Maalox Dosing for GERD
Maalox is not recommended as primary therapy for GERD—proton pump inhibitors (PPIs) are first-line treatment and significantly more effective than antacids for both symptom control and healing esophagitis. 1
Why PPIs Instead of Maalox
PPIs are Grade A recommended (strongly recommended based on good evidence) for treating esophageal GERD syndromes, providing superior healing of esophagitis and symptomatic relief compared to H2-receptor antagonists, which are in turn more effective than placebo or antacids. 1
The American Gastroenterological Association explicitly states that antacids have only short-lived effects and are not appropriate as primary GERD therapy. 2
While many patients with mild GERD may use antacids for symptomatic self-care, this approach does not address the underlying pathophysiology or provide sustained symptom control. 3
Limited Role for Maalox in GERD Management
If you must use Maalox, it should only be as adjunctive therapy for breakthrough symptoms, not as primary treatment. 1, 4
Alginate-containing antacids (like Gaviscon) are preferred over standard antacids when adjunctive therapy is needed, as alginates neutralize the post-prandial acid pocket and provide more sustained relief. 4
The most rapidly acting agents for on-demand symptom relief are antacids, but their efficacy can only be sustained by combining them with an H2RA or PPI—not by using antacids alone. 1
Antacids should be personalized to the GERD phenotype as adjunctive agents for breakthrough symptoms, particularly after meals and at bedtime. 1, 4
Proper GERD Treatment Algorithm
Start with standard once-daily PPI therapy (taken 30 minutes before the first meal) for a 4-8 week trial. 1, 4
If symptoms persist after 4-8 weeks, escalate to twice-daily PPI dosing (before breakfast and dinner) rather than continuing with ineffective antacid therapy. 1, 4
Patients whose heartburn has not adequately responded to twice-daily PPI therapy should be considered treatment failures and require diagnostic evaluation with endoscopy. 1
Common Pitfall to Avoid
Do not rely on Maalox as monotherapy for GERD—this approach fails to provide adequate acid suppression, does not heal esophagitis, and leaves patients undertreated with persistent symptoms and risk of complications. 1, 3, 2