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Antacids
Specific Indications for their
use
There are a bewildering number of
antacids to choose from. They are all the same in the ultimate action, but
they differ in their ability to neutralize stomach acid and thereby reduce
the pain of ulcers, heartburn, and indigestion. The side effects vary for
the different agents, some tending to cause diarrhea and others
constipation. For this reason, the best antacids are generally a combination
of two agents, one that tends to induce diarrhea and one that tends to cause
constipation, so that the opposing effects counter each other and the drugs
have no noticeable side effects. Antacids should be taken about one hour
after a meal for maximum benefit. When taken on an empty stomach, the
antacid effect lasts about 20 minutes, whereas if taken after a meal, the
effect may last 2-3 hours. Liquid, gel, or suspension preparations are
preferred because the medicine is already in the best form (liquid) to
counter stomach acid. tablets are less effective and, if used, they must be
chewed thoroughly in order to be of maximum benefit. Some antacids act very
fast, but their effects are very short, and they must be taken often.
Continuous or prolonged use of antacids can cause problems with nutrient
levels (vitamins and minerals), so they should be used only as needed.
ULCERS. The exact cause of
ulcers has not been determined. What is clear is that the normally
protective surface of the stomach, esophagus, or small intestine is eroded
or damaged, allowing stomach acid to irritate the underlying tissue and
cause a severe burning-type pain. Some of the most recent medical research
suggests that a local bacterial infection may be the root of the problem,
and curing this infection cures the ulcer. Until the cause or a cure can be
established, the treatment of ulcers, remains symptomatic, using either
antacids to neutralize the acid, or drugs that reduce the production of
stomach acid. Only the antacids are currently available without a
prescription. In most studies on patients with ulcers, the vigorous,
continuous use of antacids has been shown to be as effective as the drugs,
that block the production of acid. this is true for both relieving the pain
and in the rate of healing.
HEARTBURN / INDIGESTION.
About 10% of people suffer from heartburn daily, and another 33%
occasionally. This burning sensation in the chest, sometimes followed by a
bitter taste in the mouth, is not connected to the heart, but is a stomach
acid problem. The valve that separates the stomach from the esophagus (the
pipe that food goes through from the mouth to get to the stomach) does not
work well and allows stomach acid to get into the esophagus. This problem is
relieved by antacids, which act by neutralizing the acid. As noted below, a
number of antacids are effective and useful for this problem.
In addition to taking antacids as
needed, there are several other steps that can ease the problem of frequent
heartburn: eat smaller amounts of food at one time (to reduce free
acid content in the stomach); lose weight (to take pressure off the valve
that lets the acid leak into the esophagus); eat at least 3-4 hours before
lying down or going to bed (so the stomach is empty and doesn't put pressure
on the valve); stop smoking (it irritates the esophagus); raise the head of
your bed 3-4 inches (to help the valve keep the acid from backing up); and
avoid certain foods that tend to make the problem worse – fatty, spicy,
acidic foods, red wine, and coffee (that stimulate more acid or irritate the
tissue). Finally, calcium stimulates acid secretion, so antacids containing
calcium may aggravate the problem and should be avoided.
Antacids — Major Players
Magnesium
hydroxide.
This popular, effective (potent), fast-acting antacid and laxative is rarely
found as a single ingredient It works best when used in combination with
aluminum hydroxide. It is excellent for single, occasional use alone.
Pregnant women: no evidence of risk. Nursing mothers: no evidence
of risk to infant. Seniors: no special problems. Drug
interactions: alcohol – increased stomach irritation, decreased benefit;
also interferes with the absorption of numerous drugs.
Aluminum
hydroxide. This is not as good as antacid since it tends to induce
constipation. However, aluminum hydroxide and magnesium hydroxide counter
each others; effects, making this combination the best overall antacid
available. Possible phosphate deficiency can occur with prolonged use.
Pregnant woman: safety not established. Nursing mothers: no
evidence of risk to infant. Seniors: reduce dose or increased
constipation likely. Drug interactions: interferes with absorption of
numerous drugs, including anticoagulants, digitalis, tetracycline,
penicillamine, and steroids.
Calcium carbonate.
This is a potent antacid, but the calcium is absorbed and may cause kidney
problems if used too frequently or in large doses. it also has a
constipating effect and therefore is not recommended for routine use.
Calcium also stimulates same time it is helping. Pregnant women, nursing
mothers, and seniors: no evidence of data for special needs.
Brand names include
Alamag, Marblen, Titrilac Plus, and Tums Extra in liquid form. Tablets are
sold under Alka-Mints, Alkets, Amitone, Calcilac, Chooz, Diatrol, Dicarbosil,
Di-Gel, Dimacid, Equilet, Genalac, Glycate, Mallamint, Marblen, Noralac,
Rolaids Calcium Rich, Titracid, Titrlac, Tums, and Tums-E-X.
Sodium
bicarbonate. This effective, fast-acting antacid should not be used in
large or repeated doses because it is absorbed (taken into the blood) and
can be toxic. Sodium bicarbonate also contains a lot of salt, which is not
good, especially for people for rapid, short antacid effects (baking soda or
as Alka-Seltzer and other brands). Pregnant women, nursing mothers, and
seniors: no special needs or cautions. People with high blood pressure
should avoid the extra salt. |
