Vomiting antacids

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

Calcium-containing antacids—rebound hyperacidity, metabolic alkalosis, hypercalcemia, vomiting, confusion, headache, renal calculi, and neurologic impairment... 

Profuse or prolonged vomiting can lead to complications of dehydration and metabolic abnormalities. Patients must have adequate hydration and electrolyte replacement orally (if tolerated) or intravenously to prevent and correct these problems. Some pharmacologic treatments work locally in the GI tract (e.g., antacids and prokinetic agents), whereas others work in the central nervous system (e.g., antihistamines and antiemetics).1... 

Cefdinir 14 mg/kg per day in 1-2 doses (adult 300 mg twice daily or 600 mg once daily) Diarrhea, rash, vomiting, diaper rash, yeast infections Preferred oral cephalosporin (good taste) separate from Al or Mg antacids and Fe supplements by 2 hours... 

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... 

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. 

Factors that theoretically affect bioavailability include alterations in GI transit time, gastric pH, edema of the GI tract, vomiting and diarrhea, and concomitant drug therapy, especially antacid or H2-antagonist administration. 

Localised upper abdominal pain is the most common symptom of peptic ulcer disease. The pain is relieved by antacids, proton pump inhibitors and H2 antagonists. The pain may or may not be relieved by food and is often v/orse during the night. Peptic ulceration may be accompanied by occasional vomiting, anorexia and weight loss. Diffuse abdominal pain is not a characteristic symptom of peptic ulcer disease. 

Magnesium deficiency, usually the result of decreased absorption or excessive excretion, results in neuromuscular weakness and ultimately convulsions. Dietary deficiency in catde is known as the grass staggers. Magnesium toxicity from impaired excretion or excessive consumption of antacids results in vomiting, hypertension, and central nervous systems effects. Inhalation of magnesium oxide from welding can cause metal fume fever similar to that from zinc. 

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

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... 

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... 

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... 

Metabolic alkalosis can occur when there is excessive H+ loss from the body, via loss of gastric contents in vomiting, or when a patient takes excessive quantities of antacid medication. 

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. 

Patient education May take without regard to meals or antacids. Report headache, pain, coughing, or vomiting of blood. Take drug as prescribed for effectiveness. Avoid tasks that require alertness and motor skills until drug response is established. Avoid foods and liquids that cause gastric irritation (individualized for each patient). 

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