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Sunday, July 27, 2025

Gaviscon


Gaviscon is a reflux suppressant and antacid medication used for the treatment and symptomatic relief of gastroesophageal reflux disease (GERD), heartburn, acid indigestion, and acid-related dyspepsia. It works primarily by forming a protective alginate gel "raft" on top of the stomach contents that prevents reflux of acid into the esophagus. Some formulations of Gaviscon also contain antacids like sodium bicarbonate and calcium carbonate, which help to neutralize excess stomach acid.

Gaviscon is available over-the-counter (OTC) in liquid suspension, chewable tablets, and sachets, and is widely used for rapid, short-term symptom relief.

Pharmacological Classification

  • Therapeutic Class: Reflux suppressant, Antacid

  • Pharmacologic Class: Alginates with or without antacids

  • ATC Code: A02BX13 (Alginic acid combinations)

Mechanism of Action

Gaviscon works via a dual-action mechanism:

1. Physical Raft Formation (Alginate Action)

  • After ingestion, the sodium alginate in Gaviscon reacts with gastric acid to form a viscous gel or “raft”.

  • This floats on top of the stomach contents, physically preventing reflux of acid and food into the esophagus.

  • The raft can remain in the stomach for up to 4 hours, acting as a mechanical barrier to acid reflux.

2. Acid Neutralization (Antacid Action – if present)

  • Sodium bicarbonate and calcium carbonate react with hydrochloric acid (HCl) in the stomach to produce:

    • Carbon dioxide (CO₂): Helps float the raft

    • Water and neutral salts: Reduce gastric acidity

  • This provides symptomatic relief of heartburn and indigestion.

Formulations and Active Ingredients

Common UK Formulations

Gaviscon Original (Liquid & Tablets)

  • Sodium alginate

  • Sodium bicarbonate

  • Calcium carbonate

Gaviscon Advance

  • Higher concentration of sodium alginate and potassium bicarbonate

  • Offers longer duration of action

Gaviscon Double Action

  • Combines:

    • Alginate for reflux suppression

    • Antacid (calcium carbonate and sodium bicarbonate) for acid neutralization

Gaviscon Infant

  • Formulated with sodium alginate only

  • No sodium bicarbonate or calcium carbonate

  • Used in infants and neonates with posseting or reflux

Indications

Adults and Children over 12 years

  • Heartburn and acid indigestion

  • Gastroesophageal reflux (GERD)

  • Symptoms associated with hiatus hernia

  • Pregnancy-related reflux

  • Post-meal acid regurgitation

Children (under 12 years)

  • Under medical supervision for reflux-related symptoms

Infants

  • Gaviscon Infant is used for gastric regurgitation, posseting, or reflux under pediatric supervision

Dosage and Administration

Adults and Children over 12 years

  • Liquid: 10–20 mL after meals and at bedtime

  • Tablets: 2–4 tablets after meals and at bedtime

  • Maximum: Follow package insert; often 4 doses/day

Children 6–12 years

  • Liquid: 5–10 mL after meals and at bedtime

Gaviscon Infant

  • Typically administered with feed (mixed with formula/breast milk or water)

  • Dosage: Varies by infant weight and age

  • Always follow healthcare professional guidance

Administration Notes

  • Shake liquid bottle well before use

  • Chew tablets thoroughly before swallowing

  • Do not lie down immediately after use (for better reflux control)

  • Do not exceed stated dose

Pharmacokinetics

  • Onset of action: Within minutes for both raft and antacid effects

  • Duration: Up to 4 hours (Gaviscon Advance may last longer)

  • Systemic absorption: Minimal to none for alginates

  • Elimination: Excreted via feces; antacid salts may be absorbed and eliminated renally

Contraindications

  • Hypersensitivity to any ingredient

  • Severe renal impairment (especially with aluminum- or magnesium-containing antacids)

  • Low-phosphate diets (phosphate-binding potential of calcium)

  • Infants under 1 year (unless Gaviscon Infant is prescribed)

Warnings and Precautions

  • High sodium content:

    • Caution in patients with hypertension, heart failure, renal impairment, or on sodium-restricted diets

  • Calcium content: Avoid high doses in patients at risk of hypercalcemia or kidney stones

  • Drug interactions: May interfere with the absorption of some medications (see below)

  • Chronic use: Prolonged or excessive use may mask serious gastrointestinal disease

Adverse Effects

Common (1–10%)

  • Flatulence

  • Abdominal distension

  • Belching (due to CO₂ from bicarbonate)

  • Nausea

Uncommon to Rare (<1%)

  • Constipation or diarrhea

  • Chalky taste

  • Hypersensitivity reactions (rash, itching, bronchospasm)

  • Hypercalcemia or milk-alkali syndrome (with high calcium intake)

Drug Interactions

Gaviscon can affect the absorption of several oral medications by altering gastric pH or forming complexes. Separate administration by at least 2 hours is recommended.

Drugs to Separate from Gaviscon

  • Iron supplements (e.g., ferrous sulfate)

  • Tetracycline antibiotics

  • Levothyroxine

  • Bisphosphonates

  • Fluoroquinolone antibiotics (e.g., ciprofloxacin)

  • Digoxin

  • Ketoconazole (acidic pH required)

  • Propranolol

Use in Special Populations

Pregnancy

  • Safe for use during pregnancy (non-systemic)

  • Gaviscon Advance is commonly used for reflux in pregnancy

  • Recommended by NICE for heartburn relief in pregnant women

Breastfeeding

  • Compatible with breastfeeding

Infants and Children

  • Gaviscon Infant is specifically formulated for neonates and infants

  • Requires proper administration based on weight

Elderly

  • Generally well tolerated, but monitor sodium and calcium intake

Storage and Stability

  • Store below 25°C

  • Keep out of reach of children

  • Use within the expiry period indicated on packaging

  • Shake liquids well before use

Comparison with Other Reflux Medications

Gaviscon vs. Antacids

  • Gaviscon contains alginate, forming a physical raft, which antacids do not

  • Gaviscon offers longer reflux protection, especially in postural reflux

Gaviscon vs. H2 Blockers (e.g., ranitidine)

  • Gaviscon works immediately; H2 blockers take longer

  • H2 blockers reduce acid production, while Gaviscon blocks reflux physically

Gaviscon vs. PPIs (e.g., omeprazole)

  • Gaviscon gives faster symptom relief for mild to moderate heartburn

  • PPIs are better for erosive esophagitis and chronic GERD

Patient Counseling Points

  • Take Gaviscon after meals and at bedtime

  • If taking other oral medications, separate by at least 2 hours

  • Safe for short-term and as-needed use; consult doctor for chronic symptoms

  • Do not exceed the recommended dosage

  • Consult a healthcare professional if symptoms persist for more than 7 days

Available Brands and Forms

  • Gaviscon Original – liquid & chewable tablets

  • Gaviscon Advance – higher strength alginate for longer-lasting effect

  • Gaviscon Double Action – with added antacids for acid neutralization

  • Gaviscon Infant – powder sachets for pediatric use

  • Generic alginate formulations also available




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