Альмокс

General characteristics. Structure:

Deystvuyushche substance: 218 mg of aluminum of oxide (in the form of aluminum of hydroxide of gel or aluminum of hydroxide of kompressovanny gel), 75 mg of magnesium of oxide (in the form of paste hydroxide magnesium) in each 5 ml of suspension.

Excipients: sorbitol solution uncrystallizable, alcohol of ethyl 96%, hydroxyethylcellulose, methylparahydroxybenzoate, пропилпарагидроксибензоат, butylparahydroxybenzoate, lemon oil, saccharin sodium, the water purified.

The medicine which is representing the balanced combination of aluminum hydroxide and magnesium hydroxide, having enveloping and adsorbing effect and also protects a mucous membrane of a stomach from inflammatory and erosive геморагических defeats. Shows weak carminative and moderate cholagogue action, and also easy laxative effect.

Pharmacological properties:

Pharmacodynamics. Aluminum hydroxide neutralizes free hydrochloric acid in a stomach, reduces activity of pepsin that leads to reduction of the digesting activity of a gastric juice. In a stomach forms aluminum chloride which under the influence of alkaline contents of intestines turns into basic salts of aluminum. They are a little soaked up and at short reception of Almoks practically do not change concentration of salts of aluminum in blood. Aluminum hydroxide connects phosphate ions in intestines and thus limits their absorption and reduces concentration of phosphates.

Magnesium hydroxide also neutralizes hydrochloric acid in a stomach, turning into magnesium chloride which possesses small laxative action. Thus counteraction to effect of the aluminum hydroxide causing a lock is carried out.

Альмокс has the enveloping and adsorbing effect. Due to stimulation of synthesis of prostaglandins has also some cytoprotective effect, and also indometacin, diclofenac, acetylsalicylic acid protects a mucous membrane of a stomach from inflammatory and erosive геморагических defeats in result of use of the irritating and ulcerogenic agents, such as ethanol, corticosteroid means and non-steroidal anti-inflammatory drugs (NPVS), for example.

The sorbitol which is contained in Almoksa shows weak carminative and moderate cholagogue action, and also easy laxative effect, supplementing effect of magnesium hydroxide.

Альмокс does not cause an alkalosis and education in a stomach of carbon dioxide which, in turn, is the reason of a meteorism, feelings of weight in the field of an epigastrium and secondary strengthening of secretion of hydrochloric acid.

The therapeutic effect after reception of medicine occurs in 3-5 minutes. Duration of action depends on gastric emptying speed. At reception on an empty stomach it varies from 20 to 60 minutes, at reception in an hour after meal antiacid action can continue till 3 o'clock.

Pharmacokinetics. Aluminum hydroxide. In intestines small amounts of drug which practically do not change concentration of salts of aluminum in blood can systematically rezorbirovatsya. Aluminum hydroxide is removed with a stake.

Magnesium hydroxide. Magnesium ions can also rezorbirovatsya in number of about 10% of the accepted dose and do not change concentration of ions of magnesium in blood. Hydroxide usually locally is distributed magnesium. It is removed with a stake.

Indications to use:

-    A symptomatic treatment of conditions of a hyperoxemia (hyperacidity) at diseases of a gullet, stomach and duodenum (esophagites, hernia of an esophageal opening of a diaphragm), a gastroesophageal reflux disease, acute and chronic gastritis and a gastroduodenit, a peptic ulcer of a stomach and a duodenum, postresection gastritis and a gastroanastomozit.
-    Prevention of emergence of erosive cankers of the digestive tract (DT) at prolonged treatment by glucocorticosteroids (GKS) and NPVS.

Route of administration and doses:

To adults and children 14 years are more senior appoint 5 - 10 ml of Almoks 3 - 4 times a day. If necessary it is possible to increase a single dose to 15 ml.

To children from 10 to 14 years appoint a half of the recommended dose for adults.

For achievement of the cytoprotective action on mucous membranes of upper parts of a digestive tract medicine is accepted in 10 - 15 minutes prior to food.

For achievement of antiacid action of Almoks usually accept in 45 - 60 min. after meal and in the evening before going to bed.

After achievement of therapeutic effect the daily dose is reduced to 5 ml by 3 - 4 times a day within 2 - 3 months.

During treatment of patients with a renal failure it is necessary to reduce a daily dose or to increase an interval between receptions. At long reception of Almoks (more than 14 days) regular medical control of serumal level of magnesium is necessary.

For prevention accept on 5 - 15 ml in 15 minutes prior to reception of medicines with irritant action.

Before use the bottle with medicine needs to be shaken up carefully!

Within 15 minutes after Almoks's reception it is not necessary to drink liquids.

Features of use:

Aluminum hydroxide can lead to a lock, and magnesium hydroxide can cause an intestines hyperkinesia, use of this product in high doses can cause or complicate obstruction of intestines and intestinal impassability, especially at patients with the increased risk of such complications, for example, at patients with a renal failure or at patients of advanced age.

Patients need to see a doctor at:
-   body degrowth;
-   emergence of difficulties when swallowing and a constant sensation of discomfort in a stomach;
-   disturbance of digestion which appeared for the first time, change of a course of already existing digestion disturbances;
-   renal failure.

Aluminum salts in general are badly soaked up in digestive tract and therefore system effects at patients with normal function of kidneys arise seldom. However use of overdoses of drug either long administration of drug, or can even lead use of usual doses of drug for patients whose food allowance is characterized by the low content of phosphorus to reduction of content of phosphate in an organism, is followed by strengthening of processes of a resorption in a bone tissue and emergence of a hypercalcuria with the increased risk of osteomalacy (because of linkng of aluminum with phosphate).

At patients with a renal failure the increased plasma concentration both aluminum, and magnesium are observed. Such patients have a prolonged use of high doses of salts of aluminum and magnesium can lead to development of encephalopathy, dementia, microcytic anemia or to worsen a current of the osteomalacy induced by dialysis.

Aluminum hydroxide can be dangerous to the patients with a porphyria receiving a hemodialysis.

If during treatment symptoms last more than 10 days or the condition of the patient worsens, it is necessary to check an etiology of a disease and to reconsider a treatment technique.

Use at a stomach ache of an unknown origin is not recommended, at a divertuculosis, at disturbances of acid-base equilibrium in an organism in the presence of a metabolic alkalosis, at cirrhosis, at heavy heart failure, at toxicosis of pregnant women, at renal disturbances (because of danger of development of a gipermagniyemiya and intoxication by aluminum).

Use of the antacids containing aluminum for patients of advanced age should be limited. At prolonged use at patients of advanced age the aggravation of symptoms of the existing diseases of bones and joints is possible.

At treatment of patients with a renal failure at prolonged use of medicine (more than 14 days) regular medical control and tracking of serumal level of magnesium is necessary.

Drug contains sorbitol that allows to accept it a sick diabetes mellitus, but it is not necessary to apply the patient with inborn intolerance of fructose as it can cause irritation of a stomach and diarrhea.

Альмокс contains alcohol therefore emergence of complications at patients with diseases of a liver and brain, at patients with epilepsy and alcoholism, at pregnant women and children up to 10 years is possible.

Use during pregnancy and feeding by a breast. Pregnancy. During pregnancy only the doctor can appoint Almoks, having weighed a ratio risk / advantage. In this case no more than 3 days and only under observation of the doctor are recommended to use drug.

Reliable data about teratogenic action on animals are absent. Now in clinical practice there is no evidence of development of inborn defects and fetotoksichny effects. On the other hand, the possibility of further observation of pregnancies during which exposure by medicine took place is too limited to exclude probability of risk. Thus, for safety reasons this medicine should not be used during pregnancy if in it there is no emergency.

It is necessary to consider the maintenance of the ions of aluminum and magnesium capable to influence transit in digestive tract:
-   salts of magnesium can cause diarrhea;
-   salts of aluminum can be the cause of a lock and worsen a current of locks which are often observed during pregnancy.

It is necessary to avoid prolonged use and exceeding of doses of this drug. Feeding period breast. During treatment by drug it is necessary to stop feeding by a breast.

Use for children. Do not appoint to children up to 10 years, despite a possibility of exact dosing.

Ability to influence speed of response at control of motor transport or work with other mechanisms. The ethanol which is contained in Almoksa cannot affect ability of control of motor transport or work with mechanisms at reception of the recommended daily doses of medicine.

Side effects:

Reduction of content of phosphorus in an organism at prolonged use of drug is possible or at its use in high doses, or even at use of usual doses of drug for patients whose food allowance is characterized by the low content of phosphorus, strengthening of processes of a resorption in a bone tissue, a hypercalcuria, osteomalacy as this medicine contains aluminum, a giperalyuminiyemiya, a gipermagniyemiya. At patients with a renal failure the increased plasma concentration both aluminum, and magnesium are observed. Such patients have a prolonged use of high doses of salts of aluminum and magnesium can lead to development of encephalopathy, dementia, microcytic anemia or to worsen a current of the osteomalacy induced by dialysis.

Aluminum hydroxide can be dangerous to the patients with a porphyria receiving a hemodialysis.

Side reactions:
From digestive tract: manifestations of a lock which disappear at a dose decline, nausea, vomiting, stomach spasms are possible.

Laboratory indicators: gipermagniyemiya, hypophosphatemia, hypocalcemia, hypercalcuria, giperalyuminiyemiya.

From kidneys and urinary tract: nephrocalcinosis, renal failure.

Hypersensitivity reactions: allergic reactions of local and general type.

From the central nervous system: at prolonged use of drug at patients with a renal failure and at the patients who are on a hemodialysis displays of encephalopathy, a neurotoxicity (change of mood and intellectual activity) are possible.

From a musculoskeletal system: osteoporosis. At long reception of high doses of drug at deficit of phosphorus in food emergence of osteomalacy is possible.

Others: change of flavoring feelings.

At prolonged use of drug at patients with a renal failure and at the patients who are on a hemodialysis thirst manifestations, a lowering of arterial pressure, a hyporeflexia are possible.

In case of detection of any undesirable influences or unusual reactions consult to the doctor of rather further use of drug!

Interaction with other medicines:

Альмокс interacts with some other medicines which are applied orally.

The interval between Almoks's use and other medicines has to be not less than 1-2 hours.

Альмокс changes acidity of contents of a stomach, influences absorption, bioavailability, the maximum serumal concentration, and also removal of the majority of medicines at simultaneous use.

The combinations demanding use of measures. As reduction of absorption from digestive tract of the drugs accepted along with Almoks is observed, it is necessary to do a break between reception of antacids and other medicines.

Whenever possible it is necessary to maintain a 2-hour interval between administration of drug and the following medicines: H2 - antihistamines, antitubercular drugs: Ethambutolum, an isoniazid (peroral), атенолол, метопролол, propranolol, chloroquine, tsiklina, diflunizat, digoxin, diphosphonates, фексофенадин, iron (salts), ftorkhinolona, sodium fluoride, glucocorticoid drugs (interaction with Prednisolonum and dexamethasone is described), indometacin, кайексалат, кетоконазол, лансопразол, linkozamida, fenotiazinovy neuroleptics, Penicillaminum, phosphorus (additives), thyroxine.

Combinations which should be considered: at simultaneous use with salicylates removal of salicylates kidneys owing to urine alkalization amplifies.

Simultaneous use of aluminum of hydroxide and citrates can lead to increase in level of aluminum, especially at patients with a renal failure.
Альмокс reduces absorption of digoxin, indometacin, salicylates, Chlorpromazinum, Phenytoinum, Reserpinum, H2 blockers (Cimetidinum, ranitidine, famotidine), β-adrenoblockers, a diflunisal, hinolon (ciprofloxacin, norfloxacin, an ofloksatsin, an enoksatsin, a grepafloksatsin), azithromycin, a tsefpodoksim, a pivampitsillin, rifampicin, indirect anticoagulants, barbiturates, a feksofenadin, Dipiridamolum, bile acids (chenodesoxycholic and ursodezoksikholevy acids), Penicillaminum, quinidine, a lansoprazol, glycosides of a foxglove, salts of iron, drugs of lithium, quinidine, a meksiletin, fenotiazinovy drugs, antibiotics of a tetracycline row, an isoniazid and a ketokonazol.

The reduced absorption of these medicines is connected with formation of insoluble complexes and/or alkalization of contents of a stomach.

At simultaneous use of drugs in a kishechnorastvorimy cover a superalkalinity of a gastric juice can lead to the accelerated destruction of their cover and cause irritation of a stomach and duodenum.

M-holinoblokatory slow down gastric emptying and prolong Almoks's action.

Альмокс can affect results of some laboratory and functional researches and tests: it reduces the level of gastric secretion when determining its acidity; violates the test of visualization of diverticulums and stsintigrafiya of bones by means of technetium (Ts99); moderately and for a short time increases the serumal level of gastrin; increases the serumal level of phosphorus, рН serum and urine.

Contraindications:

- Hypersensitivity (allergy) to drug components;
- severe forms of a renal failure (in connection with existence in magnesium drug);
- existence of disakharidazny insufficiency, inborn intolerance of fructose (contains sorbitol);
- Alzheimer's disease;
- usual lock;
- chronic diarrhea;
- a heavy abdominal pain of not specified genesis, at suspicion of an acute appendicitis;
- hypophosphatemia;
- existence of ulcer colitis;
- colostomy or ileostomy;
- hemorrhoids;
- feeding period breast;
- children's age up to 10 years.

Overdose:

At single exceeding of a dose other signs of overdose, except a lock, a meteorism, feeling of metal taste in a mouth are not observed.

At long reception of high doses formation of stones in kidneys, emergence of heavy locks, drowsiness, a gipermagniyemiya is possible. Also signs of a metabolic alkalosis can be observed: change of mood or intellectual activity, numbness or muscle pain, nervousness and bystry fatigue, breath delay, unpleasant flavoring feelings.

It is necessary to accept absorbent carbon at once, to wash out a stomach and to stimulate vomiting.

Storage conditions:

To store in the place protected from light, at a temperature not above 25 °C. Not to freeze! To store in the place, unavailable to children! Period of validity 2 years.

Issue conditions:

Without recipe

Packaging:

On 100 g and 150 g of medicine in bottles plastic of polyethyleneterephthalate, corked by caps polymeric screw. One bottle in a cardboard pack together with a measured glass and a leaf insert.