Adjunct to other drugs (e.g., anti-infectives, histamine H2-receptor antagonists, proton-pump inhibitors) for the relief of peptic ulcer pain and to promote the healing of peptic ulcers.
Because of the inconvenience of the regimens needed to promote ulcer healing, high recurrence rate, ineffectiveness in eradicating Helicobacter pylori, palatability issues, and adverse effects, antacids rarely are used alone any longer for the treatment of peptic ulcer disease. Instead, antacids currently are used principally as an adjunct to other antiulcer regimens for as-needed (prn) relief of peptic ulcer pain.
Acid Indigestion
Self-medication for the relief of acid indigestion (dyspepsia), heartburn, and sour stomach.
Gastroesophageal Reflux Disease (GERD)
Self-medication for the relief of mild forms of GERD (e.g., symptoms induced by a heartburn-inducing meal).
Antacids generally provide more rapid but less prolonged relief of GERD symptoms compared with histamine H2-receptor antagonists, and combined therapy generally is more effective than either class of drugs alone.
Consult a clinician if symptoms persist or warning signs of more severe GERD develop (e.g., dysphagia, bleeding, weight loss, choking [acid-induced cough, shortness of breath, and/or hoarseness], chest pain).
Other agents (e.g., histamine H2-receptor antagonists, proton-pump inhibitors) preferred by American College of Gastroenterology (ACG) and American Gastroenterological Association (AGA) for management of more severe forms of GERD.
Have been used for self-medication for the relief of breakthrough symptoms in patients receiving proton-pump inhibitors.
Hyperphosphatemia
Aluminum-containing antacids (except aluminum phosphate): Management of hyperphosphatemia or prevention of recurrent phosphatic renal calculi (in conjunction with a low phosphate diet).
Aluminum carbonate generally preferred to aluminum hydroxide for this use.
Calcium Replacement
Calcium carbonate is used for calcium supplementation.
Stress Ulceration and GI Bleeding
Has been used for prevention of stress ulceration† and GI bleeding†.
Gastric Acid Aspiration
Has been used for prevention of gastric acid aspiration† in patients undergoing cesarean section or emergency surgery; generally has been replaced by histamine H2-receptor antagonist or citrate solution.
Dosage and Administration
Administration
Oral Administration
Administer orally.
Oral suspensions more rapidly and effectively solubilized than powders or tablets; reserve oral tablets for chronic use in patients who refuse oral suspensions because of inconvenience or unpalatable taste. Rapidly disintegrating tablets may be a suitable alternative in some patients.
Chew tablets, including rapidly dissolving tablets, thoroughly before swallowing.
Dose and frequency of administration depend on the acid secretory rate of the stomach, gastric emptying time, and the disorder being treated.
Adults
Peptic Ulcers
For peptic ulcer disease, dosages of antacids are empirical and various antacid dosages have been used.
Adjunctive Therapy
Oral
For supplemental ulcer pain relief, 40–80 mEq acid neutralizing capacity on an as-needed (prn) basis.
Treatment
Oral
Other therapies currently are preferred for treatment of active peptic ulcers. (See Peptic Ulcers under Uses.)
If antacids are used for the treatment of peptic ulcers, usual high-dose regimens for ulcer healing employ 80–160 mEq acid neutralizing capacity, given 1 and 3 hours after meals and at bedtime.
Additional doses of antacids may be administered to relieve ulcer pain that occurs between regularly scheduled doses.
In patients with duodenal ulcers, antacids usually are given for 4–6 weeks. If symptoms of duodenal ulcer recur, antacids can be administered 1 and 3 hours after meals and at bedtime for 1 week and, if pain is relieved, less frequently for an additional 1–2 weeks.
In patients with gastric ulcers, antacids are administered until healing is complete.
Gastroesophageal Reflux Disease (GERD)
For GERD, dosages of antacids are empirical and various antacid dosages have been used.
Oral
For relief of heartburn, one recommended regimen employs 40–80 mEq acid neutralizing capacity on an as-needed (prn) basis intially. If necessary, dosage can be titrated to a regularly scheduled basis such as 40–80 mEq acid neutralizing capacity given after meals and at bedtime.
Hyperphosphatemia
Oral
In conjunction with dietary phosphate restriction in the management of hyperphosphatemia, 30–40 mL of aluminum hydroxide or aluminum carbonate suspension is administered 3 or 4 times daily.
Calcium Replacement
Oral
For calcium replacement dosage with calcium carbonate, see Dosage in the monograph on Calcium Salts.
Stress Ulceration and GI Bleeding
Oral
In the management of stress ulceration† and GI bleeding†, antacids are usually administered every hour, and the antacid dosage should be titrated to maintain the nasogastric aspirate above pH 3.5.
For severe symptoms, antacid suspensions may be diluted with water or milk and given by continuous intragastric infusion.
Gastric Acid Aspiration
Oral
To reduce the risk of anesthesia-induced gastric acid aspiration, an antacid suspension has been given 30 minutes before anesthesia.
Prescribing Limits
Adults
GERD
Oral
Do not exceed 500–600 mEq acid neutralizing capacity daily or regularly scheduled (versus as-needed; prn) therapy for longer than 2 weeks continuously.
Sodium Bicarbonate
Maximum daily dosage of sodium or bicarbonate is 200 mEq in patients <60 years of age and 100 mEq in patients >60 years of age. Contraindicated for prolonged therapy because it may cause metabolic alkalosis or sodium overload.
Maalox® Quick Dissolve® Chewables and Maalox® Quick Dissolve® Chewables Maximum Strength contain aspartame (NutraSweet®), which is metabolized in the GI tract to phenylalanine following oral administration.
Sensitivity Reactions
Tartrazine Sensitivity
Some antacid formulations contain the dye tartrazine (FD&C yellow No. 5), which may cause allergic-type reactions (bronchial asthma in susceptible individuals) in certain susceptible individuals (e.g., patients who are sensitive to aspirin).
General Precautions
Aluminum Antacids
Risk of hypophosphatemia with prolonged administration or large doses, particularly in patients with inadequate dietary intake of phosphorus.
Monitor serum phosphate concentrations at monthly or bimonthly intervals in patients on maintenance hemodialysis who are receiving chronic aluminum antacid therapy.
Calcium Carbonate
May cause gastric hypersecretion and acid rebound.
Monitor serum calcium concentrations weekly and whenever manifestations of hypercalcemia occur in patients receiving large doses of calcium carbonate.
Magnesium Antacids
Commonly cause a laxative effect, and frequent administration of these antacids alone often cannot be tolerated; repeated doses cause diarrhea which may cause fluid and electrolyte imbalances.
Sodium Bicarbonate
May cause metabolic alkalosis when given in large doses.
Specific Populations
Renal Impairment
Aluminum Antacids: Long-term administration in patients with renal failure or chronic renal failure may result in hyperaluminemia since small amounts of aluminum are absorbed from the GI tract and excretion of aluminum is decreased in patients with renal failure. Aluminum accumulation in the CNS may be the cause of dialysis encephalopathy, while aluminum accumulation in the bones may result in or worsen dialysisosteomalacia.
Calcium Carbonate: Patients with renal impairment or dehydration and electrolyte imbalance are predisposed to developing the milk-alkali syndrome. Hypercalcemia risk in chronic hemodialysis patients.
Magnesium Antacids: In patients with severe renal impairment, hypermagnesemia characterized by hypotension, nausea, vomiting, ECG changes, respiratory or mental depression, and coma. Do not administer in patients with renal failure, and antacids containing more than 50 mEq of magnesium in the recommended daily dosage should be used cautiously and only under the supervision of a clinician who should monitor electrolytes in patients with renal disease.
Sodium Bicarbonate: May cause metabolic alkalosis in patients with renal insufficiency.
All antacids potentially may increase or decrease the rate and/or extent of absorption of concomitantly administered oral drugs by changing GI transit time or by binding or chelating the drug. In vitro studies indicate that magnesium hydroxide or trisilicate has the greatest potential for drug binding and aluminum hydroxide and calcium carbonate are intermediate.
Allow 1–2 hours to elapse between doses of antacids and tetracyclines
Actions
Mechanism of action in the treatment of peptic ulcers is based on ability of antacids to react with hydrochloric acid and thus increase gastric pH.
With usual doses, antacids generally do not increase and maintain gastric pH above 4–5.
Antacids, in decreasing order of their ability to neutralize a given amount of acid, are calcium carbonate, sodium bicarbonate, magnesium salts, and aluminum salts.
Aluminum-containing antacids (except aluminum phosphate) combine with dietary phosphate in the intestine forming insoluble, nonabsorbable aluminum phosphate which is excreted in the feces. If phosphate intake is limited and renal function is normal, aluminum antacids (except aluminum phosphate) decrease phosphate absorption and hypophosphatemia and hypophosphaturia occur.
Magnesium-containing antacids have a laxative action.
Advice to Patients
Advise patients to consult a clinician if ulcer pain worsens or is not relieved after the first week of therapy.
Importance of consulting a clinician if GERD symptoms persist or warning signs of more severe GERD develop (e.g., dysphagia, bleeding, weight loss, choking [acid-induced cough, shortness of breath, and/or hoarseness], chest pain).
Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as concomitant illnesses.
Importance of informing patients of other important precautionary information. (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 09/2009. For the most current and up-to-date pricing information, please visit www.drugstore.com. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
† Use is not currently included in the labeling approved by the US Food and Drug Administration.
Remember, keep this and all other medicines out of the reach of children,
never share your medicines with others, and use this medication only for the indication prescribed.
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