Magnesium hydroxide Digoxin

Aluminum Hydroxide + Magnesium Hydroxide (Maalox) [OTC] [Antacid/Aluminum Magnesium Salts] Uses Hyper-acidity (peptic ulcer, hiatal hernia, etc) Action Neutralizes gastric acid Dose Adults. 10-20 mL or 2-4 tabs PO qid or PRN Feds. 5-15 mL PO qid or PRN Caution [C, ] Disp Tabs, susp SE May cause t Mg in renal insuff, constipation, D Interactions In addition to AlOH, X effects OF digoxin, quinolones, phenytoin, Fe supl, ketoconazole EMS None OD May cause constipation, loss of appetite, painful urination, heart rhythm changes, muscle weakness, and peripheral edema symptomatic and supportive... 

No adverse interactions appear to occur with clopidogrel and alu-minium/magnesium hydroxide, atenolol, cimetidine, digoxin, food, insulin, nifedipine, oestrogens, phenobarbital, phenytoin or tolbutamide. 

When digoxin was given with 30 mL of an aluminium/magnesium hydroxide antacid and mexiletine, the digoxin AUC was approximately halved. As mexiletine , (p.931) does not appear to interact with digoxin the interaction was attributed to the antacid. ... 

Other bioavailability studies have not found a significant interaction between digoxin capsules and aluminium/magnesium hydroxide. ... 

In vitro studies with digitoxin suggest that it might possibly interact like digoxin, and be absorbed by various antacids, but lanatoside C probably does not interact. Bioavailability studies have not found a significant interaction between beta-acetyidigoxin and aluminium/magnesium hydroxide. ... 

The absorption of raloxifene is reduced by colestyramine, and their concurrent use is not recommended. No clinically relevant changes in raloxifene pharmacokinetics occur with alumini-um/magnesium hydroxide, amoxicillin, ampicillin or calcium carbonate. Raloxifene does not alter digoxin or methylprednisolone levels. Oral antibacterials, antihistamines, aspirin, benzodiazepines, H2-receptor antagonists, ibuprofen or paracetamol (acetaminophen) were used in clinical studies without any obvious effect on raloxifene levels. Smoking does not appear to alter the efficacy of raloxifene. 

Figure 6.20 Adsorption of digoxin by some antacids at 37 0.1°C ( ) magnesium trisilicate, (A) aluminium hydroxide gel BP (Aludrox was used in the concentration range 2.5-10%v/v), (A) light magnesium oxide, (O) light magnesium carbonate, ( ) calcium carbonate. Initial concentration of the glycoside 0.25 mg%.

Figure 10.16 Adsorption of digoxin from Lanoxin paediatric elixir at 37 0.1 °C by , Aluminium Hydroxide Gel BP (10% v/v) A, Magnesium Trisilicate Mixture BPC (10% v/v) A, Gelusil suspension (10% v/v) , Lanoxin elixir diluted 1 10 with water.

Other studies describe reductions in digoxin absorption of 11% with aluminium hydroxide, 15% with bismuth carbonate and light magnesium carbonate, and 99.5% with magnesium trisilicate. ... 

Evidence of no interaction. A study in 4 patients chronically treated with digoxin 250 to 500 micrograms daily, found that the concurrent use of either 10 mL of aluminium hydroxide mixture BP or magnesium trisilicate mixture BP, three times daily, did not reduce the bioavailability of the digoxin and none of the patients showed any reduction in the control of their symptoms. ... 

Allen MD, Greenblatt DJ, Harmatz JS, Smith TW. Effect of magnesium aluminum hydroxide and kaolin-pectin on absorption of digoxin from tablets and capsules. J Clin Pharmacol (1981) 21,26-30. 

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