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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.

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