EPICOGEL SUSP 125ML

Indications

Approved Uses

Symptomatic relief of hyperacidity-related dyspepsia including heartburn/acid indigestion and reflux symptoms, and relief of gas-related symptoms such as flatulence/bloating.

Off-Label Uses

Historically used as a phosphate binder in chronic kidney disease (aluminium hydroxide), but this is generally discouraged due to aluminium toxicity risk and is not recommended for routine use.

Dosage & Administration

Dosing by Condition

Adults (typical antacid/antiflatulent dosing): 10-20 mL after meals and at bedtime (up to 4 times daily) for heartburn/acid indigestion/reflux symptoms; for gas/bloating, 10-20 mL after meals and at bedtime as needed within the same maximum daily frequency. Follow local label maximums if stated.

Initial Dose

10 ml (2 teaspoons) after meals and at bedtime

Maintenance Dose

10-20 ml three to four times daily, 20-60 minutes after meals

Maximum Dose

Maximum daily dose is product-label dependent; if label is unavailable, do not exceed typical antacid suspension limits (commonly up to 80 mL/day in divided doses for adults) and avoid continuous use >14 days without medical advice.

Children's Dosage

Children 6-12 years: 5 ml (1 teaspoon) 3-4 times daily after meals; children under 6 years: use only under medical supervision

Dose Adjustment Notes

Renal impairment: avoid prolonged/high-dose use; use the lowest effective dose for the shortest duration and avoid in moderate-severe renal impairment due to risk of aluminium and magnesium accumulation (hypermagnesemia/aluminium toxicity).

How to Take

Shake well before each dose. Measure with a calibrated spoon/cup. Take orally after meals and at bedtime (commonly 20-60 minutes after meals for best symptom control). Separate from other oral medicines by at least 2 hours (some require longer). Water may be taken if desired but is not required.

How to Prepare

Shake well before each use. Measure the dose using a suitable measuring device.

Side Effects

Common Side Effects

Constipation, diarrhea, chalky taste, nausea; occasionally abdominal cramps/bloating.

Side Effect Frequency

Common: constipation (aluminium), diarrhea (magnesium), chalky/unpleasant taste, nausea; Uncommon/Rare: hypophosphatemia with prolonged/high-dose aluminium exposure, hypermagnesemia in renal impairment, and aluminium accumulation/toxicity in renal impairment or prolonged high-dose use.

Safety & Warnings

Contraindications

Hypersensitivity to any component; severe renal impairment (avoid due to aluminium/magnesium accumulation).

Warnings & Precautions

Do not use continuously for >14 days without medical advice; use caution/avoid prolonged use in renal impairment; prolonged/high-dose use may cause hypophosphatemia; separate from other oral medicines by at least 2-4 hours; shake well before use and seek evaluation for alarm symptoms (e.g., GI bleeding, weight loss, persistent pain).

Age Restriction

Children <6 years: use only on medical advice; 6-11 years: use with caution and follow label/physician dosing; ≥12 years: usual OTC dosing.

Driving Warning

Safe

Drug Interactions

Drug Interactions

Reduces absorption of many oral drugs via chelation/adsorption or pH effects-especially tetracyclines, fluoroquinolones, iron, levothyroxine, bisphosphonates, and azole antifungals; separate by at least 2-4 hours (longer for some agents per product guidance).

Interaction Severity

MAJOR/clinically significant: tetracyclines and fluoroquinolones (chelation markedly reduces absorption-separate by at least 2 hours, often 4-6 hours depending on the antibiotic). MODERATE: levothyroxine, iron salts, bisphosphonates, azole antifungals (ketoconazole/itraconazole), and digoxin (reduced absorption/bioavailability-separate dosing). MINOR: may affect dissolution/absorption of some enteric-coated or pH-dependent products.

Food Interaction

Take after meals and at bedtime for best and longer-lasting effect; food generally prolongs antacid action.

Special Populations

Pregnancy

Caution

Breastfeeding

Caution

Children

Children 6-12 years: 5 ml (1 teaspoon) 3-4 times daily after meals; children under 6 years: use only under medical supervision

Elderly

Standard adult dosing; use with caution in elderly patients with renal impairment due to increased risk of aluminium and magnesium accumulation

Kidney Impairment

Mild-moderate renal impairment: use with caution, lowest effective dose, short duration; severe renal impairment (e.g., CrCl <30 mL/min or dialysis): avoid/contraindicated unless directed by a specialist.

Liver Impairment

No adjustment needed

Storage & Patient Advice

Preparation Instructions

Shake well before each use. Measure the dose using a suitable measuring device.

Stopping the Medicine

Safe to stop anytime; no tapering required

Overdose

Symptoms: GI upset (diarrhea/constipation, abdominal discomfort, nausea/vomiting); in renal impairment, risk of hypermagnesemia (weakness, hypotension, bradycardia, respiratory depression) and aluminium toxicity with excessive/prolonged use; management is supportive, stop product, correct fluids/electrolytes, and consider dialysis for severe toxicity in renal failure.

Patient Counseling

Shake well and measure doses accurately. Take after meals and at bedtime; separate from other oral medicines by at least 2 hours (longer for some antibiotics/thyroxine/iron). Use the lowest effective dose for the shortest time; seek medical advice if symptoms persist beyond ~2 weeks, recur frequently, or if alarm features occur (GI bleeding, weight loss, dysphagia, persistent vomiting). Use caution/seek advice in kidney disease. Expect possible constipation or diarrhea; stop and seek care if severe weakness, confusion, or palpitations occur (possible electrolyte issues).

Monitoring Requirements

For long-term use, especially in patients with renal impairment, monitoring of serum phosphate, magnesium, and aluminum levels may be necessary. For short-term use, no routine monitoring is required.

Pharmacology

Mechanism of Action

Aluminium hydroxide and magnesium hydroxide neutralize gastric hydrochloric acid, increasing gastric pH and reducing pepsin activity; dimethicone acts as an antifoaming agent that lowers surface tension of gas bubbles, promoting coalescence and easier passage of gas.

Onset of Action

Within about 5-15 minutes.

Duration of Effect

Typically about 1-3 hours; shorter on an empty stomach and longer when taken after meals.

Half-Life

Not applicable/clinically not meaningful because the product acts locally with minimal systemic absorption; no reliable or clinically used half-life is assigned for the antacid components in this context.

Bioavailability

Minimal systemic absorption: aluminium hydroxide is very poorly absorbed (<1%); magnesium hydroxide is poorly absorbed (only a small fraction, typically a few percent; not ~15%); dimethicone is not absorbed.

Metabolism

No systemic metabolism; aluminium hydroxide and magnesium hydroxide neutralize gastric acid locally, and dimethicone is inert and not metabolized.

Excretion

Primarily fecal excretion of the unabsorbed aluminium/magnesium salts and dimethicone; any absorbed magnesium and aluminium are eliminated renally (risk of accumulation in renal impairment).

Protein Binding

Not applicable (negligible systemic absorption; no clinically relevant plasma protein binding).

Product Information

Available Dosage Forms

Oral suspension

Composition per Dose

Each 10 mL: Aluminium hydroxide dried 810 mg + Magnesium hydroxide 200 mg + Dimethicone 25 mg (calculated from 81,20,25 mg/ml strength)

Generic Availability

Yes

OTC Alternatives

Other OTC antacids/alginate or antiflatulent options: calcium carbonate (e.g., Rennie/Tums), alginate-antacid combinations (e.g., Gaviscon), other Al/Mg antacid suspensions (e.g., Maalox-type), and simethicone/dimethicone-only products for gas.

Gi Condition

Acid Reflux/GERD

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