From the FDA Drug Label
Directions shake well before using do not take more than 12 teaspoonfuls in 24 hours do not use the maximum dosage for more than 2 weeks dosage: 2 teaspoonfuls 5-6 times daily after meals and at bedtime followed by a sip of water if needed The recommended dose of Almagel (aluminum hydroxide) for a woman at 40 weeks gestational age (GA) with epigastric pain is 2 teaspoonfuls 5-6 times daily after meals and at bedtime, not to exceed 12 teaspoonfuls in 24 hours 1.
From the Research
For a woman at 40 weeks gestational age experiencing epigastric pain, the recommended dose of Almagel (aluminum hydroxide) is typically 1-2 teaspoons (5-10 mL) taken orally 4 times daily, preferably 30 minutes after meals and at bedtime. This medication works by neutralizing stomach acid and forming a protective barrier in the stomach, which can help relieve epigastric pain caused by acid reflux or heartburn, common in late pregnancy. However, it's essential to note that epigastric pain in late pregnancy could also be a symptom of preeclampsia, so the woman should be evaluated for blood pressure, proteinuria, and other concerning symptoms before attributing the pain solely to gastric issues 2. While aluminum hydroxide is generally considered safe during pregnancy, it should be used for the shortest duration necessary as it may cause constipation and can interfere with the absorption of certain medications and nutrients. If symptoms persist beyond a few days or worsen, medical evaluation is necessary to rule out more serious conditions. Some studies suggest that alternative treatments like quince sauce may be as effective as ranitidine in managing GERD symptoms in pregnancy 3, but aluminum hydroxide remains a common and recommended option for heartburn relief during pregnancy 2. It's also worth noting that interventions for heartburn in pregnancy, including pharmaceutical treatments and lifestyle modifications, have been shown to be effective in relieving symptoms, but more research is needed to fully evaluate their effectiveness and potential side effects 2. In terms of safety, aluminum hydroxide is considered safe for use during pregnancy, but it's crucial to follow the recommended dosage and duration of treatment to minimize potential side effects 4. Overall, the use of Almagel (aluminum hydroxide) for epigastric pain in pregnancy should be guided by the most recent and highest-quality evidence, with consideration of the potential benefits and risks of treatment.