TOLMICEN 1% Price

Overview

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This medicine contains an important and useful components, as it consists of
Tolciclateis available in the market in concentration

Name

Aluminium Oxide + Magnesium Hydroxide + Simethicon

Precaution

The combination of **aluminum oxide**, **magnesium hydroxide**, and **simethicone** is used primarily as an **antacid** and **anti-gas** preparation. It is essential to be cautious when using this combination in certain populations or under specific circumstances: - **Renal Impairment**: In patients with **renal dysfunction**, there is a risk of **aluminum and magnesium accumulation**, which could lead to toxicity. In severe renal disease, aluminum can build up and cause **neurotoxicity**, while magnesium can lead to **hypermagnesemia** (elevated magnesium levels), causing symptoms like **bradycardia**, **respiratory depression**, and **hypotension**. - **Pregnancy and Breastfeeding**: The combination is typically considered **safe** during pregnancy (Category C), but should be used with caution and under medical supervision, especially during the **third trimester**. Although **simethicone** is considered safe for use during pregnancy, **aluminum and magnesium** compounds should be used cautiously to avoid excessive accumulation in the body. It is important to monitor the dose carefully during breastfeeding, as small amounts of the ingredients may pass into breast milk. - **Gastrointestinal Disease**: Caution is advised in patients with **gastrointestinal conditions**, such as **irritable bowel syndrome (IBS)** or **bowel obstruction**, as the effects of magnesium hydroxide could exacerbate diarrhea or other gastrointestinal symptoms. - **Electrolyte Imbalances**: **Aluminum** and **magnesium** may cause **electrolyte disturbances**, including **hypocalcemia** (low calcium) or **hypermagnesemia** (high magnesium). Therefore, it is important to monitor for **signs of electrolyte imbalance** in long-term use. **Monitoring Parameters**: - **Serum Electrolytes**: Routine monitoring of **magnesium** and **calcium** levels is recommended to ensure **electrolyte balance**. - **Renal Function**: Regular monitoring of **serum creatinine** and **glomerular filtration rate (GFR)** is essential for patients with kidney disease to avoid drug accumulation. - **Gastrointestinal Function**: Monitor for signs of **gastrointestinal discomfort**, **constipation**, **diarrhea**, or **bloating**.

Indication

This combination is commonly used to treat: - **Heartburn**: Provides relief from acid reflux and indigestion by neutralizing stomach acid. - **Indigestion and Gastric Upset**: Alleviates discomfort associated with dyspepsia, bloating, and nausea. - **Flatulence and Gas**: **Simethicone**, an **anti-foaming agent**, helps reduce bloating, discomfort, and excessive gas in the stomach and intestines by breaking down gas bubbles. - **Gastroesophageal Reflux Disease (GERD)**: Used for short-term relief from the symptoms of GERD, including heartburn and regurgitation. - **Peptic Ulcers and Gastritis**: Offers symptomatic relief for patients with peptic ulcers and inflammation of the stomach lining (gastritis).

Contra indication

- **Renal Failure**: This combination should be avoided in patients with **severe renal insufficiency** as **aluminum and magnesium** can accumulate, leading to **neurotoxicity** and **hypermagnesemia**. - **Hypersensitivity**: Patients with known **hypersensitivity** to **aluminum**, **magnesium**, or **simethicone** should avoid this combination. - **Gastrointestinal Obstruction**: This combination is contraindicated in patients with **intestinal obstruction** or severe **bowel motility disorders**, as it may worsen the condition or mask underlying issues. - **Hypermagnesemia**: Patients with **existing hypermagnesemia** (high magnesium levels) should not use this combination, as it could exacerbate the condition.

Side Effect

- **Common Side Effects**: - **Constipation** (due to aluminum oxide) and **diarrhea** (due to magnesium hydroxide) are common side effects. However, the combination may balance these effects, reducing the likelihood of severe gastrointestinal issues. - **Bloating**, **gas**, or a feeling of **fullness** may be experienced, especially due to the simethicone. - **Less Common Side Effects**: - **Hypermagnesemia**: Symptoms include **nausea**, **vomiting**, **hypotension**, **bradycardia**, and in severe cases, **respiratory depression**. - **Aluminum Toxicity**: In patients with **renal impairment**, prolonged use may lead to **neurotoxicity** (e.g., memory loss, confusion) and **bone disease** due to the accumulation of aluminum. - **Electrolyte Imbalance**: Prolonged use could result in **hypocalcemia** or **hypermagnesemia**, especially in patients with impaired renal function. - **Abdominal discomfort** or **gastrointestinal upset**.

Pregnancy Category ID

0

Mode of Action

- **Aluminum Oxide**: This compound acts as an **antacid**, neutralizing excess stomach acid by reacting with hydrochloric acid in the stomach. This provides relief from heartburn and indigestion. - **Magnesium Hydroxide**: Magnesium hydroxide also neutralizes stomach acid and helps to alleviate discomfort from heartburn and indigestion. It has a **laxative effect**, helping to prevent constipation caused by aluminum oxide. - **Simethicone**: Simethicone works as an **anti-foaming agent**, helping to reduce the surface tension of gas bubbles in the gastrointestinal tract, which helps break down large gas bubbles and relieves the discomfort of **bloating** and **flatulence**. The combination works synergistically to provide comprehensive relief from both **gas-related discomfort** (simethicone) and **acid-related symptoms** (aluminum oxide and magnesium hydroxide).

Interaction

- **Antibiotics**: This combination can reduce the absorption of certain **antibiotics**, particularly **tetracyclines** (e.g., **doxycycline**) and **quinolones** (e.g., **ciprofloxacin**). To avoid this interaction, these medications should be taken **2 hours** apart. - **Iron Supplements**: The absorption of **iron** is reduced when taken concurrently with antacids. It is recommended to separate the doses by at least **2 hours**. - **Digoxin**: **Magnesium** can interfere with the action of **digoxin**, particularly in patients with low magnesium levels. Monitoring **serum digoxin levels** is recommended. - **Levothyroxine**: The absorption of **levothyroxine** may be reduced when taken with antacids. It is best to take **levothyroxine** at least **2 hours before or after** taking this combination. - **Other Antacids**: Using other antacids or **H2-receptor antagonists** (e.g., **ranitidine**) may increase the risk of **alkalosis**, and **gastric acid suppression** could reduce the efficacy of other medications.

Pregnancy Category Note

Information not available

Adult Dose

For adults, the typical dose is: - **10-15 mL** taken **1 to 3 times a day** after meals, or as needed for **heartburn**, **indigestion**, or **gas relief**. - In cases of more severe gastric discomfort, the dose may be increased to **15 mL** up to **4 times daily**. - It is essential to **chew or shake** the liquid form before swallowing to ensure proper dosing and distribution of the active ingredients.

Child Dose

For pediatric patients, dosing is typically lower: - **Children over 12 years** may be prescribed the adult dose, usually **10-15 mL** up to **3 times a day**. - For **children under 12 years**, the dose should be **adjusted** by a healthcare provider based on the child’s weight and the severity of symptoms. - **Children under 6 years** should avoid this combination unless recommended by a pediatrician. The pediatric dose should be prescribed with caution and adjusted for the child's specific needs, ensuring that it is used only under healthcare supervision.

Renal Dose

In patients with **renal impairment**, the dose should be reduced or the medication should be avoided entirely, particularly in cases of **severe renal failure**. In patients with moderate renal dysfunction, monitoring of **serum creatinine**, **magnesium**, and **calcium levels** is essential to avoid **toxicity**.

Administration

Information not available