Treatment of acid related symptoms of gastro-oesophageal reflux such as acid regurgitation, heartburn and indigestion, for example following meals or during pregnancy.

Posology:

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.

Method of administration:

For oral administration.

This medicinal product is contraindicated in patients with known or suspected hypersensitivity to the active substances or to any of the excipients listed in section 6.1.

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 medicinal product is considered high in sodium. This should be particularly taken into account for those on a low salt diet

Each 10 ml contains 130 mg (3.25 mmol) of calcium. Care needs to be taken in treating patients with hypercalcaemia, nephrocalcinosis and recurrent calcium containing renal calculi.

If symptoms do not improve after seven days, the clinical situation should be reviewed.

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

Prolonged use should be avoided.

As with other antacid products, taking Gaviscon Double Action Mixed Berries Flavour Oral Suspension can mask the symptoms of other more serious, underlying medical conditions.

Gaviscon Double Action Mixed Berries Flavour Oral Suspension should not be used in the following cases:

• Patients with severe/impaired renal function/-insufficiency

• Patients with hypophosphatemia

There is a possibility of reduced efficacy in patients with very low levels of gastric acid.

There is increased risk for hypernatremia in children with gastroenteritis or suspected renal insufficiency.

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

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

Pregnancy:

A moderate amount of data on pregnant women (between 300-1000 pregnancy outcomes) indicate no malformative or feto/neonatal toxicity of the active substances.

Based on this and previous experience, the medicinal product may be used during pregnancy and lactation, if clinically needed.

Nevertheless, taking into account the presence of calcium carbonate it is recommended to limit the treatment duration as much as possible.

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.

Fertility:

Pre-clinical animal investigations have revealed alginate has no negative effect on parental or offspring fertility or reproduction.

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

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

Adverse events which have been associated with sodium alginate, sodium hydrogen carbonate 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.

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: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Symptoms

Some abdominal distension may be noticed.

Management

In the event of overdosage symptomatic treatment should be given.

Pharmacotherapeutic group: A02BX, Other drugs for peptic ulcer and gastro-oesophageal reflux disease.

The medicinal product is a combination of two antacids (calcium carbonate and sodium hydrogen carbonate) and an alginate.

On ingestion, the medicinal product reacts rapidly with gastric acid to form a protective barrier (raft) of alginic acid gel having a near neutral pH and which floats on the stomach contents. Effective impediment of gastro-oesophageal reflux may last for up to 4 hours. In severe cases the raft itself may be refluxed into the oesophagus, in preference to the stomach contents and exert a demulcent effect.

Calcium carbonate neutralises gastric acid to provide fast relief from indigestion and heartburn. This effect is increased by the addition of sodium hydrogen carbonate which also has a neutralising action. The total neutralising capacity of the product at the lowest dose of 10 ml is approximately 10 mEqH⁺.

The mode of action of the medicinal product is physical and does not depend on absorption into the systemic circulation.

There are no preclinical data of relevance to the prescriber, which are additional to those already included in other sections of the SmPC

Carbomer

Methyl parahydroxybenzoate (E218)

Propyl parahydroxybenzoate, (E216)

Saccharin sodium

Raspberry flavour

Cranberry flavour

Fantasy fruit masking flavour

Sodium hydroxide

Sodium

Propylene glycol*

Purified water

*present in cranberry, raspberry and fantasy fruit flavours

Not applicable.

2 years.

Use within 6 months of opening

Do not store above 30° C. Do not refrigerate or freeze.

Amber glass bottles or Pink coated Amber glass bottles

With a polypropylene cap with a polyethylene tamper-evident band lined with expanded polyethylene wad with either a measuring device (natural polypropylene) containing 5 ml, 10 ml, 15 ml, and 20 ml graduations, or a measuring spoon (crystal polystyrene) containing 2.5 ml and 5 ml measure.

Pack sizes:150, 200, 250ml, 300 and 600 ml.

Not all pack sizes may be marketed. The carton and measuring device or spoon may not be made available in all markets/pack sizes.

No special requirements for disposal.