Mag-Al Plus Xs Suspension
It is used to ease too much gas in the stomach.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, Antiflatulent
Pharmacologic Class
Inorganic salts (antacids), Silicone derivative (antiflatulent)
Pregnancy Category
Not formally assigned for OTC products; components generally considered low risk (Category B/C for Aluminum Hydroxide and Magnesium Hydroxide, Simethicone is not absorbed).
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Mag-Al Plus Xs Suspension is an over-the-counter liquid medicine that helps relieve heartburn, acid indigestion, sour stomach, and gas. It works by neutralizing stomach acid and breaking up gas bubbles in your digestive system.
How to Use This Medicine
Taking Your Medication Correctly
To ensure you get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your medication and follow the instructions closely. Take your medication after meals and at bedtime, or as directed by your doctor. Before using, shake the medication well to mix the ingredients evenly.
When taking a liquid dose, measure it carefully using the measuring device that comes with the medication. If a measuring device is not provided, ask your pharmacist for one to ensure accurate dosing.
Storing and Disposing of Your Medication
To maintain the effectiveness and safety of your medication, store it at room temperature with the lid tightly closed. Avoid freezing the medication and keep it in a dry place, away from bathrooms. Keep all medications in a safe location, out of the reach of children and pets.
What to Do If You Miss a Dose
If you take your medication on a regular schedule, take the missed dose as soon as you remember. However, if it's 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 ensure you get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your medication and follow the instructions closely. Take your medication after meals and at bedtime, or as directed by your doctor. Before using, shake the medication well to mix the ingredients evenly.
When taking a liquid dose, measure it carefully using the measuring device that comes with the medication. If a measuring device is not provided, ask your pharmacist for one to ensure accurate dosing.
Storing and Disposing of Your Medication
To maintain the effectiveness and safety of your medication, store it at room temperature with the lid tightly closed. Avoid freezing the medication and keep it in a dry place, away from bathrooms. Keep all medications in a safe location, out of the reach of children and pets.
What to Do If You Miss a Dose
If you take your medication on a regular schedule, take the missed dose as soon as you remember. However, if it's 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 as directed, usually after meals and at bedtime.
- Do not take within 2-4 hours of other medications, especially antibiotics (like tetracyclines or fluoroquinolones), iron supplements, or thyroid hormones, as it can interfere with their absorption.
- Avoid trigger foods that worsen your symptoms (e.g., spicy, fatty, acidic foods, caffeine, alcohol).
- 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 your doctor.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
10-20 mL (2-4 teaspoonfuls) between meals, at bedtime, or as directed by a physician. Do not exceed 80 mL (16 teaspoonfuls) in 24 hours.
Dose Range:
10 - 20 mg
Condition-Specific Dosing:
heartburn:
10-20 mL as needed
acid_indigestion:
10-20 mL as needed
gas_bloating:
10-20 mL as needed
Pediatric Dosing
Neonatal:
Not established; consult physician.
Infant:
Not established; consult physician.
Child:
For children 6-12 years: 5-10 mL (1-2 teaspoonfuls) as directed by a physician. Do not exceed 40 mL (8 teaspoonfuls) in 24 hours. For children under 6 years: Consult a physician.
Adolescent:
For adolescents 12 years and older: Adult dosing (10-20 mL).
Dose Adjustments
Renal Impairment:
Mild:
Use with caution. Monitor for signs of hypermagnesemia and aluminum toxicity with chronic use.
Moderate:
Use with caution. Avoid chronic use due to risk of hypermagnesemia and aluminum toxicity. Monitor serum magnesium and phosphate.
Severe:
Avoid or use with extreme caution and under strict medical supervision due to significant risk of hypermagnesemia and aluminum toxicity (encephalopathy, osteomalacia).
Dialysis:
Generally avoided in dialysis patients due to risk of aluminum accumulation and hypermagnesemia. If used, monitor serum aluminum and magnesium levels closely.
Hepatic Impairment:
Mild:
No specific adjustment needed as components are minimally absorbed and not hepatically metabolized.
Moderate:
No specific adjustment needed.
Severe:
No specific adjustment needed.
Pharmacology
Mechanism of Action
Aluminum Hydroxide and Magnesium Hydroxide act as antacids by neutralizing gastric hydrochloric acid, forming water and neutral salts, thereby increasing gastric pH. Magnesium hydroxide is a potent, rapid-acting antacid that can cause diarrhea, while aluminum hydroxide is a slower-acting antacid that can cause constipation; their combination balances these effects. Simethicone is an antiflatulent that reduces the surface tension of gas bubbles in the gastrointestinal tract, causing them to coalesce and be more easily expelled by belching or passing flatus.
Pharmacokinetics
Absorption:
Bioavailability:
Aluminum Hydroxide: <0.01% (minimally absorbed). Magnesium Hydroxide: Approximately 15-30% of magnesium is absorbed. Simethicone: Not absorbed systemically.
Tmax:
Antacid effect: Rapid (within minutes).
FoodEffect:
Taking after meals can prolong the antacid effect by delaying gastric emptying.
Note:
Systemic absorption is minimal for aluminum hydroxide and simethicone. A portion of magnesium is absorbed.
Distribution:
Vd:
Not applicable for non-systemically absorbed components. Absorbed magnesium distributes throughout the body.
ProteinBinding:
Not applicable for antacid action. Absorbed magnesium is approximately 30% protein bound.
CnssPenetration:
Limited for absorbed magnesium; none for aluminum hydroxide or simethicone.
Elimination:
HalfLife:
Not applicable for antacid action or non-absorbed simethicone. Absorbed magnesium has a half-life of approximately 2-6 hours, dependent on renal function.
Clearance:
Not applicable for antacid action. Absorbed magnesium is primarily cleared renally.
ExcretionRoute:
Unabsorbed aluminum and magnesium are excreted in feces. Absorbed magnesium is excreted renally. Simethicone is excreted unchanged in feces.
Unchanged:
Aluminum Hydroxide: >99% (unabsorbed). Magnesium Hydroxide: 70-85% (unabsorbed). Simethicone: 100% (unabsorbed).
Pharmacodynamics
OnsetOfAction:
Rapid (within minutes for antacid effect).
PeakEffect:
Within 30 minutes for antacid effect.
DurationOfAction:
1-3 hours, depending on gastric emptying and presence of food.
Note:
The duration of action is influenced by the rate of gastric emptying; food can prolong the effect.
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction, including:
+ 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
+ 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. If you experience any of the following side effects or any other unusual symptoms that bother you or persist, contact your doctor for advice:
Diarrhea
Constipation
Note: This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, don't hesitate to reach out to your doctor.
Reporting Side Effects
To report side effects, you can:
Call your doctor for medical advice
Contact the FDA at 1-800-332-1088
Visit the FDA's MedWatch website at https://www.fda.gov/medwatch to report side effects online.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction, including:
+ 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
+ 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. If you experience any of the following side effects or any other unusual symptoms that bother you or persist, contact your doctor for advice:
Diarrhea
Constipation
Note: This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, don't hesitate to reach out to your doctor.
Reporting Side Effects
To report side effects, you can:
Call your doctor for medical advice
Contact the FDA at 1-800-332-1088
Visit the FDA's MedWatch website at https://www.fda.gov/medwatch to report side effects online.
Seek Immediate Medical Attention If You Experience:
- Severe abdominal pain
- Black, tarry stools or blood in vomit (signs of gastrointestinal bleeding)
- Difficulty swallowing
- Unexplained weight loss
- Symptoms that worsen or do not improve after 2 weeks of use
- Signs of electrolyte imbalance (e.g., muscle weakness, confusion, irregular heartbeat, severe constipation or diarrhea)
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 the safety and efficacy of the 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, with your doctor and pharmacist. They will help you determine if it is safe to take this medication in conjunction with your other medications and health conditions.
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 the safety and efficacy of the 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, with your doctor and pharmacist. They will help you determine if it is safe to take this medication in conjunction with your other medications and health conditions.
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. Do not exceed the prescribed duration of treatment with this drug, as directed by your doctor.
This medication may interfere with the absorption of other oral medications, reducing their effectiveness. If you are taking other drugs by mouth, your doctor may recommend taking them at a different time than this medication to minimize potential interactions. Be sure to discuss this with your doctor.
If you are pregnant, planning to become pregnant, or are breast-feeding, inform your doctor. You and your doctor will need to carefully weigh the benefits and risks of this medication to both you and your baby to make an informed decision.
This medication may interfere with the absorption of other oral medications, reducing their effectiveness. If you are taking other drugs by mouth, your doctor may recommend taking them at a different time than this medication to minimize potential interactions. Be sure to discuss this with your doctor.
If you are pregnant, planning to become pregnant, or are breast-feeding, inform your doctor. You and your doctor will need to carefully weigh the benefits and risks of this medication to both you and your baby to make an informed decision.
Overdose Information
Overdose Symptoms:
- Severe diarrhea (due to magnesium)
- Severe constipation or fecal impaction (due to aluminum)
- Abdominal pain, nausea, vomiting
- Hypermagnesemia (muscle weakness, lethargy, confusion, hypotension, bradycardia, respiratory depression, coma)
- Hypophosphatemia (muscle weakness, bone pain, fatigue, confusion, seizures)
- Aluminum toxicity (in patients with renal impairment: encephalopathy, osteomalacia, proximal myopathy)
What to Do:
Discontinue use immediately. Seek emergency medical attention or call a poison control center (1-800-222-1222). Treatment is supportive and may include intravenous fluids, calcium gluconate for hypermagnesemia, and in severe cases, dialysis.
Drug Interactions
Major Interactions
- Tetracyclines (e.g., doxycycline, tetracycline): Reduced absorption due to chelation.
- Fluoroquinolones (e.g., ciprofloxacin, levofloxacin): Reduced absorption due to chelation.
- Bisphosphonates (e.g., alendronate, risedronate): Reduced absorption.
- Thyroid hormones (e.g., levothyroxine): Reduced absorption.
- Digoxin: Reduced absorption.
- Iron supplements: Reduced absorption.
- Mycophenolate mofetil: Reduced absorption.
- Sodium polystyrene sulfonate (Kayexalate): Risk of intestinal necrosis (especially with aluminum hydroxide).
Moderate Interactions
- Azole antifungals (e.g., ketoconazole, itraconazole): Reduced absorption due to increased gastric pH.
- H2 receptor antagonists (e.g., famotidine) and Proton Pump Inhibitors (e.g., omeprazole): Redundant use, but can be used for breakthrough symptoms; separate administration.
- Salicylates (e.g., aspirin): Increased urinary excretion of salicylates due to urinary alkalinization.
- Phenytoin: Reduced absorption.
- Gabapentin: Reduced absorption.
- Sucralfate: May reduce the effectiveness of sucralfate by altering gastric pH.
Minor Interactions
- Benzodiazepines (e.g., diazepam): May delay absorption.
- Corticosteroids: May reduce absorption.
Monitoring
Routine Monitoring
Symptom relief (heartburn, indigestion, gas)
Frequency: Daily, as needed
Target: Resolution or significant improvement of symptoms
Action Threshold: If symptoms persist for more than 2 weeks or worsen, 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 use in renal impairment)
Frequency: Periodically, as clinically indicated
Target: 0.7-1.1 mmol/L (1.7-2.7 mg/dL)
Action Threshold: If elevated, reduce dose or discontinue.
Serum Phosphate (for chronic high-dose aluminum use)
Frequency: Periodically, as clinically indicated
Target: 0.81-1.45 mmol/L (2.5-4.5 mg/dL)
Action Threshold: If low, consider phosphate supplementation or discontinue aluminum-containing antacid.
Symptom Monitoring
- Relief of heartburn
- Reduction in acid indigestion
- Decrease in bloating and gas pressure
- Changes in bowel habits (constipation or diarrhea)
- Signs of hypermagnesemia (muscle weakness, lethargy, confusion, hypotension, bradycardia)
- Signs of hypophosphatemia (muscle weakness, bone pain, fatigue)
Special Patient Groups
Pregnancy
Generally considered safe for occasional use during pregnancy. Aluminum and magnesium hydroxides are minimally absorbed, and simethicone is not absorbed. However, chronic or high-dose use should be discussed with a healthcare provider due to potential for electrolyte imbalances or aluminum accumulation.
Trimester-Specific Risks:
First Trimester:
Low risk for occasional use.
Second Trimester:
Low risk for occasional use.
Third Trimester:
Low risk for occasional use. Avoid excessive magnesium intake near term as it may affect uterine contractions, though this is more relevant for IV magnesium.
Lactation
Generally considered safe for use during breastfeeding. Minimal amounts of magnesium may pass into breast milk, but are unlikely to harm the infant. Aluminum and simethicone are not significantly absorbed or excreted into breast milk.
Infant Risk:
Low risk to the breastfed infant.
Pediatric Use
Use in children under 12 years should be under the guidance of a physician, as specific dosing and potential for electrolyte imbalances (especially with chronic use) need careful consideration. Risk of aluminum toxicity is higher with chronic use in children, particularly those with renal impairment.
Geriatric Use
Use with caution in elderly patients, especially those with impaired renal function, due to an increased risk of hypermagnesemia and aluminum toxicity. Monitor for signs of adverse effects and consider lower doses or less frequent administration.
Clinical Information
Clinical Pearls
- Shake the suspension well before each dose to ensure uniform distribution of active ingredients.
- Advise patients to separate administration of this antacid from other medications by at least 2-4 hours to minimize drug interactions.
- While effective for symptomatic relief, antacids do not treat the underlying cause of acid reflux or indigestion. Encourage patients to seek medical advice if symptoms are persistent or severe.
- Warn patients with renal impairment about the risks of magnesium and aluminum accumulation with chronic use.
- The combination of aluminum and magnesium hydroxides helps to balance the common side effects of constipation (aluminum) and diarrhea (magnesium).
Alternative Therapies
- Calcium Carbonate (e.g., Tums, Rolaids - antacid)
- Sodium Bicarbonate (e.g., Alka-Seltzer - antacid)
- H2 Receptor Antagonists (e.g., famotidine, ranitidine - reduce acid production)
- Proton Pump Inhibitors (e.g., omeprazole, esomeprazole - block acid production)
- Alpha-galactosidase (e.g., Beano - for gas from certain foods)
- Lactase supplements (for gas from lactose intolerance)
Cost & Coverage
Average Cost:
Typically $5-$15 per 355 mL (12 fl oz) bottle
Generic Available:
Yes
Insurance Coverage:
Over-the-counter (OTC) products are generally not covered by prescription insurance plans, but may be eligible for FSA/HSA reimbursement.
General Drug Facts
If your symptoms or health issues persist or worsen, it is 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 it is a good idea to check with your pharmacist for more information. If you have any questions or concerns about this medication, do not hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When reporting the incident, be prepared to provide details about the medication taken, the amount, and the time it occurred.