Maalox 400mg + 400mg 40 chewable tablets

In compliance with article 118 "authorization of advertising to the public" of the legislative decree of 24 April 2006, number 219

INDICATIONS

Symptomatic treatment of occasional heartburn and hyperacidity in the stomach.

CONTRAINDICATIONS

- Hypersensitivity to the active substances or to any of the excipients listed in paragraph 6.1. - Patients suffering from porphyria. - Severe forms of renal failure (see section 4.4). - Generally contraindicated in pediatric age. - State of cachexia.

WARNINGS AND PRECAUTIONS FOR USE

Aluminum hydroxide can cause constipation and an overdose of magnesium salts can cause hypomotility of the intestine; high doses of this medicine may cause or aggravate intestinal and ileal obstruction in patients at higher risk, such as those with renal impairment, with underlying constipation, with alteration of intestinal motility, in children (0 to 24 months), or elderly. Aluminum 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 on low-phosphorus diets or in children (0 to 24 months), can lead to phosphate elimination (due to an aluminium-phosphate bond) accompanied by increased bone resorption and hypercalciuria with risk of osteomalacia. It is advisable to consult your doctor in case of long-term use or in patients at risk of hypophosphatemia. In patients with renal impairment, plasma levels of aluminum and magnesium tend to increase, causing hyperaluminemia and hypermagnesemia, respectively. In these patients, long exposures to high doses of aluminum and magnesium salts can lead to encephalopathy, dementia, microcytic anemia or worsening of dialysis-induced osteomalacia. In the presence of mild and moderate forms of renal failure it is advisable to take the product under the direct supervision of a doctor. Prolonged use of the medicine should be avoided in these patients. Aluminum hydroxide may be unsafe in porphyria patients undergoing haemodialysis (see section 4.3). Pediatric population In young children, the use of magnesium hydroxide can lead to hypermagnesemia, particularly if they have kidney damage or dehydration. MAALOX 3.65% + 3.25% oral suspension contains: • parahydroxybenzoates: may cause allergic reactions (even delayed). • approximately 98 mg of I know rbitol in 10 ml (2 teaspoons). Patients with hereditary fructose intolerance should not be given this medicine. • less than 1 mmol (23 mg) of sodium per dose, i.e. it is essentially “sodium-free”. MAALOX 400 mg + 400 mg chewable tablets contains: • approximately 125 mg of sorbitol per tablet. Patients with hereditary fructose intolerance should not be given this medicine. • Sucrose, patients suffering from rare hereditary problems of fructose intolerance, glucose-galactose malabsorption, or sucrase isomaltase insufficiency should not take this medicine. • less than 1 mmol (23 mg) of sodium per dose, i.e. it is essentially “sodium-free”. • 0.000072 mg of benzyl alcohol per tablet. Benzyl alcohol can cause allergic reactions. • Large volumes should be used with caution and only if necessary, during pregnancy and breastfeeding and in patients with hepatic or renal insufficiency, due to the risk of accumulation and toxicity (metabolic acidosis).

INTERACTIONS

Since Al and Mg salts reduce the gastrointestinal absorption of tetracyclines, it is recommended to avoid taking Maalox during oral tetracycline therapy. The use of aluminum-containing antacids may reduce the absorption of drugs such as H₂-antagonists, atenolol, cefdinir, cefpodoxime, chloroquine, tetracyclines, diflunisal, digoxin, bisphosphonates, ethambutol, fluoroquinolones, sodium fluoride, glucocorticoids, indomethacin, isoniazid, ketoconazole, levothyroxine, lincosamides, metoprolol, phenothiazine neuroleptics, penicillamines, propranolol, rosuvastatin, iron salts. • Polystyrene sulfonate (Kayexalate) Caution is advised when the medicinal product is taken together with polystyrene sulfonate (Kayexalate) due to the potential risk of reduced potassium-binding efficacy of the resin, metabolic alkalosis in patients with renal impairment (reported with aluminum hydroxide and magnesium hydroxide), and intestinal obstruction (reported with aluminum hydroxide). • Aluminum hydroxide and citrates can cause hyperaluminemia, especially in patients with renal impairment. Leave at least two hours to pass (4 for fluoroquinolones) before taking MAALOX to avoid interaction with other drugs. Concomitant use of quinidine may result in increased serum quinidine levels and lead to quinidine overdose. The simultaneous use of aluminum hydroxide and citrates can lead to an increase in aluminum levels, particularly in patients with renal failure. The alkalinization of the urine following the administration of magnesium hydroxide can modify the excretion of some drugs; therefore, increased excretion of salicylates was observed.

SIDE EFFECTS

The frequency of the side effects reported below is defined using the following conventions: common (≥1/100, <1/10); uncommon (≥1/1,000, <1/100); rare (≥1/10,000, <1/1,000); very rare (<1/10,000); not known (frequency cannot be estimated from the available data). Immune system disorders. Frequency not known: angioedema, anaphylactic reactions, hypersensitivity reactions, urticaria, pruritus. Gastrointestinal disorders. Uncommon: diarrhea or constipation (see section 4.4); Frequency not known: abdominal pain. Metabolism and nutrition disorders. Very rare: hypermagnesemia, including observations after prolonged administration in patients with renal impairment; Frequency not known: hyperaluminemia, hypophosphatemia, during prolonged use or at high doses or even at normal doses of the medicine in patients with low phosphorus diets or in children (0 to 24 months), which may cause increased bone resorption, hypercalciuria, osteomalacia (see section 4.4). Reporting of suspected adverse reactions Reporting suspected adverse reactions that occur after authorization of the medicine is important, as it allows continuous monitoring of the benefit/risk balance of the medicine. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system at: http://www.aifa.gov.it/content/segnalazioni-reazioni-avverse.