- magnesium hydroxide
- aluminium hydroxide gel
GSL: General Sales List
This information is intended for use by health professionals
The active components of Maalox Plus are:
Dried Aluminium Hydroxide Gel
Also contains 320mg of sorbitol (E420), per 5ml.
For a full list of excipients, see section 6.1
White suspension, homogenous after shaking, with the odour and taste of lemon.
The symptomatic relief of:
For oral administration:
5-10ml taken 20 minutes to 1 hour after meals and at bedtime or as required.
As an appropriate proportion of the adult dose.
Children under 5 years
Maximum of 5ml t.d.s.
The normal adult dose is appropriate.
Should not be used in patients who are hypersensitive to any of the active substances or excipients, are severely debilitated or suffering from kidney failure, or hypophosphataemia.
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-phosphorous 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 anemiaor worsen dialysis-induced osteomalacia.
Aluminium hydroxide may be unsafe in patients with porphyria undergoing hemodialysis. The prolonged use of antacids in patients with renal failure should be avoided.
This product contains sorbitol (E420). Patients with rare hereditary problems of fructose intolerance should not take this medicine.
In young children the use of magnesium hydroxide can produce a hypermagnesemia, especially if they present renal impairment or dehydration.
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 risks 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 (Suspension) 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 feotus.
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 effect on the breastfed newborn/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 (≥1/10,000 to <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.
Pharmacotherapeutic group: Drugs for acid related disorders; Antacids with antiflatulents, ATC Code: A02AF02
Dried aluminium hydroxide gel
- antifoaming agent/antiflatulent
Maalox Plus is a balanced mixture of two antacids and an antiflatulent/antifoaming agent simeticone. The two antacids are magnesium hydroxide which is fast acting and aluminium hydroxide which is a slow acting antacid. The combination produces a fast onset of action and an increase in total buffering time. Aluminium hydroxide on its own is an astringent and may cause constipation. This effect is balanced by the effect of the magnesium hydroxide which is in common with other magnesium salts may cause diarrhoea.
There are no pre-clinical data of relevance to the prescriber which are additional to that already included in other sections of the SmPC.
Microcrystalline cellulose and carmellose sodium
Hydrogen peroxide 30%
Citric acid monohydrate
Sorbitol liquid 70% (non-crystallising) (E420)
Swiss cream flavour
Unopened: 2 years
After opening: 6 months
Store below 30°C.
Do not refrigerate or freeze.
White polyethylene terephthalate (PET) bottles with polypropylene (PP) closure and polyethylene (PE/LDPE) liner : 250ml and 355ml.
Not all pack sizes may be marketed
No special requirements
Aventis Pharma Limited, trading as Sanofi
410 Thames Valley Park Drive,
Date of first authorisation: 27 January 2009
Sanofi, 410 Thames Valley Park Drive, Reading, Berkshire, RG6 1PT, UK
+44 (0)800 035 2525
+44 (0)845 023 0441