KREMIL-S Chewable tablet

•For the symptomatic relief of hyperacidity associated with peptic ulcer, gastritis, esophagitis, and dyspepsia

•As supplement to H.- blockers or proton pump inhibitors for the rapid relief of ulcer symptoms. •As an antiflatulent to alleviate the symptoms of gassiness, including postoperative gas pain, associated with hyperacidity -Recommended Adult Dose: 1-2 tablets one hour after each meal and at bedtime or as prescribed by a physician.

Break or chew before swallowing.

•Patients with renal failure

•Partial intestinal obstruction, appendicitis, fecal impaction, gastric outlet obstruction, and constipation.

•Phosphate depletion and low serum phosphate, osteomalacia

Diarrhea Constipation

Alkalinization of gastric contents decreases the bioavailability of iron, ketoconazole, and tetracyclines. The absorption of tetracyclines is farther reduced by its chelation with aluminum and magnesium ions.

Concurrent administration of antacids and orally administered digoxin or indomethacin may decrease the absorption of these drugs. Doses of these drugs should be spaced as far apart as possible from doses of antacids.

Antacid-induced changes in urine pH increase urinary excretion and decrease Wood concentration of salicylates.

Concurrent administration of dicumarol with aluminum-magnesium antacid reportedly increases the absorption of dicumarol.

Administration of a magnesium and aluminum hydroxide preparation with chlordiazepoxide decreases !he rate of chlordiazepoxide absorption.

Antacids reduce the bioavailability of bisphosphonates.

Antacids have not produced teratogenic effects and are generally considered safe in pregnancy as long as chronic high doses are avoided. There have been reports of magnesium-, calcium-, or aluminum-containing antacids causing hypermagnesemia, hypomagnesemia, hypercalcemia, and increased tendon reflexes in fetuses and neonates whose mothers were using these antacids

chronically in high doses.

Neither magnesium nor aluminum hydroxide enters the breast milk significantly, and no problems have been reported in laclating women.

- Patients with advanced renal failure are at risk of aluminum accumulation and toxicity.

- Prolonged use of aluminum-containing antacids in patients with renal failure may result in or worsen dialysis osteomalacia.

- Aluminum salts form insoluble complexes with phosphate in the gastrointestinal tract and decreases phosphate absorption. Prolonged use of aluminum-containing antacids by normophosphatemic patients may result in hypophosphatemia if phosphate intake is not adequate. In its more severe forms, hypophosphatemia can lead to anorexia, malaise, muscle weakness, and osteomalacia.