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Almagate

AEMPS

Antacid (aluminium magnesium hydroxide carbonate)

ATC code: A02AD02

Updated · Methodology

Indications

C

Functional dyspepsia

Adjunct

Symptomatic relief of epigastric pain and discomfort in functional dyspepsia. Per Rome IV and dyspepsia management guidelines (/CAG 2017; GuíaSalud/AEG-semFYC), first-line depends on subtype: PPIs for epigastric pain syndrome; prokinetics for postprandial distress. Antacids give quick relief but do not modify disease course.

Sources

  1. AEMPS: Ficha técnica de Almagato (2024)
  2. Am J Gastroenterol: ACG and CAG Clinical Guideline: Management of Dyspepsia (2017)
  3. AEG, semFYC, Centro Cochrane Iberoamericano: Manejo del paciente con dispepsia. Guía de práctica clínica (actualización 2012) (2012)

ICD-10: K30 · ICD-11: DD90.3

C

Gastroesophageal reflux disease

Adjunct

Symptomatic relief in moderate heartburn and acid reflux. 2022 and the Spanish AEG GERD guideline (2022) set proton pump inhibitors (omeprazole, pantoprazole, esomeprazole) and lifestyle change as first-line in GERD. Antacids including almagate are quick symptomatic relief used before or together with a PPI, especially in episodic heartburn. Not used as monotherapy in erosive esophagitis. Antacids reduce absorption of some drugs (fluoroquinolones, tetracyclines, levothyroxine, iron) – separate doses by about 2 hours; use with caution in renal impairment due to aluminum and magnesium accumulation.

Sources

  1. AEMPS: Ficha técnica de Almagato (2024)
  2. AEG: Guía AEG sobre enfermedad por reflujo gastroesofágico (2022)
  3. Am J Gastroenterol: ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease (2022)

ICD-10: K21 · ICD-11: DA22

How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

Aluminium and magnesium hydroxide carbonate in crystalline form. Neutralizes gastric acid with fast onset (5–10 minutes) and up to 3 hours' duration on an empty stomach. Not absorbed – acts only in the gastric lumen. Compared with other antacids, the balanced aluminium-to-magnesium ratio causes less constipation (from aluminium) and less diarrhea (from magnesium). In Spain it is among the most popular over-the-counter antacids under the brand Almax by Almirall.

Safety

Contraindications

  • Hypersensitivity to components
  • Severe renal impairment (eGFR under 30) – hypermagnesemia risk
  • Hypophosphatemia
  • Alzheimer's disease (theoretical aluminium accumulation risk)
  • Age under 6

Serious adverse effects

  • Hypermagnesemia in CKD
  • Hypophosphatemia and osteomalacia with long-term use
  • Allergic reactions (rare)
  • Reduced absorption of other drugs with loss of efficacy

Common adverse effects

  • Constipation or diarrhea (individual response)
  • Nausea
  • Taste alteration
  • Flatulence

Pregnancy: can you take Almagate?

Acceptable in pregnancy for short-term heartburn relief. Systemic bioavailability is essentially nil.

Breastfeeding: can you take Almagate?

Compatible with breastfeeding. Essentially does not pass into milk.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Take 1.5 g chewable tablet or 10 mL suspension one hour after meals and at bedtime as needed. Do not co-administer with other drugs – aluminium and magnesium salts reduce absorption of tetracyclines, fluoroquinolones, levothyroxine, bisphosphonates, and iron salts. Allow at least 2 hours between almagate and these agents. Long-term use beyond 2 weeks without evaluation is not recommended – the underlying cause of dyspepsia needs clarification.

Common myths

Myth: «antacids are safe – take them like sweets.» Fact: long-term high-dose antacids cause hypophosphatemia, osteomalacia, increased stone formation risk, and impaired absorption of vitamins and minerals. In CKD, the risk of hypermagnesemia and aluminium toxicity rises. Constant antacid need is a reason to investigate (endoscopy, Helicobacter pylori testing), not to keep self-medicating. Myth: «Almax is faster and more effective than omeprazole.» Fact: antacids work 1–3 hours; PPIs work for up to 24 hours and suppress acid secretion much more powerfully. For regular heartburn, PPIs are first-line.

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Frequently asked

What is Almagate used for?

Almagate is evaluated for the following indications with varying evidence strength: Functional dyspepsia (evidence tier C), Gastroesophageal reflux disease (evidence tier C). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Almagate?

Common side effects of Almagate (≥ 1 in 100): Constipation or diarrhea (individual response), Nausea, Taste alteration, Flatulence. See the Safety section for uncommon and serious reactions.

Is Almagate safe during pregnancy?

Acceptable in pregnancy for short-term heartburn relief. Systemic bioavailability is essentially nil.

Is Almagate compatible with breastfeeding?

Compatible with breastfeeding. Essentially does not pass into milk.

Who should not take Almagate?

Almagate is contraindicated in: Hypersensitivity to components; Severe renal impairment (eGFR under 30) – hypermagnesemia risk; Hypophosphatemia; Alzheimer's disease (theoretical aluminium accumulation risk); Age under 6. Full list in the Safety section.

Official sources

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Other drugs in this group

Deglycyrrhizinated licorice (DGL), Esomeprazole, Famotidine, Lansoprazole, Omeprazole, Rabeprazole, Mastic gum, Pantoprazole