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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, to reduce 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.

Side effects

Side effects are very rare when antacids are taken as directed. They are more likely when the medicine is taken in large doses or over a long time. Minor side effects include a chalky taste, mild constipation or diarrhea, thirst, stomach cramps, and whitish or speckled stools. These symptoms do not need medical attention unless they do not go away or they interfere with normal activities.

Other uncommon side effects may occur. Anyone who has unusual symptoms after taking antacids should get in touch with his or her health care provider.

Interactions

Antacids have multiple drug interactions, usually due to inhibition of absorption of other medications. In rare cases, the absorbable antacids may alter the pH of the stomach contents or urine sufficiently to alter drug absoprtion or excretion. Consult specific references.

Key Terms

Acid indigestion

Indigestion that results from too much acid in the stomach.

Chronic

A word used to describe a long-lasting condition. Chronic conditions often develop gradually and involve slow changes.

 

Heartburn

A burning sensation, usually in the center of the chest, near the breastbone.

 

Indigestion

A feeling of discomfort or illness that results from the inability to properly digest food.

 

Inflamed bowel

Irritation of the intestinal tract.

 

Inflammation

Pain, redness, swelling, and heat that usually develop in response to injury or illness.

 

Pregnancy safety categories

A system for reporting the known safety issues of drugs for use during pregnancy, The ratings range from A, proven safe by well controlled studies, to X, proven harmful.

 

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