4.1. Therapeutic indications

Treatment of symptoms resulting from the reflux of acid, bile and pepsin into the oesophagus such as acid regurgitation, heartburn and indigestion, for example following meals or during pregnancy, and for symptoms of excess stomach acid (hyperacidity). Can also be used to treat the symptoms of gastro-oesophageal reflux during concomitant treatment with or following withdrawal of acid suppressing therapy.

4.2. Posology and method of administration

For oral administration.

Adults and children 12 years and over: 10-20 ml after meals and at bedtime, up to four times per day.

Children under 12 years: Should be given only on medical advice.

Elderly: No dose modifications necessary for this age group.

Hepatic Impairment: No dose modification necessary.

Renal Insufficiency: Caution if highly restricted salt diet is necessary (see section 4.4).

4.3. Contraindications

Hypersensitivity to sodium alginate, sodium bicarbonate, calcium carbonate, the esters of hydroxybenzoates (parabens) or to any of the excipients listed in section 6.1.

4.4. Special warnings and precautions for use

If symptoms persist, or treatment is required for more than 7 days continuously, medical advice should be sought.

As with other antacid products, taking this product can mask the symptoms of other more serious, underlying medical conditions.

Treatment of children younger than 12 years of age is not generally recommended, except on medical advice.

Excipient warnings:

This medicinal product contains 127.88 mg sodium per dose, equivalent to 6.4 % of the WHO recommended maximum daily intake for sodium.

The maximum daily dose of this product is equivalent to 51.15% of the WHO recommended maximum daily intake for sodium.

This product is considered high in sodium. This should be particularly taken into account for those on a low salt diet (e.g. in some cases of congestive heart failure and renal impairment).

Each 20 ml contains 260 mg (6.5mmol) of calcium. Care needs to be taken in treating patients with hypercalcaemia, nephrocalcinosis and recurrent calcium containing renal calculi.

Contains methyl parahydroxybenzoate (E218) and propyl parahydroxybenzoate (E216) which may cause allergic reactions (possibly delayed).

This medicine contains 1.05 mg benzyl alcohol (from Fennel flavour) per 10 ml. Benzyl alcohol may cause allergic reactions.

Large amounts of benzyl alcohol can build up in the body and may cause side effects (called "metabolic acidosis"). This should be taken into consideration by patients who have a liver or kidney disease or are pregnant or breast-feeding.

4.5. Interaction with other medicinal products and other forms of interaction

Due to the presence of calcium and carbonates which act as an antacid, a time-interval of 2 hours should be considered between intake of this product and the administration of other medicinal products, especially H2-antihistaminics, tetracyclines, digoxine, fluoroquinolones, iron salts, thyroid hormones, ketoconazole, neuroleptics, thyroxine, penicilamine, beta-blockers (atenolol, metoprolol, propanolol), glucocorticoid, chloroquine, diphosphonates, and estramustine. See also section 4.4.

4.6. Fertility, pregnancy and lactation

Pregnancy

Open controlled studies in 281 pregnant women did not demonstrate any significant adverse effects of Gaviscon on the course of pregnancy or on the health of the foetus/new-born child. Based on this and previous experience the medicinal product may be used during pregnancy, if clinically needed.

Breastfeeding:

No effects of the active substances have been shown in breastfed newborns/infants of treated mothers. This product can be used during breast-feeding if clinically needed.

Fertility

Clinical data do not suggest that this product has an effect on human fertility.

4.7. Effects on ability to drive and use machines

This product has no or negligible influence on the ability to drive and use machines.

4.8. Undesirable effects

Adverse events which have been associated with sodium alginate, sodium bicarbonate and calcium carbonate are given below, tabulated by system organ class and frequency. Frequencies are defined as: Very common (≥1/10); Common (≥1/100 and <1/10); Uncommon (≥1/1000 and <1/100); Rare (≥1/10,000 and <1/1000); Very rare (< 1/10,000); Not known (cannot be estimated from the available data). Within each frequency grouping, adverse events are presented in order of decreasing seriousness.

System Organ Class

Frequency

Adverse Events

Immune System Disorders

Very Rarely

Anaphylactic reaction, anaphylactoid reaction. Hypersensitivity reactions such as urticaria.

Metabolism and Nutritional Disorders

Not Known

Alkalosis1, acid rebound1, Hypercalcaemia1, Milk-alkali Syndrome1

Respiratory, Thoracic and Mediastinal Disorders

Very Rarely

Respiratory effects such as bronchospasm.

Gastrointestinal Disorders

Not Known

Constipation1

Description of Selected Adverse Reactions

1 Usually occurs following larger than recommended dosages.

Reporting of Suspected Adverse Reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: http://www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

4.9. Overdose

Symptoms

Symptoms are likely to be minor in acute overdose; some abdominal distension may be noticed. Milk-alkali syndrome has occurred in individuals taking large doses of calcium carbonate per day for prolonged periods.

Management

In the event of overdosage symptomatic treatment should be given.