Dyspepsia. Dyspepsia covers upper abdominal pain, fullness, early satiety, bloating, and nausea.

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1 Antacids Hawler medical university Collage of pharmacy/ fourth year /pharmacy practice Sham A. Talat Shareef (B.Sc. Msc. clinical pharmacy) Head of Department Of Clinical Pharmacy in DOH

2 Objectives Brand name Generic name Primary indication, drug classes Dosage forms Patient counseling information Important side effects and contraindications

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4 Dyspepsia Dyspepsia covers upper abdominal pain, fullness, early satiety, bloating, and nausea. It can occur with gastric and duodenal ulceration and, gastric cancer, but most commonly it is of uncertain origin.

5 Referral cases Urgent endoscopic investigation is required if dyspepsia is accompanied by alarm features (e.g. bleeding, dysphagia, recurrent vomiting, or weight loss). Urgent investigation should also be considered for patients over 55 years with unexplained, recent-onset dyspepsia that has not responded to treatment.

6 Non pharmacological treatment Patients with dyspepsia should be advised about lifestyle changes (avoidance of excess alcohol and of aggravating foods such as fats). other measures include weight reduction, smoking cessation, and raising the head of the bed. Some medications may cause dyspepsia these should be stopped, if possible.

7 Antacids Antacids (usually containing aluminium or magnesiumm compounds) can often relieve symptoms in ulcer dyspepsia in non-erosive gastro-oesophageal reflux disease functional (non-ulcer) dyspepsia

8 Dispensing informations Antacids are best given when symptoms occur or are expected, usually between meals and at bedtime, although additional doses may be required.

9 Which antacid dosage form are more effective? Liquid preparations are more effective than tablet preparations

10 What does most antacids contain? Aluminium- and magnesium-containing antacids (e.g. aluminium hydroxide, and magnesium carbonate, hydroxide and magnesium trisilicate, being relatively insoluble in water, are long-acting if retained in the stomach. They are suitable for most antacid purposes. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids may be constipating; antacids containing both magnesium and aluminium may reduce these colonic side-effects.

11 Which antacids No longer recommended to dispense?why Sodium bicarbonate: should no longer be prescribed alone for the relief of dyspepsia but it is present as an ingredient in many indigestion remedies. However, it retains a place in the management of urinary-tract disorders and acidosis. Bismuth-containing antacids (unless chelates): are not recommended because absorbed bismuth can be neurotoxic, causing encephalopathy; they tend to be constipating. Calcium-containing antacids: can induce rebound acid secretion: with modest doses the clinical significance is doubtful, but prolonged high doses also cause hypercalcaemia and alkalosis.

12 Other important component may be added to the antacid Simeticone Simeticone (activated dimeticone) is added to an antacid as an antifoaming agent to relieve flatulence. These preparations may be useful for the relief of hiccup in palliative care. Alginates Alginates taken in combination with an antacid increases the viscosity of stomach contents and can protect the oesophageal mucosa from acid reflux. Some alginate containing preparations form a viscous gel ( raft ) that floats on the surface of the stomach contents, thereby reducing symptoms of reflux.

13 Co-magaldrox ( aluminium hydroxide, magnesium hydroxide) Trade name : MUCOGEL MAALOX Indication :Dyspepsia MEDICINAL FORMS: Oral suspension, chewable tablets DISPENSING INFORMATION: are low in sodium. Maalox pulse: in addition cotaines semithecone (Simeticone (activated dimeticone) is an antifoaming agent.

14 Gaviscon

15 Difference in contents Gaviscon original contains Sodium Alginate, calcium carbonate and sodium bicarbonate. Gaviscon Advance contains Sodium Alginate and potassium bicarbonate. Gaviscon double action contains Sodium alginate, calcium carbonate, sodium bicarbonate Gaviscon Advance contains double the amount of Sodium Alginate than the Gaviscon original.

16 Difference in packaging and availability Gaviscon Original: is available in the form of chewable tablets, liquid and liquid sachets. Gaviscon Advance: is available in the form of tablets and liquids. Gaviscon double action: available in the form of chewable tablets, liquid and liquid sachets.

17 Gaviscon Original Soothing heartburn relief. Gets to work instantly. Lasts up to 2x longer than antacids. Suitable for use in pregnancy.

18 Gaviscon double action Dual relief from heartburn and indigestion.

19 Gaviscon Advance Liquids Soothing relief from heartburn, indigestion & reflux cough. Extra strength formula.

20 Gaviscon Infant Contains Sodium alginate and magnesium alginate Helps to prevent gastric reflux and regurgitation. Oral powder suspension Suitable for children ages 1 to 2

21 ANTACIDS CONTAIN ALGINATES

22 RENNE What Rennie Soft Chews contains: Each tablet contains the active ingredient: calcium carbonate 800mg.

23 RENNE Adults & children over 12 years: 1-2 tablets to be sucked or chewed, as required, preferably 1 hour after meals and before bedtime. For heartburn an extra 2 tablets may be taken between these times. Do not take more than 10 tablets a day. Children under 12 years: Not recommended. Pregnancy and breast-feeding: Rennie Soft Chews can be used during pregnancy and breastfeeding if taken as instructed

24 WHAT ARE RENNIE AND WHAT ARE THEY USED FOR? Rennie Soft Chews are soft and chewy antacid tablets, with a smooth freshmint taste, which quickly and effectively relieve the discomfort of indigestion, heartburn, acid indigestion, dyspepsia, nervous indigestion, flatulence, upset stomach, indigestion during pregnancy and biliousness.

25 containdications If you have severe kidney disease. If you have high calcium in the urine or kidney stones. If you have high calcium or low phosphate levels in the blood.

26 SIDE EFFECTS Long term use of high doses can cause high blood levels of calcium, especially in people with kidney conditions. Symptoms of this may include nausea, vomiting, upset stomach, diarrhoea, tiredness, muscular weakness, headache, kidney problems and impaired sense of taste.

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