ACTION AND MECHANISM- Antacid. Almagate is an aluminum and magnesium derivative that acts as a non-absorbable antacid by neutralizing hydrochloric acid in the stomach. Increased gastric pH also reduces the formation and activity of pepsin. In addition, it adsorbs the pepsin formed and adsorbs and neutralizes bile acids when they reflux into the stomach. SPECIAL WARNINGS- Evaluate patients who develop gastrointestinal bleeding of unknown origin. PATIENT ADVICE- If symptoms continue or worsen after 14 days of treatment, consult your doctor and/or pharmacist.- Separate the antacid from any other oral medication by 2-3 hours.- Inform your doctor and/or pharmacist if you experience any of the following symptoms:* Blood in vomit or stool. CONTRAINDICATIONS- Hypersensitivity to Almagate or any other component of the medication.- [ALZHEIMER'S DISEASE]. Aluminum may be related to the onset of this disease.- Patients with gastrointestinal bleeding of unknown cause (see Precautions; gastrointestinal bleeding).- [HEMORRHOIDS].- [EDEMA].- [DIARRHEA]. Magnesium salts may promote diarrhea.- Toxemia of pregnancy.ADVANCED AGEAluminum may interfere with the absorption of phosphorus and calcium, promoting the onset of osteoporosis. It is therefore recommended to avoid high doses or prolonged treatments.Its use is contraindicated in cases of Alzheimer's disease, due to the possible relationship between this disease and aluminum.EFFECTS ON DRIVINGIt does not appear to have significant effects.PREGNANCYSafety in animals: no data available.Safety in humans: no adequate and well-controlled studies in humans are available. The administration of antacids is considered safe during pregnancy, although it is recommended not to administer them at high doses or for long periods of time, due to the risk of systemic effects. Cases of tendon hyperreflexia have been reported in newborns of mothers who used aluminium and/or magnesium salts during pregnancy. Effects on fertility: No specific studies have been conducted in humans. PHARMACOKINETICS- Absorption: the absorption of aluminium and magnesium is minimal.- Excretion: the absorbed metal ions are eliminated via the kidneys, while the rest appear in the faeces. INDICATIONS- Symptomatic treatment of [GASTRIC HYPERACIDITY] in adults and adolescents from 12 years of age. INTERACTIONS- Antiulcer agents. The increase in pH could reduce the activation of PPIs (e.g. omeprazole) in the canaliculi of the parietal glands. Avoid the combination.- Salicylates. Antacids may alkalinize urine, promoting salicylate elimination. In addition to these interactions, it should be noted that antacids may interfere with the absorption of any orally administered medication through various mechanisms. It may be advisable to space doses 2-3 hours apart. The following interaction mechanisms have been described: - Drugs with pH-dependent absorption. Antacids may affect the solubility and subsequent intestinal absorption of drugs in which gastric pH is a limiting factor. Thus, a decrease in the absorption of drugs such as atenolol, azole antifungals, NSAIDs, digoxin, erlotinib, gabapentin, and ulipristal has been observed. - Formation of insoluble chelates. Aluminum can form insoluble complexes with drugs such as quinolones, iron salts, or tetracyclines, reducing their absorption. BREASTFEEDING Safety in animals: no data available. Safety in humans: Both aluminum and magnesium can be excreted in milk, but due to the low intestinal absorption of almagate, they are not likely to appear in significant quantities. Compatible with breastfeeding as long as low doses are used and for a short period of time. CHILDREN Almagate can be used in adolescents from 12 years of age at the same doses as in adults. The use of antacids is not recommended in children under 12 years of age, as they may mask serious symptoms such as appendicitis. In addition, there is a risk of hypermagnesemia or aluminum poisoning in children treated with magnesium and aluminum salts. GUIDELINES FOR CORRECT ADMINISTRATION - Chewable tablets: chew or allow to dissolve in the mouth. DOSAGE "ALMAX, ALMAGATO STADAPHARM" - Adults: 1 g/8 h. If necessary, an additional dose may be administered at bedtime. Maximum dose 8 g/24 h.- Children and adolescents < 18 years:* Adolescents 12 years and older: same as adults.* Children < 12 years: not recommended.- Elderly: no dosage adjustment is required. Avoid prolonged treatment or high doses.Duration of treatment: avoid treatment lasting longer than 14 days without medical advice.Forgotten doses: administer the missed dose as soon as possible unless the next dose is almost due. Administer the next dose at the usual time. Do not double the next dose.DOSAGE IN LIVER FAILURENo specific dosage recommendations have been made.DOSAGE IN RENAL FAILURE- Mild to moderate renal impairment (CLcr 30-90 ml/min): avoid high doses.- Severe renal impairment (CLcr < 30 ml/min): not recommended.PRECAUTIONS- [RENAL FAILURE]. Risk of magnesium and aluminum accumulation in these patients. It is recommended to use it with caution in cases of mild to moderate insufficiency (CLcr 30-90 ml/min), and to avoid it in cases of severe insufficiency (CLcr < 30 ml/min).- [DIGESTIVE HEMORRHAGE]. Patients with gastrointestinal bleeding should be evaluated, since almagate may mask more serious conditions such as stomach cancer.- [INTESTINAL MALABSORPTION]. Almagate may reduce phosphate absorption by forming insoluble complexes. Caution is recommended in patients with intestinal malabsorption, on a diet low in phosphorus, or in [CONVALESCENCE] due to the risk of hypophosphatemia. ADVERSE REACTIONS The effects are mild, transient, and infrequent due to low intestinal absorption. Adverse reactions are described according to each frequency interval, being considered very common (>10%), common (1-10%), uncommon (0.1-1%), rare (0.01-0.1%), very rare (<0.01%) or of unknown frequency (cannot be estimated from the available data). - Digestive: unknown frequency [DIARRHOEA]. OVERDOSE Symptoms: no cases have been described. Interference with phosphate absorption is to be expected, and hypophosphatemia and osteomalacia may occur, especially in chronic poisoning. Measures to be taken: symptomatic treatment