Classic antacids, such as aluminum hydroxide, aluminum phosphate, calcium carbonate, and magnesium carbonate, are only absorbed to a limited extent. No toxic effects from aluminum, for instance, have as yet been described, nor would they be expected. However, since the chronic intake of small amounts of aluminum is considered problematic, magaldrate, algeldrate, almasilate, hydrotalcite, and sucralfate, from which only traces of aluminum (at most) arc believed to be absorbed, or the aluminum-free preparations of calcium carbonate plus magnesium carbonate or hydroxide, are of more interest therapeutically.

Recommendation. Antacids and ulcer therapeutics of choice during breastfeeding are the newer aluminum combinations, such as magaldrate and sucralfate as well as aluminum-free antacids. Older aluminum and magnesium combinations are also acceptable. When higher doses are taken over

4.3.2 H2-receptor blockers and other ulcer therapeutics

a longer period of time, or in patients with impaired kidney function, it is generally recommended that the serum concentration of aluminum or magnesium be monitored.

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