An antacid is a substance that is used to neutralize excess hydrochloric acid (HCl) in the stomach; excess stomach acid often

leads to a burning pain known as heartburn. Antacids contain alkaline salt compounds that produce hydroxide ions (OH-) in water. OH- joins with hydrogen ions (H+) from the dissociated HCl in the stomach fluid, forming water molecules. The cations produced when the alkaline salt compound mixes with the stomach fluid joins with chlorine ions (Cl-) from the HCl, forming salts. As the OH- pairs with the H+, the acidity of the stomach fluid decreases and the pH is raised. This is known as a neutralization, or acid-base, reaction (Tro 2011). Maalox Advanced Maximum Strength Liquid is a popular brand of antacid that can be purchased over the counter at most drugstores. The active ingredients that participate in the neutralization reactions of this product are Al(OH)3 (aluminum hydroxide) and Mg(OH)2 (magnesium hydroxide). Other ingredients include simethicone, butylparaben, carboxymethylcellulose sodium, flavor, glycerin, hypromellose, microcrystalline cellulose, potassium citrate, propylene glycol, propylparaben, purified water, saccharin sodium, and sorbitol (Maalox 2013). Al(OH)3 and Mg(OH)2 are weak electrolytes; therefore, the two compounds partially dissociate in water, but do not dissociate completely (Tro 2011). Because this product is in liquid form and contains water, the ions are already partially dissociated before consumption; the ions formed when these two compounds are in aqueous states are Al3+, Mg2+, and OH- (Tro 2011). When a person consumes Maalox Advanced Maximum Strength Liquid orally, it is transported through the esophagus to the stomach. When the substance reaches the stomach fluid, the OH- ions pair with some of the H+ ions in the stomach fluid, creating water molecules and raising the pH of the stomach fluid as the concentration of H+ ions decreases. Al3+ and Mg2+ pair with Cl- in the stomach fluid, creating aqueous salts. Because Al(OH)3 and Mg(OH)2 partially dissociate in water, some of the formula units remain intact, producing no ions (Tro 2011). The molecular equations for these neutralization reactions are as follows: Al(OH)3 (aq) + 3HCl (aq) 3H2O (l) + AlCl3 (aq) Mg(OH)2 (aq) + 2HCl (aq) 2H2O (l) + MgCl2 (aq) The complete ionic equations are as follows: Al(OH)3 (aq) + 3H+ (aq) + 3Cl- (aq) 3H2O (l) + Al3+ (aq) + 3Cl- (aq) Mg(OH)2 (aq) + 2H+ (aq) + 2 Cl- (aq) 2H2O (l) + Mg2+ (aq) + 2Cl- (aq) The net ionic equations are as follows: Al(OH)3 (aq) + 3H+ (aq) 3H2O (l) + Al3+ (aq) Mg(OH)2 (aq) + 2H+ (aq) 2H2O (l) + Mg2+ (aq) The most common side effect of consuming Al(OH)3 is constipation. Excessive consumption of Al(OH)3 has also been connected with low phosphate levels in the body, a condition known as hypophosphatemia. Although some Al3+ ions bind to Cl- ions in the stomach fluid, others bind to existing phosphate ions (PO43-) in the stomach (Aluminum 2013). Phosphate ions are an important substance in the body, and low phosphate levels can result in bone pain, confusion, and muscle weakness (Hypophosphatemia 2012).

The most common side effect of consuming Mg(OH)2 is diarrhea. Excessive consumption of Mg(OH)3 can lead to high magnesium levels in the blood, a condition known as hypermagnesemia (Aluminum 2013). The initial signs of hypermagnesemia are headache, nausea, and skin flushing (Fulop 2013). Al(OH)3 and Mg(OH)2 are often used in conjunction with one another in antacids; this allows for an efficient concentration of cations without the administration of excessive amounts of either Al(OH)3 or Mg(OH)2, resulting in less likelihood of diarrhea or constipation than if a total equivalent amount of only Al(OH)3 or Mg(OH)2 were present in the drug (Aluminum 2013). In order to decrease the possibility of side effects, Maalox Advanced Maximum Strength Liquid should be taken at the indicated dosage of 2-4 teaspoons, twice a day. One 4-teaspoon dose delivers 1600 grams of Al(OH)3 and 1600 grams of Mg(OH)2 (Maalox 2013). The risk of hypophosphatemia and hypermagnesemia can be decreased by using the antacid at the indicated dosage for a maximum duration of two weeks; these two conditions have been connected to prolonged, chronic use of aluminum- and magnesium-containing antacids, respectively (Maalox 2013, Fulop 2012). Other ingredients in Maalox Advanced Maximum Strength liquid are simethicone, butylparaben, carboxymethylcellulose sodium, flavor, glycerin, hypromellose, microcrystalline cellulose, potassium citrate, propylene glycol, propylparaben, purified water, saccharin sodium, and sorbitol (Maalox 2013). Simethicone is an agent that breaks gas bubbles in the stomach fluid, allowing the gas to be more easily eliminated. Butylparaben and propylparaben are used as anti-microbial preservatives; butylparaben also serves as a suspending agent (Butylparaben 2013, Propylparaben 2013). Carboxymethylcellulose sodium, hypromellose, and microcrystalline cellulose consist of modified cellulose, a polysaccharide, and are used as emulsifiers to keep components distributed throughout the suspension as uniformly as possible (Modified). Purified water is used as a solvent, while propylene glycol and glycerol act as a co-solvents, increasing the solubility of the other substances in the mixture (Monophasic 2012). Saccharin sodium and sorbitol contribute sweetness, which makes the taste of the medication tolerable; potassium citrate counteracts bitterness, and other flavors are added to increase this palatability (Sweeteners 2012, Sohi 2012).

References Aluminum Hydroxide / Magnesium Hydroxide Side Effects. (2013). Retrieved from
http://www.drugs.com/sfx/aluminum-hydroxide-side-effects.html Butylparaben. (2013). Retrieved from http://www.drugs.com/inactive/butylparaben-12.html Fulop, T. (2012). Hypermagnesemia. Retrieved from http://emedicine.medscape.com/article/
246489-overview#aw2aab6b4 Hypophosphatemia. (2012). Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/ PMH0001351/ Inactive Ingredients in Pharmaceutical Products. (1997, February 1). Pediatrics, 99(2): 268-278. Liamis, G., Milionis, H.J., Elisaf M. (2010). Medication-induced hypophosphatemia: a review. QJM, 103 (7): 449-459. Maalox Advanced Maximum Strength Liquid. (2013). Retrieved from
http://www.maaloxus.com/ index.shtml?maxLiquid Modied Cellulose. (2013). Retrieved from http://www.inrfood.com/ingredients/6947 Monophasic Liquid Dosage Form: Oral Solutions, Syrups, and Elixers. (2012). Retrieved from:
http://pharmawiki.in/monophasic-liquid-dosage-form/ Propylparaben. (2013). Retrieved from http://www.drugs.com/inactive/propylparaben-87.html Simethicone. (2013). Retrieved from http://www.drugs.com/mtm/simethicone.html Sweeteners in Pharmaceutical Suspensions. (2012). Retrieved from
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