Brands of sodium alginate with potassium bicarbonate
Acidex Advance® , Gaviscon Advance®
Issues for surgery
Loss of symptomatic relief from dyspepsia and gastro-oesophageal reflux disease (GORD) if omitted.
Advice in the perioperative period
Elective and emergency surgery
Omit dose(s) whilst fasting.
Perioperative considerations
For patients with increased risk factors for aspiration (e.g. pregnancy, obesity, non-fasted state in emergency surgery) consider administration of acid-suppressing medication (oral or intravenous) pre-operatively.
Post-operative advice
Restart post-operatively, when required.
For patients on enteral feeds – see Interactions with other common medicines used in the perioperative period.
Patients undergoing anti-reflux surgery or total gastrectomy
Review continued need for antacids following surgery.
Interactions with common anaesthetic agents
None.
Interactions with other common medicines used in the perioperative period
Antimicrobials
Common antimicrobials used in the perioperative period where a significant reduction in bioavailability has been shown or where there is a theoretical interaction include:
- Quinolone antimicrobials (ciprofloxacin, levofloxacin)
- Tetracycline antimicrobials (doxycycline)
Consult product literature for recommendations on separating doses to ensure absorption.
Iron
Administration of oral iron preparations should be separated from antacids to allow for appropriate absorption, consult product literature for recommended interval.
Corticosteroids
Large doses of some antacids can reduce the bioavailability of corticosteroids; however, it appears small doses do not interact. Given the uncertainty consider separating administration of oral corticosteroids and antacids by 2-3 hours.
Further information
Risk of aluminium toxicity
Absorption of aluminium from aluminium salts is enhanced by citrates which are found in many effervescent preparations e.g. soluble analgesia. Caution is needed in individuals with renal impairment as aluminium toxicity could occur.
References
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 18th September 2021]
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 18th September 2021]
Summary of Product Characteristics – Gaviscon Advance® (Sodium alginate with potassium bicarbonate) Aniseed Oral Suspnsion. Forum Health Products Limited. Accessed via www.medicines.org.uk 18/09/2021 [date of revision of the text March 2019