calcium carbonate + magnesium carbonate, heavy + simeticone: clinical use

Prescribing considerations

• Investigate recurrent or persistent dyspepsia, reflux or bloating rather than continuing symptomatic treatment.
• Review renal function, calcium intake, stone history, interacting oral medicines and concurrent antacids or calcium supplements.
• Avoid prolonged excessive exposure because hypercalcaemia, hypermagnesaemia, alkalosis and milk-alkali syndrome may occur.
• The sorbitol-containing formulation is unsuitable in hereditary fructose intolerance.

Contraindications and cautions

• Hypersensitivity to an active substance or excipient
• Hypercalcaemia or a condition causing hypercalcaemia
• Calcium-containing renal calculi
• Severe renal insufficiency
• Hypophosphataemia
• Hypercalciuria

Monitoring

• Monitor plasma calcium and magnesium if use is considered in mild-to-moderate renal impairment.
• Monitor serum calcium during concomitant thiazide treatment.
• Assess renal function and calcium, magnesium and acid–base status if toxicity or sustained excessive use is suspected.

Clinical pharmacology

The carbonate salts neutralise gastric hydrochloric acid. A small proportion of calcium and magnesium may be absorbed and is normally renally excreted. Simeticone acts physically within the gastrointestinal tract and is not systemically absorbed.

Formulation and product differences

• The two selected documents describe the same licensed chewable-tablet formulation under different product names.
• The tablets contain sorbitol and mint and lemon flavourings and are cream-white, flat, round and scored.