL, reduce dose or discontinue. Monitor for signs of hypophosphatemia (e.g., muscle weakness, bone pain).
Renal Function (BUN, Creatinine) (for chronic/high-dose use)
Frequency: Periodically, as clinically indicated
Target: Normal range for age
Action Threshold: If impaired, consider alternative agents or reduce dose significantly.
Symptom Monitoring
- Persistent heartburn or indigestion
- Abdominal pain
- Nausea
- Vomiting
- Constipation
- Diarrhea
- Muscle weakness
- Fatigue
- Dizziness
- Confusion
Special Patient Groups
Pregnancy
Generally considered safe for occasional use during pregnancy, but consult a healthcare provider before use. Prolonged or high-dose use should be avoided due to potential for electrolyte imbalances (e.g., hypophosphatemia from aluminum, hypermagnesemia in the fetus if maternal renal impairment).
Trimester-Specific Risks:
First Trimester:
Low risk with occasional use.
Second Trimester:
Low risk with occasional use.
Third Trimester:
Low risk with occasional use. Avoid excessive magnesium intake near term due to potential for fetal magnesium toxicity (rare, but possible with very high doses or maternal renal impairment).
Lactation
Considered compatible with breastfeeding. Minimal amounts of aluminum and magnesium are absorbed and excreted into breast milk, and are not expected to cause adverse effects in a healthy, full-term infant.
Infant Risk:
Low risk.
Pediatric Use
Use with caution, especially in children under 6 years of age, and only under medical supervision. Risk of electrolyte imbalances (hypermagnesemia, hypophosphatemia) is higher in infants and young children, particularly those with renal impairment or dehydration. Avoid prolonged use.
Geriatric Use
Use with caution, especially in elderly patients with pre-existing renal impairment, as they are at increased risk for hypermagnesemia and aluminum accumulation/toxicity (e.g., osteomalacia, neurotoxicity). Monitor renal function and electrolyte levels with chronic use.
Clinical Information
Clinical Pearls
- This combination antacid balances the constipating effect of aluminum with the laxative effect of magnesium, often leading to fewer bowel side effects than single-ingredient antacids.
- Advise patients to separate administration of this antacid from other medications by at least 2 hours to minimize drug interactions.
- Warn patients with renal impairment about the significant risk of hypermagnesemia and aluminum toxicity with chronic use.
- Long-term, high-dose use of aluminum-containing antacids can lead to hypophosphatemia and bone demineralization.
- Not intended for chronic daily use without medical supervision. If symptoms persist, further evaluation is warranted.
Alternative Therapies
- H2-receptor antagonists (e.g., famotidine, ranitidine)
- Proton pump inhibitors (e.g., omeprazole, lansoprazole)
- Alginate-based antacids (e.g., Gaviscon Advance)
- Single-ingredient antacids (e.g., Calcium Carbonate, Magnesium Hydroxide)
Cost & Coverage
Average Cost:
Varies, typically $5-$15 per 12 oz (355 mL) bottle
Generic Available:
Yes
Insurance Coverage:
OTC (Over-The-Counter) - generally not covered by prescription insurance, but may be eligible for FSA/HSA.
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication, including the amount taken and the time it happened, to facilitate prompt and effective treatment.