Axcel Eviline Forte Suspension

Axcel Eviline Forte Suspension is an oral antacid suspension made by Kotra Pharma (M) Sdn Bhd in Malaysia under the Axcel brand. Each 5 ml contains 400 mg of magnesium hydroxide, 400 mg of aluminium hydroxide, and 40 mg of simethicone (activated polymethylsiloxane), and it is supplied as a liquid in bottles of around 120 ml. The ‘Forte’ name indicates the stronger formulation within the Eviline range.

Magnesium hydroxide and aluminium hydroxide are alkaline salts that neutralise hydrochloric acid in the stomach, while simethicone is an anti-foaming agent that helps small gas bubbles in the gut merge into larger ones. Combining magnesium, which tends to loosen the stools, with aluminium, which tends to firm them, is a common way of balancing the effect on bowel habits. The suspension is white and should be shaken well before every dose.

It is an over-the-counter product and can be purchased from pharmacies without a prescription; the label shows it as suitable for adults and children aged 12 years and above. Because the product contains aluminium and magnesium, people with kidney disease and pregnant women should get advice before use, and our pharmacist team can help you if you take other regular medicines that may be affected. Keeping the packaging leaflet with the bottle makes it easier to check the label directions whenever you need them.

For oral administration only. Shake the bottle well before use, measure 5 ml with a clean dosing cup or oral measure, and take it after meals or when necessary. The label states the product is for adults and children aged 12 years and above. Do not take more than the amount stated on the label.

Do not take other medicines at the same time as this suspension; leave a gap of about 2 hours, as antacids can reduce the absorption of many medicines. Chew nothing and swallow the liquid directly, and keep the bottle upright with the cap tightly closed after use.

Adults and children aged 12 years and above: 5 ml when necessary, or after meals, as stated on the product label. Children under 12 years: not recommended unless advised by a doctor. The sources reviewed do not state a maximum daily amount, so do not exceed the label instructions and do not use the suspension continuously for more than 2 weeks without medical advice.

If you miss a dose, there is no need to make it up; simply take the next dose when needed and do not double up. Stop and see a doctor if you have black stools, vomiting of blood, difficulty swallowing, unexplained weight loss, chest pain, or if your symptoms persist or keep returning.

Use before the expiry date printed on the bottle and carton. Once opened, keep the cap tightly closed and discard the suspension if it changes in colour, smell, or texture.

Store in a cool, dry place at the temperature stated on the packaging (usually below 30°C) away from direct sunlight, with the cap tightly closed. Do not freeze, and keep out of the sight and reach of children.

• Common: Constipation, due to the aluminium content, especially with larger or prolonged use.
• Common: Loose stools or diarrhoea, due to the magnesium content.
• Common: Nausea, a chalky taste, or a feeling of stomach fullness.
• Serious: Weakness, drowsiness, low blood pressure, or a slow heartbeat from raised magnesium levels, which can occur especially in people with kidney impairment and requires urgent medical care.
• Serious: Bone pain, muscle weakness, or tiredness with long-term use from low phosphate levels, which needs medical review because it can affect bone health.
• Serious: Allergic reaction such as rash, swelling of the face, or breathing difficulty, which requires emergency treatment.

• Known hypersensitivity to magnesium hydroxide, aluminium hydroxide, simethicone, or any other ingredient in the suspension.
• Severe renal impairment, because aluminium and magnesium can accumulate to harmful levels.
• Low blood phosphate levels (hypophosphataemia), because aluminium hydroxide binds dietary phosphate.

• Antacids can reduce the absorption of tetracycline and quinolone antibiotics such as ciprofloxacin, so take these at least 2 hours apart from the suspension unless a pharmacist advises otherwise.
• Take iron supplements, levothyroxine, digoxin, azole antifungals, bisphosphonates, and some HIV or antimalarial medicines well apart from this suspension, as absorption may be reduced.
• Aluminium- and magnesium-containing products taken together with other antacids or laxatives may increase the risk of excess mineral levels, especially in people with kidney problems.
• No specific food interactions are known, but taking the suspension after meals is in line with the label directions.

• Shake the bottle thoroughly before each dose, because the active ingredients settle at the bottom.
• Use the 5 ml measure and not a household spoon so the dose is accurate.
• Keep a gap of about 2 hours between this suspension and other medicines, especially antibiotics and iron tablets.
• Do not use the suspension every day for more than 2 weeks without seeing a doctor.
• Tell your pharmacist if you have kidney disease or are in the first trimester of pregnancy before using it.
• Keep the bottle tightly capped and out of reach of children, and store it at the temperature stated on the packaging (usually below 30°C).

Precautions: The label for Axcel Eviline Forte Suspension lists hypophosphataemia, renal impairment, and the first trimester of pregnancy as situations that need special care. Speak to a doctor or pharmacist before use if you have kidney disease, are pregnant or breastfeeding, or take regular medicines that may be affected by antacids. Long-term or high-dose use is not advised without medical supervision, and the product is not recommended for children under 12 years unless a doctor advises.

When to See a Doctor or Pharmacist: See a doctor if you notice black or bloody stools, vomit that looks like coffee grounds, difficulty or pain when swallowing, unexplained weight loss, or persistent chest pain. Please also seek advice if symptoms continue beyond 2 weeks, keep returning, or if you develop weakness, confusion, or a slow heartbeat.