Maalox Dosage for Gastric Ulcer Patients
Maalox (aluminum hydroxide and magnesium hydroxide) is NOT the recommended treatment for gastric ulcers—proton pump inhibitors (PPIs) are the preferred agents for both therapy and prophylaxis of gastric ulcer disease. 1
Why Maalox is Not Recommended
PPIs have been proven superior to antacids for gastric ulcer healing and symptom control. 1 The evidence clearly demonstrates:
- PPIs are the treatment of choice for gastric ulcers, with omeprazole 20-40 mg once daily providing cumulative healing rates of up to 100% after 4-8 weeks 2
- Antacids like Maalox provide only symptomatic relief but do not address the underlying pathophysiology of ulcer disease 1
- H2-receptor antagonists are less effective than PPIs for gastric ulcer healing and do not consistently maintain gastric pH above 6 3
Recommended Treatment Algorithm
Initial Management
- Start a PPI immediately (omeprazole 20-40 mg once daily or equivalent) for ulcer healing 4, 3
- Test for H. pylori infection in all gastric ulcer patients and provide eradication therapy if positive 1, 4
- Discontinue NSAIDs immediately if possible; if NSAIDs must be continued, maintain PPI co-therapy indefinitely 4, 3
For Bleeding Gastric Ulcers
- Administer high-dose PPI therapy: 80 mg omeprazole bolus followed by 8 mg/hour continuous infusion for 72 hours after endoscopic hemostasis 1, 3
- Transition to standard oral PPI (omeprazole 20 mg once daily) after the 72-hour infusion 4
Maintenance Therapy
- Continue PPI once daily for duration dictated by underlying cause 1
- If NSAIDs must be continued: maintain PPI indefinitely for gastroprotection 4, 3
If Maalox Must Be Used (Symptomatic Relief Only)
While not evidence-based for ulcer healing, if Maalox is requested for symptomatic relief as an adjunct:
- Typical dosing: 10-20 mL (or 2-4 tablets) taken 1 and 3 hours after meals and at bedtime 5, 6
- This provides only temporary symptom relief and does not heal ulcers 1, 5
- Must be combined with definitive PPI therapy for actual ulcer healing 1
Critical Pitfalls to Avoid
- Do not rely on antacids as primary therapy—they do not heal gastric ulcers and delay appropriate treatment 1
- Sucralfate is ineffective for gastric ulcers (only works for duodenal ulcers when NSAIDs are stopped) 1, 3
- H2-receptor antagonists are inadequate as they are significantly less effective than PPIs for gastric ulcer healing 4, 3
- Any gastric ulcer failing to heal within 12-15 weeks requires endoscopic re-evaluation to exclude malignancy 7