What is the recommended dosage and treatment plan for Gaviscon (sodium alginate) chew for patients with heartburn or acid reflux?

Gaviscon Chewable Tablet Dosing for Heartburn and Acid Reflux

For breakthrough heartburn or acid reflux symptoms, chew 2-4 Gaviscon tablets four times daily after meals and at bedtime, followed by half a glass of water—do not swallow tablets whole. 1

Specific Dosing Instructions

• Chew 2-4 tablets four times per day, taken specifically after meals and at bedtime, or as needed for symptom relief 1
• Always follow with half a glass of water or other liquid after chewing for optimal efficacy 1
• Never swallow the tablet whole—chewing is essential for the alginate mechanism to work properly 1
• Onset of cooling/soothing effect occurs within approximately 66 seconds, with complete heartburn relief achieved within 3-4 minutes 2

Clinical Role in GERD Management

Gaviscon alginate antacids should be used as adjunctive therapy for breakthrough symptoms in patients already on PPI therapy, not as primary treatment. 3

• The American Gastroenterological Association recommends personalizing alginate antacid use specifically for breakthrough symptoms rather than empiric continuous use 3
• PPIs remain first-line therapy and are more effective than antacids alone for healing esophagitis and providing sustained symptom relief 3
• Alginates work by forming a physical barrier that floats on gastric contents, reducing acid exposure in the esophagus 4, 5

Evidence for Efficacy

• Alginate antacid chewable tablets significantly reduce esophageal acid exposure, decreasing the percentage of time with pH <4 from 14.8% (placebo) to 5.1% (alginate) in the 4-hour post-meal period 4
• The acid-reducing effect is time-limited, primarily effective during the first hour after administration 5
• When added to omeprazole in NERD patients, alginate combination therapy achieved 56.7% complete heartburn resolution versus 25.7% with omeprazole alone 6

Treatment Algorithm Position

• Step 1: Start with single-dose PPI therapy (once daily before meals) for 4-8 weeks as initial management 7, 8
• Step 2: If partial response, increase to twice-daily PPI dosing 3, 8
• Step 3: Add alginate antacids like Gaviscon for breakthrough symptoms that occur despite optimized PPI therapy 3
• Step 4: If symptoms persist after 8 weeks of twice-daily PPI plus adjunctive therapy, proceed to endoscopy and pH-impedance monitoring 3

Common Pitfalls to Avoid

• Do not use alginate antacids as monotherapy for chronic GERD—they are adjunctive agents only, as PPIs provide superior acid suppression and esophagitis healing 3
• Do not swallow tablets whole—the chewing action and subsequent water intake are critical for forming the protective alginate raft 1
• Do not expect sustained 24-hour protection—alginate effects are primarily limited to the first 1-2 hours post-dose, making timing after meals essential 5
• Avoid using alginates as a substitute for proper PPI optimization (correct timing 30-60 minutes before meals, twice-daily dosing if needed) 8

Safety Profile

• Alginate antacids have excellent tolerability with minimal adverse events—in studies, only mild diarrhea was reported in isolated cases 4, 6
• Over 95% of patients and physicians rated tolerability as good in large observational studies 9
• Safe for use in pregnancy for reflux symptoms 9