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Drugs and Therapeutics
Published in James Sherifi, General Practice Under the NHS, 2023
Sodium alginate was originally extracted from seaweed. Along with simple antacids, such as magnesium trisilicate, it was the mainstay of managing dyspepsia before the introduction of more targeted drugs. Gaviscon was aggressively marketed for heartburn, gastro-oesophageal reflux, with dubious claims of a dual action in acid suppression and coating the lower oesophagus, thus preventing mucosal irritation.
Immunosuppressants, rheumatic and gastrointestinal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Alginate-antiacids form a viscous fluid with surface-active properties, acting as a barrier against reflux from the stomach to the oesophagus. Dimethicone, gaviscon and algicon are all used. Gaviscon has a high sodium carbonate content and algicon a significant amount of aluminium. Dimethicone is more a feed thickener than an antacid. The use of antacids is limited by their toxicity, and efficacy is not fully proven [9].
The role of primary care and the GP in supporting breastfeeding
Published in Amy Brown, Wendy Jones, A Guide to Supporting Breastfeeding for the Medical Profession, 2019
First do no harm. It is of course important to diagnose cows’ milk protein allergy or gastro-oestophageal reflux disease where it is present and provide evidence-based treatment and support for the family. There are also real dangers to overdiagnosing medical conditions and to overprescribing. These dangers include risking the breastfeeding journey and all the subsequent risks of not breastfeeding, as outlined in the Lancet breastfeeding series 2016 (www.thelancet.com/series/breastfeeding), risks to baby from unnecessary exclusion diets or medication and risks to the mother, including risks to her mental health if she stops breastfeeding sooner than she had intended. Recent studies have shown concerns around a significant increase in fracture risk in children who received proton pump inhibitors and H2 antagonists in the first 6 months of life. Gaviscon is commonly found to cause constipation in infants and mothers report that it can be difficult to give to a breastfed baby.
Development and characterization of novel ambroxol sustained-release oral suspensions based on drug-polymeric complexation and polymeric raft formation
Published in Pharmaceutical Development and Technology, 2020
Ahmad Bani-Jaber, Samaa Abdullah
Gaviscon liquid had higher raft volume and weight than F3 and F6 suspension of nearly two folds (Table 4). This reflected the higher solid content of Gaviscon liquid label claimed to contain 250 mg NA, 133.5 mg sodium bicarbonate, and 80 mg CC per 5 ml i.e. total solid per 5 ml 463.5 mg. According to Table 1, the corresponding solid content of F3 and F6 suspensions are 185 and 152.5 mg per 5 ml, respectively. In addition, NA grade used in this study was high MWt, whereas the grade that is used to prepare NA-antacid raft forming formulation, such as Gaviscon, is low MWt, which allows for the incorporation of NA at higher concentration (Hampson et al. 2005). The three products exhibited similar raft strengths (Table 4) indicative of similar degree of NA-crosslinking by calcium for Gaviscon and F3 suspension and the high efficacy of excess CRG in F6 suspension without CC in maintaining raft strength. However, rafts of F3 suspension and F6 suspension were more durable than that of Gaviscon liquid under agitation that simulate stomach movement as the median resilience time of their rafts was almost four folds longer than that of Gaviscon (Table 4). The use of high MWt NA in the suspensions would suppress agitation driven raft erosion and polymer dissolution.
Two placebo-controlled crossover studies in healthy subjects to evaluate gastric acid neutralization by an alginate–antacid formulation (Gaviscon Double Action)
Published in Drug Development and Industrial Pharmacy, 2019
Joanne Wilkinson, Khalid Abd-Elaziz, Izaak den Daas, Johan Wemer, Michiel van Haastert, Victoria Hodgkinson, Michelle Foster, Cathal Coyle
Alginate-containing treatments have been used for the symptomatic treatment of heartburn and indigestion for over 40 years. Alginates are natural polysaccharides, derived from seaweed, that form a viscous “raft” on exposure to acid and act to impede or replace the reflux of gastric material [14,15]. Gaviscon Double Action (Gaviscon DA; RB, Slough, UK) is an alginate formulation that was developed to deliver the dual action of reflux suppression and acid neutralization, with the addition of two antacids, calcium carbonate and sodium bicarbonate [16]. Clinical studies demonstrate that Gaviscon DA is effective for the relief of reflux and dyspeptic symptoms [17,18], likely owing to both the alginate raft and antacid components of the formulation. The mode of action of the alginate raft of Gaviscon DA has been well-characterized both in vitro and in vivo [16,19,20]. It rapidly localizes on top of the acid pocket, a major source of postprandial reflux, physically replacing it and shifting the pH transition point away from the esophago-gastric junction [19,20]. Furthermore, compared to non raft-forming antacids alone, Gaviscon DA shows significant superiority in decreasing postprandial acid reflux and esophageal acid exposure [19,21]. The antacid action of Gaviscon DA is less well characterized. While the acid neutralization capacity has been assessed in vitro [22], confirmation of intragastric acid neutralization activity in vivo is lacking. Owing to regional variations in gastric acid content, determination of intragastric pH over time requires a net measurement of acidity throughout the stomach [23]. Here, we present the findings from studies evaluating the intragastric acid neutralization activity of Gaviscon DA versus placebo in healthy subjects using a multielectrode catheter.
Safety considerations when managing gastro-esophageal reflux disease in infants
Published in Expert Opinion on Drug Safety, 2021
Melina Simon, Elvira Ingrid Levy, Yvan Vandenplas
In summary: aluminum-free alginates are associated with short-term symptom relieve. No severe adverse events were reported in presumed healthy infants. Although safety issues have been insufficiently evaluated, the many years of experience with alginates allows to hypothesize that their short-term administration during a couple of weeks is likely to be devoid of a significant risk of severe adverse events. The leaflet warning of Gaviscon Infant® to not use it in combination with thickened formula limits its application possibilities.