Antacids are available
over the counter and are taken by mouth to quickly relieve occasional
heartburn, the major symptom of
gastroesophageal reflux disease and
indigestion. Treatment with antacids alone is
symptomatic and only justified for minor symptoms.[4] Alternative uses for antacids include constipation, diarrhea, hyperphosphatemia, and urinary alkalization.[2] Some antacids are also used as an
adjunct to pancreatic enzyme replacement therapy in the treatment of
pancreatic insufficiency.[5]
Non-particulate antacids (
sodium citrate) increase gastric
pH with little or no effect on gastric volume, and therefore may see some limited use in pre-operative procedures. Sodium citrate should be given within 1 hour of surgery to be the most effective.[6]
Side effects
Conventional effervescent tablets contain a significant amount of
sodium and are associated with increased odds of adverse cardiovascular events according to a 2013 study.[7] Alternative sodium-free formulations containing
magnesium salts may cause diarrhea, whereas those containing
calcium or
aluminum may cause
constipation.[8]: Table 2 Long-term use of antacids containing
aluminum may increase the risk of developing
osteoporosis.[9]In vitro studies have found a potential for acid rebound to occur due to antacid overuse, however the significance of this finding has been called into question.[10][11]
A proposed method to mitigate the effects of
stomach acidity and
chelation on drug absorption is to space out the administration of antacids with interacting
medications by at least two hours,[15] however this method has not been well studied for drugs affected by
urine alkalization.[13]
There are concerns regarding interactions between delayed-release tablets and antacids, as antacids may increase the stomach
pH to a point at which the coating of the delayed-release tablet will dissolve, leading to degradation of the drug if it is
pH sensitive.[14]
Several liquid antacid preparations are
marketed. Common liquid preparations include
milk of magnesia and magnesium/aluminum
combinations. A potential advantage of using a liquid preparation over a tablet is that liquids may provide quicker relief, however this may coincide with a shorter duration of action.[17]
Tablets
Chewable tablets
Chewable tablets are one of the most common forms of antacids, most frequently made from
carbonate or
hydroxidesalts, and are readily available over the counter. Upon reaching the
stomach, the powdered antacid salts bind to
hydronium (H+) ions, producing
chloride salts, carbon dioxide, and water. This process reduces the concentration of H+ ions in the stomach, raising the pH and neutralizing the acid.[8]: Figure 1 Common carbonate salts available in tablet form include those of calcium, magnesium, aluminum, and sodium.[13]
Some common American brands are
Tums, Gaviscon chewable tablets, and
Maalox chewable tablets.[18]
^
abInternal Clinical Guidelines Team. (UK) (2014). Dyspepsia and Gastro-Oesophageal Reflux Disease: Investigation and Management of Dyspepsia, Symptoms Suggestive of Gastro-Oesophageal Reflux Disease, or Both. National Institute for Health and Care Excellence: Clinical Guidelines. London: National Institute for Health and Care Excellence (UK).
PMID25340236.
^
abcdSalisbury BH, Terrell JM (2020).
"Antacids". StatPearls. Treasure Island (FL): StatPearls Publishing.
PMID30252305.
Archived from the original on 5 November 2021. Retrieved 24 November 2020.
^Graham DY (June 1982). "Pancreatic enzyme replacement: the effect of antacids or cimetidine". Digestive Diseases and Sciences. 27 (6): 485–490.
doi:
10.1007/BF01296725.
PMID6282548.
S2CID10640940.
^Apfelbaum JL, Agarkar M, Connis RT, Coté CJ, Nickinovich DJ, Warner MA, et al. (American Society of Anesthesiologists Committee on Standards and Practice Parameters) (March 2017). "Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration". Anesthesiology. 126 (3): 376–393.
doi:
10.1097/ALN.0000000000001452.
PMID28045707.
^"Taking Antacids". Medline Plus. U.S. Department of Health and Human Services, National Institutes of Health, U.S. National Library of Medicine. 7 November 2014. Archived from
the original on 5 July 2016.
^Texter EC (February 1989). "A critical look at the clinical use of antacids in acid-peptic disease and gastric acid rebound". The American Journal of Gastroenterology. 84 (2): 97–108.
PMID2644821.
^Thompson WG (12 September 2014).
"Antacids". IFFGD Publication #520. International Foundation for Functional Gastrointestinal Disorders, Inc. (IFFGD). Archived from
the original on 6 May 2016.
^Barnett CC, Richardson CT (November 1985). "In vivo and in vitro evaluation of magnesium-aluminum hydroxide antacid tablets and liquid". Digestive Diseases and Sciences. 30 (11): 1049–1052.
doi:
10.1007/BF01315602.
PMID4053915.
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