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Dyspepsia - pregnancy-associated - Management
What should issues should I consider before prescribing antacids or alginates?
- Antacids and alginates are considered safe in pregnancy when used at the correct dosage, despite a lack of evidence from controlled or observational studies. They are considered to be an unclassified risk in pregnancy by the United States Food and Drug Administration [American Gastroenterological Association, 2006], and pregnancy is not listed as a contraindication or caution to antacid use in the British National Formulary (BNF) [BNF 54, 2007]. Some products, such as Gaviscon®, are licensed for use in pregnancy [ABPI Medicines Compendium, 2005; ABPI Medicines Compendium, 2007].
- The recommended antacids and alginates are listed in Table 1. Liquids are generally preferred as they are considered more effective [BNF 54, 2007], and tablets are not as widely available on the NHS.
- Antacids and alginates are usually used as required or just before symptoms are expected (e.g. before meals and sleep).
- Taking antacids with food may prolong their duration of action.
- Antacids may impair the absorption of some drugs, and they can prevent the absorption of iron supplements. If an interaction is anticipated, the drug should ideally be taken at least 2 hours after the antacid is used.
- Antacids and alginates are well tolerated with few adverse effects when used at the correct dosage:
- Magnesium products tend to cause diarrhoea, whereas aluminium products cause constipation [BNF 54, 2007]. Taking a product with both minerals may alleviate these symptoms, although CKS found no evidence to support this.
- Some alginate products have a high sodium content. If hypertension or pre-eclampsia is likely to be problematic, it may be better to avoid these, although there is a lack of evidence to support this [Duley, 2004].
Table 1. Antacid and alginate products recommended for prescription by CKS.
Product type | Active ingredients and form | Proprietary names |
|---|
Combined magnesium and aluminium (co-magaldrox) | Magnesium hydroxide, dried aluminium hydroxide suspension | Maalox® Mucogel® |
Combined alginate products | Sodium alginate combined with various ingredients, including calcium carbonate, potassium bicarbonate, magnesium carbonate | Gaviscon® Advance* Peptac® Rennie® Duo* |
* Licensed for use in pregnancy. |
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