calcium carbonate/magnesium hydroxide (Rolaids Extra Strength, Rolaids Regular Strength, Rolaids Regular Strength Liquid, Rolaids Ultra Strength, Rolaids Ultra Strength Liquid, Mylanta Supreme)
Classes: Antacids, Combos
Dosing and uses of Rolaids, Mylanta Supreme (calcium carbonate-magnesium hydroxide)
Adult dosage forms and strengths
calcium carbonate/magnesium hydroxide
chewable tablet
- 550mg/110mg (Rolaids Regular Strength)
- 675mg/135mg (Rolaids Extra Strength)
- 1000mg/200mg (Rolaids Ultra Strength)
oral suspension
- (400mg/135mg)/5mL (Mylanta Supreme)
- (550mg/110mg)/5mL (Rolaids Regular Strength Liquid)
- (1000mg/200mg)/5mL (Rolaids Ultra Strength Liquid)
Heartburn & Indigestion
Antacid: Typical dose 800-3,000 mg of calcium carbonate PO prn for symptoms
Tablet: Chew 2-4 tabs PO prn
Suspension: 10-20 mL PO prn
Tablet and suspension strength varies; not to exceed ~7 g of calcium carbonate/day
Dosing Considerations
Calcium carbonate (elemental calcium equivalent)
- 400 mg (160 mg)
- 550 mg (220 mg)
- 675 mg (270 mg)
- 1000 mg (400 mg)
Magnesium hydroxide (elemental magnesium equivalent)
- 110 mg (45 mg)
- 135 mg (55 mg)
- 200 mg (85 mg)
Administration
Avoid taking drugs whose absorption is affected by antacids within 1 hr of administration
Suspension: Shake well before using, protect from freezing
Tablets: Chew thoroughly
Pediatric dosage forms and strengths
Safety and efficacy not established
Rolaids, Mylanta Supreme (calcium carbonate-magnesium hydroxide) adverse (side) effects
Frequency not defined
Calcium carbonate
- Anorexia
- Constipation
- Flatulence
- Nausea
- Vomiting
- Hypercalcemia
- Hypophosphatemia
- Xerostomia
- Acid rebound
- Milk-alkali syndrome
Magnesium hydroxide
- Nausea
- Constipation
- Vomiting
- Hypotension
- Respiratory depression
- Diarrhea
- Abdominal crampin
- Electrolyte imbalance
- Muscle weakness
- Parageusia
Warnings
Contraindications
Calcium carbonate
- Hypersensitivity
- Hypercalciuria
- Renal calculi
- Hypophosphatemia
- Hypercalcemia
- Suspected digoxin toxicity
Magnesium hydroxide
- Hypersensitivity
- Renal failure
- Existing electrolyte imbalance
- Appendicitis symptoms
- Acute surgical abdomen
- Myocardial damage
- Heart block
- Fecal impaction
- Rectal fissures
- Intestinal obstruction or perforation
Cautions
OTC use: Do not use the maximum dosage for >2 weeks; if symptoms persist, discontinue and contact a health care provider
Magnesium hydroxide: Caution with neuromuscular disease (eg, myasthenia gravis) and renal insufficiency
Calcium carbonate: Caution with a history of kidney stones; Ca oxalate formation may increase risk
Pregnancy and lactation
Pregnancy category: C (calcium carbonate); B (magnesium hydroxide)
Calcium and magnesium both cross the placenta; antacids containing calcium or magnesium are considered to be low risk during pregnancy, however avoid excessive use
Supplement calcium and magnesium during pregnancy and lactation according to recommended daily allowance
Lactation: Calcium and magnesium both appear in breast milk, use in nursing mothers appears to be safe
Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Rolaids, Mylanta Supreme (calcium carbonate-magnesium hydroxide)
Mechanism of action
Antacid: Neutralizes gastric secretions resulting in increased gastric pH
Absorption
Onset of antacid action dependent on gastric emptying time
Bioavailability: 25-35% (calcium carbonate); 15-30% (magnesium hydroxide)
Distribution
Protein bound: 45% (calcium carbonate)
Elimination
Excretion
- Calcium carbonate: 80% as unabsorbed calcium in feces, 20% via urine
- Magnesium hydroxide: Primarily via urine
