Antacids

Antacids are a group of drugs that have been on the market  Fecal impaction
for many years. They were initially first-line defense against  Nausea
peptic ulcer disease; however, the discovery of proton pump  Vomiting
inhibitors revolutionized the treatment of peptic ulcer disease.  Abdominal cramps
Currently, antacid use is restricted to relieve mild intermittent  Hypomagnesemia
gastroesophageal reflux disease (GERD) with associated  Hypophosphatemia
heartburn. This activity reviews the indications,
contraindications, pharmaceutical action, adverse events, and Calcium Carbonate - The adverse reactions often seen with
other key elements of antacid therapy in the clinical setting as this group of antacids are:
relates to the essential points needed by members of an
interprofessional team managing the care of patients with  Abdominal pain
 Anorexia
heartburn and mild GERD.
 Constipation
Antacids are a group of drugs that have been on the market for  Acid rebound
many years. They were initially first-line defense against  Nausea
peptic ulcer disease; however, the discovery of proton pump  Vomiting
 Flatulence
inhibitors revolutionized the treatment of peptic ulcer disease.
 Xerostomia
Currently, antacid use is restricted to relieving mild
 Headache
intermittent gastroesophageal reflux disease (GERD)  Hypercalcemia
associated with heartburn. The estimated prevalence of  Hypophosphatemia
heartburn at least once per week in North America ranges  Milk-alkali syndrome
from 18% to 28%, with 25% of adults reporting heartburn
daily. Antacids can exhibit clinically significant interactions with
other medication a patient may be taking. Some examples
Antacids are medications that do not require a prescription; in
include:
other words, they are self-prescribed. Antacids are a
combination of various compounds with various salts of
 Using antacids concomitantly with acidic drugs (e.g.,
calcium, magnesium, and aluminum as active ingredients. The
digoxin, chlorpromazine isoniazid) can result in
antacids act by neutralizing the acid in the stomach and by
impaired absorption of these acidic drugs, reducing
inhibiting pepsin, which is a proteolytic enzyme. Each of these the blood concentrations of the drugs and impairing
cationic salts has a characteristic pharmacological property their therapeutic effects.
that determines its clinical use. Antacids have therapeutic use  Concurrent antacid use with some drugs (e.g.,
for the following: pseudoephedrine, levodopa) can result in increased
absorption of the drugs, leading to potential toxicity
 Heartburn symptoms in GERD or adverse events from increased serum concentration
 Duodenal and gastric ulcers of these drugs.
 Stress gastritis  Antacids containing magnesium trisilicate and
 Pancreatic insufficiency magnesium hydroxide can bind to drugs like
 Non-ulcer dyspepsia tetracycline and fluoroquinolone antibiotics,
 Diarrhea caused by bile-acid impeding their absorption and therapeutic effects.
 Biliary reflux  Sodium bicarbonate significantly affects urine
 Constipation acidity, which can alter the renal elimination of some
 Osteoporosis drugs by the kidney; sodium bicarbonate inhibits the
 Urinary alkalinization excretion of basic drugs such as amphetamines and
 Phosphate binding in chronic renal failure quinidine while increasing the excretion of acidic
drugs like aspirin.
Mechanism of Action
The absolute contraindication is hypersensitivity to any
The antacids reduce the acid reaching the duodenum by component of the formulation. Also, antacid agents require
neutralizing the acid present in the stomach. The main caution in patients with:
therapeutic objectives are:
 Renal failure
 Alleviating pain  Heart failure
 Relieving pylorospasms  Edema
 Avoid digestion and corrosion by acid chyme  Cirrhosis
 Low-sodium diets
Other mechanisms add to the ulcer healing properties of this  Uremia
class of drugs. The exact mechanism is still unclear, but it is  GI hemorrhages
believed to be a combination of:  Hyperparathyroidism
 Renal calculus
 Ability to promote angiogenesis  Achlorhydria
 Bind to bile acids
 Inhibit peptic activity No information is available regarding toxicities caused by
 Suppress Helicobacter pylori growth aluminum- and calcium-containing antacids. However,
antacids are to be used cautiously in the high-risk population
Adverse effects are prominent in the infant and the elderly mentioned above.
populations. The chronic use of antacids in this population is
not a recommendation due to safety concerns.
Aluminum Hydroxide - Aluminum use is associated with an

increased risk of toxicity in individuals with renal failure and
infants. It presents as:
 Osteopenia
 Microcytic anemia
 Neurotoxicity
 Osteomalacia
 Constipation

Antacids

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Antacids are a group of drugs that have been on the market  Fecal impaction

Aluminum Hydroxide - Aluminum use is associated with an

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