- aluminium hydroxide gel
- magnesium hydroxide
GSL: General Sales List
This information is intended for use by health professionals
Maalox Plus Tablets
Aluminium hydroxide gel (dried)
Bi-layered white and yellow tablets, 16mm in diameter, with 'Maalox' embossed on one side.
The symptomatic relief of:
Route of administration: Oral
Adults (including elderly persons): 1-2 tablets well chewed, four times a day, taken twenty minutes to one hour after meals and at bedtime, or as required.
Children: Not recommended
Should not be used in patients who are severely debilitated or suffering from kidney failure.
Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine.
Hypersensitivity to the active ingredients or to any of the excipients.
Aluminium hydroxide may cause constipation and magnesium salts overdose may cause hypomotility of the bowel; large doses of this product may trigger or aggravate intestinal obstruction and ileus in patients at higher risk such as those with renal impairment, or the elderly.
Aluminium hydroxide is not well absorbed from the gastrointestinal tract, and systemic effects are therefore rare in patients with normal renal function. However, excessive doses or long-term use, or even normal doses in patients with low-phosphorus diets, may lead to phosphate depletion (due to aluminium-phosphate binding) accompanied by increased bone resorption and hypercalciuria with the risk of osteomalacia. Medical advice is recommended in case of long-term use or in patients at risk of phosphate depletion.
In patients with renal impairment, plasma levels of both aluminium and magnesium increase. In these patients, a long-term exposure to high doses of aluminium and magnesium salts may lead to encephalopathy, dementia, microcytic anaemia, or worsen dialysis-induced osteomalacia,
Aluminium hydroxide may be unsafe in patients with porphyria undergoing haemodialysis. The prolonged use of antacids in patients with renal failure should be avoided.
Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrose-isomaltase insufficiency should not take this medicine.
Maalox Plus should not be taken simultaneously with other medicines as they may interfere with their absorption if taken within 1 hour.
Aluminium-containing antacids may prevent the proper absorption of drugs such as tetracyclines, vitamins, ciprofloxacin, ketoconazole, hydroxychloroquine, chloroquine, chlorpromazine, rifampicin, cefdinir, cefpodoxime, levothyroxine, rosuvastatin, H2 antagonists, atenolol, cyclines, diflunisal, digoxin, bisphosphonates, ethambutol, fluoroquinolones, sodium fluoride, glucocorticoids, indomethacin, isoniazid, lincosamides, metoprolol, phenothiazine neuroleptics, penicillamine, propranolol, and iron salts.
Levothyroxine may also bind to simeticone which may delay or reduce the absorption of levothyroxine.
Caution is advised when used concomitantly with polystyrene sulphonate due to the potential risk of reduced effectiveness of the resin in binding potassium of metabolic alkalosis in patients with renal failure (reported with aluminium hydroxide and magnesium hydroxide), and of intestinal obstruction (reported with aluminium hydroxide).
Concomitant use of aluminium products with quinidines may increase the serum levels of quinidine and lead to quinidine overdosage.
Because of the aluminium content, Maalox Plus should not be concomitantly administered with tetracycline-containing antibiotics or any tetracycline salts.
Aluminium hydroxide and citrates may result in increased aluminium levels, especially in patients with renal impairment.
Urine alkalinisation secondary to administration of magnesium hydroxide may modify excretion of some drugs; thus, increased excretion of salicylates has been seen.
The safety of Maalox Plus Tablets in pregnancy has not been established.
There are no available data on Maalox Plus use in pregnant women. No conclusions can be drawn regarding whether or not Maalox Plus is safe for use during pregnancy. Maalox Plus should be used during pregnancy only if the potential benefits to the mother outweigh the potential risks, including those to the fetus.
Because of the limited maternal absorption, when used as recommended, minimal amounts, if any, of aluminium hydroxide and magnesium salt combinations are expected to be excreted into breast milk.
Simeticone is not absorbed from the gastrointestinal tract.
No effects on the breastfed new born/infant are anticipated since the systemic exposure of the breast-feeding woman to aluminium hydroxide, magnesium hydroxide and simeticone is negligible.
The following CIOMS frequency rating is used, when applicable:
Very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000to <1/1,000), very rare (<1/10,000), not known (cannot be estimated from available data).
Immune system disorders
Frequency not known: hypersensitivity reactions, such as pruritus, urticaria, angioedema and anaphylactic reactions.
Gastrointestinal side effects are uncommon.
Uncommon: diarrhoea or constipation (see section 4.4)
Frequency not known: Abdominal pain
Injury, poisoning and procedural complications:
Frequency not known:
Hyperaluminemia (related to Aluminium component).
Metabolism and nutrition disorders
Very rare: Hypermagnesemia, including observations after prolonged administration of magnesium hydroxide to patients with renal impairment.
Frequency not known:
Hypophosphatemia, in prolonged use or at high doses or even normal doses of the product in patients with low-phosphorus diets, which may result in increased bone resorption, hypercalciuria, osteomalacia (see section 4.4).
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
Serious symptoms are unlikely following overdosage.
Reported symptoms of acute overdose with aluminium hydroxide and magnesium salts combination include diarrhoea, abdominal pain, vomiting.
Large doses of this product may trigger or aggravate intestinal obstruction and ileus in patients at risk (see section 4.4)
Aluminium and magnesium are eliminated through urinary route; treatment of acute overdose consists of administration of IV Calcium Gluconate, rehydration and forced diuresis. In case of renal function deficiency, haemodialysis or peritoneal dialysis is necessary.
Dried aluminium hydroxide gel - antacid
Magnesium hydroxide - antacid
Simeticone - Antifoaming agent/antiflatulent
The antacids are balanced such that gastrointestinal side effects (constipation and diarrhoea) are minimal.
Swiss Cream flavour
Citric acid, anhydrous
Sorbitol liquid non-crystallising (E420)
Iron oxide yellow (E172)
Pregelatinised starch (Maize starch)
Store below 25°C
Plastic/aluminium strip packs packed in cardboard boxes
Packs of 10,12,20,24,30,36,40,48,50,60,70,72,80,84,90,96,100 tablets are available
Paper/foil roll tubes of 12 tablets sold individually or packed in cellophane pillow packs or cardboard cartons
Packs of 12, 24, 36, 48, 72, 144 tablets are available
Aventis Pharma Limited, trading as Sanofi
410 Thames Valley Park Drive,
23 January 2009
Sanofi, 410 Thames Valley Park Drive, Reading, Berkshire, RG6 1PT, UK
+44 (0)800 035 2525
+44 (0)845 023 0441