Nausea antacids

Magnesium-containing antacids—severe diarrhea, dehydration, and hypermagnesemia (nausea, vomiting, hypotension, decreased respirations)... 

Azithromycin 1 0 mg/kg x 1 day, 5 mg/kg per day x 4 days 10 mg/kg per day x 3 days or 30 mg/kg single dose (adult dose 500 mg x 1,250 mg x 4 days 500 mg/day x 3 days) Nausea, vomiting, diarrhea, abdominal pain S3 Separate from Al or Mg antacids by 2 hours diarrhea/vomiting more common with singledose regimen 3- or 5-day courses preferred increasing pneumococcal resistance many failures with H. influenzae infection... 

GI complaints are the most common adverse effects of NSAIDs. Minor complaints such as nausea, dyspepsia, anorexia, abdominal pain, flatulence, and diarrhea occur in 10% to 60% of patients. NSAIDs should be taken with food or milk, except for enteric-coated products (milk or antacids may destroy the enteric coating and cause increased GI symptoms in some patients). 

Single or combination nonprescription antacid products, especially those containing magnesium hydroxide, aluminum hydroxide, and/or calcium carbonate, may provide sufficient relief from simple nausea or vomiting, primarily through gastric acid neutralization. 

Common antacid dosage regimens for the relief of nausea and vomiting include one or more small doses of single- or multiple-agent products. 

Antacids containing calcium carbonate have the greatest neutralising capacity but tend to cause acid rebound with long-term use. Calcium carbonate may also lead to hypercalcaemia and the milk-alkali syndrome, which is characterised by nausea, headache and renal damage. 

Milk-alkali syndrome Milk-alkali syndrome, an acute illness with symptoms of headache, nausea, irritability, and weakness, or a chronic illness with alkalosis, hypercalcemia and, possibly, renal impairment, has occurred following the concurrent use of high-dose calcium carbonate and sodium bicarbonate. Hypophosphatemia Prolonged use of aluminum-containing antacids may result in hypophosphatemia in normophosphatemic patients if phosphate intake is not adequate. 

Milk-alkali syndrome (may result from excessive antacid use) confusion, headache, nausea, vomiting, anorexia, urinary stones, hypercalcemia... 

Nausea Usually transient and dose-related. May improve with dose reduction or symptomatic measures (e.g., food, antacids, addition of drugs that block 5-HT 3 receptors, such as cisapride). There has been increasing concern about using cisapride in combination with antidepressants that can substantially inhibit CYP 3A3/4 (i.e., fluvoxamine, nefazodone). The reason is that high levels of cisapride can cause arrhythmias as a result of delayed intracardiac conduction. 

When levodopa is given without a peripheral decarboxylase inhibitor, anorexia and nausea and vomiting occur in about 80% of patients. These adverse effects can be minimized by taking the drug in divided doses, with or immediately after meals, and by increasing the total daily dose very slowly antacids taken 30-60 minutes before levodopa may also be beneficial. The vomiting has been attributed to stimulation of the chemoreceptor trigger zone located in the brain stem but outside the blood-brain barrier. Fortunately, tolerance to this emetic effect develops in many patients. Antiemetics such as phenothiazines should be avoided because they reduce the antiparkinsonism effects of levodopa and may exacerbate the disease. 

Atazanavir PI2 400 mg daily or 300 mg daily with ritonavir 100 daily. Adjust dose in hepatic insufficiency Take with food. Separate dosing from ddl or antacids by 1 h. Separate dosing from cimetidine and other acid-reducing agents by 12 h Nausea, vomiting, diarrhea, abdominal pain, headache, peripheral neuropathy, skin rash, indirect hyperbilirubinemia, prolonged PR and/or QTC interval See footnote 4 for contraindicated medications. Also avoid indinavir, irinotecan, and omeprazole. Avoid in severe hepatic insufficiency... 

Delavirdine NNRTI 400 mg tid Separate dosing from ddl or antacids by 1 h Rash, t liver enzymes, headache, nausea, diarrhea See footnote 4 for contraindicated medications. Also avoid concurrent fosamprenavir and rifabutin. Teratogenic in rats... 

Fosamprenavir PI2 1400 mg bid or 700 mg bid with ritonavir 100 bid or 1400 mg daily with ritonavir 100-200 mg daily. Adjust dose in hepatic insufficiency Separate dosing from antacids by 2 h. Avoid concurrent high-fat meals Diarrhea, nausea, vomiting, hypertriglyceridemia, rash, headache, perioral paresthesias, t liver enzymes See footnote 4 for contraindicated medications. Do not administer with lopinavir/ritonavir or in severe hepatic insufficiency. Also avoid cimetidine, disulfiram, metronidazole, vitamin E, ritonavir oral solution, and alcohol when using the oral solution... 

Raltegravir Integrase inhibitor 400 mg bid Separate dosing from antacids Diarrhea, nausea, fatigue, headache, dizziness, muscle aches, t creatine kinase Avoid rifampin... 

Tipranavir PI2 Must be taken with ritonavir to achieve effective levels tipranavir 500 mg bid/ritonavir 200 mg bid. Avoid use in hepatic insufficiency. Approved for pediatric usage Take with food. Separate from ddl by at least 2 h. Avoid antacids. Avoid in patients with sulfa allergy. Refrigeration required Diarrhea, nausea, vomiting, abdominal pain, rash, t liver enzymes, hypercholesterolemia, hypertriglyceridemia See footnote 4 for contraindicated medications. Avoid concurrent fosamprenavir, saquinavir. Do not administer to patients at risk for bleeding... 

Zalcitabine NRTI1 0.75 mg tid3 Administer 1 h before or 2 h after an antacid Peripheral neuropathy oral ulcerations, pancreatitis, headache, nausea, rash, arthralgias Avoid concurrent cimetidine avoid concurrent neuropathic drugs (eg, ddl, zalcitabine, isoniazid). Do not administer with lamivudine... 

Amprenavir PI 1200 mg bid Separate dosing from didanosine or antacids by 1 hour. Avoid high-fat meals. Rash, diarrhea, nausea See footnote 2 for concurrent drug contraindication s. Oral solution contraindicated in young children and pregnant women. 

Harry Mann is the 64-year-old owner of a furniture removal business, Kwik Move. Kwik Move provides a good income, but Harry is ambitious. He is not a patient man his quick temper makes his relationships with employees tricky. He has recently been stressed out by his van driver s frequent, unexplained absences. Harry works 12 hours a day, smokes continually, hasn t had a day off in 30 years and has no time for anyone with problems. On Monday, he arrives at work early after his usual greasy breakfast fry-up and a long wait in traffic. The van driver has not turned up again and Harry is furious. He decides to drive the van and move the client s furniture himself. Arriving at the client s house, Harry soon feels very unwell. He is weak and breathless, has a sharp pain in his chest and nausea two antacid tablets do not help. He moves a couple of packing cases and his chest pain worsens. Fortunately, the house owner insists on taking Harry to the local hospital. 

Adverse reactions. Heartburn, nausea and vomiting due to gastric irritation are common, and attempts to reduce this with milk or antacids impair absorption of tetracyclines (see below). Loose bowel movements occur, due to alteration of the bowel flora, and this sometimes develops into diarrhoea and opportunistic infection (antibiotic associated or pseudomembranous colitis) may supervene. Disorders of epithelial surfaces, perhaps due partly to vitamin B complex deficiency and partly due to mild opportunistic infection with yeasts and moulds, lead to sore mouth and throat, black hairy tongue, dysphagia and perianal soreness. Vitamin B preparations may prevent or arrest alimentary tract symptoms. 

Nausea can occur. Esophagitis following inhalation of cromoglicate has been reported. It was much improved by prophylactic antacids given before each inhalation (SEDA-5, 169). In a patient with lactose intolerance, cromoglicate disodium capsules with lactose produced nausea, bloating, and flatulence. Lactose-free formulations produced no such symptoms (SEDA-13, 135). 

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