Antacids Health Article

Definition

Antacids are medicines that neutralize stomach acid.

Purpose

Antacids are used to relieve acid indigestion, upset stomach, sour stomach, and heartburn. Additional components of some formulations include dimethicone, toreduce gas pains (flatulence) and alginic acid, which, in combination with antacids, may help manage GERD (gastro-esophageal reflux disease). Antacids should not be confused with gastric acid inhibitors, such as the H-2 receptor blockers (cimetidine, ranitide and others) or the proton pump inhibitors (lansoprazole, omeprazole and others). Although all three classes of drugs act to reduce the levels of gastric acid, their mechanisms are different, and this affects the appropriate use of the drug. Antacids have a rapid onset and short duration of action, and are most appropriate for rapid relief of gastric discomfort for a short period of time.

Antacids may be divided into two classes, those that work by chemical neutralization of gastric acid, most notably sodium bicarbonate; and those that act by adsorption of the acid (non-absorbable antacids), such as calcium and magnesium salts.

The chemical antacids show the most rapid onset of action, but may cause "acid rebound," a condition in which the gastric acid returns in greater concentration after the drug effect has stopped. Also, since these antacids may contain high concentrations of sodium, they may be inappropriate in patients with hypertension.

Calcium and magnesium salts act by adsorption of the acid, and are less prone to the rebound effect, but may have other significant disadvantages. These antacids are particularly prone to drug interactions, and patients taking other medications must often avoid simultaneous administration of the medications. These antacids are more effective in liquid formulations than in tablet or capsule form, and so may be inconvenient for routine dosing.

The non-absorbable antacids may have additional uses beyond control of hyperacidity. Calcium salts may be used as diet supplements in prevention of osteoporosis. Aluminum carbonate is useful for binding phosphate, and has been effective in treatment and control of hyperphosphatemia or for use with a low phosphate diet to prevent formation of phosphate urinary stones. This application is particularly valuable in patients with chronic renal failure. Antacids with aluminum and magnesium hydroxides or aluminum hydroxide alone effectively prevent significant stress ulcer bleeding in post-operative patients or those with severe burns.

Recommended dosage

The dose depends on the type of antacid. Consult specific references.

When using antacids in chewable tablet form, chew the tablet well before swallowing. Drink a glass of water after taking chewable aluminum hydroxide. Lozenges should be allowed to dissolve completely in the mouth. Liquid antacids should be shaken well before using.

Precautions

Antacids should be avoided if any signs of appendicitis or inflamed bowel are present. These include cramping, pain, and soreness in the lower abdomen, bloating, and nausea and vomiting.

Antacids may affect the results of some medical tests, such as those that measure how much acid the stomach produces. Health care providers and patients should keep this in mind when scheduling a medical test.

Antacids that contain magnesium may cause diarrhea. Other types of antacids may cause constipation.

Avoid taking antacids containing sodium bicarbonate when the stomach is uncomfortably full from eating or drinking.

Antacids should not be given to children under six years of age.

Antacids that contain calcium or sodium bicarbonate may cause side effects, such as dizziness, nausea, and vomiting, in people who consume large amounts of calcium (from dairy products or calcium supplements). In some cases, this can lead to permanent kidney damage. Before combining antacids with extra calcium, check with a physician.

Some antacids contain large amounts of sodium, particularly sodium bicarbonate (baking soda). Anyone who is on a low-sodium diet should check the list of ingredients or check with a physician or pharmacist before taking an antacid product.

Excessive use of antacids may cause or increase the severity or kidney problems. Calcium based antacids may lead to renal stone formation.

ALLERGIES. Allergies to antacids are extremely rare, however the inactive ingredients in some formulations may include dyes or other products with allergic potential.

PREGNANCY. Antacids are not classified under the pregnancy safety categories A, B, C, D and X. Occasional use of antacids in small amounts during pregnancy is considered safe. However, pregnant women should check with their physicians before using antacids or any other medicines. Pregnant women who are consuming extra calcium should be aware that using antacids that contain sodium bicarbonate or calcium can lead to serious side effects.

BREASTFEEDING. Some antacids may pass into breast milk. However, no evidence exists that the ingestion of antacids through breast milk causes problems for nursing babies whose mothers use antacids occasionally.