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Almagate: A clinical and biochemical review

Almagate is a crystalline hydrated aluminum-magnesium hydroxycarbonate containing antacid with a unique rigid lattice structure. The observations from preclinical and clinical studies have shown that almagate has a higher acid-neutralizing capacity (ANC) with a buffering capacity in pH 3–5 making it effective for longer duration compared to aluminum hydroxide, magnesium hydroxide, and magaldrate. Almagate achieves pH 4 within 2 min as reported by in vitro studies. It was reported to have longer Rossett–Rice time and buffering capacity with bile acid adsorption capacity at pH 3. It also has inhibition activity against pepsin. It does not cause overalkalization and the risk of rebound acidity is low. Almagate was found to have the lowest intrinsic sodium content of 25 ppm compared to aluminum hydroxide (1200 ppm), magnesium hydroxide (1100 ppm), and magaldrate (360 ppm). Unlike aluminum hydroxide, magnesium hydroxide, and magaldrate, almagate maintains capacity to dilute acid even at increasing gastric pH. This review presents the clinical, nonclinical, and biochemical properties of almagate.