Antacids are over-the-counter medications used to treat conditions caused by excessive stomach acid production, such as heartburn, acid reflux, and abdominal pain.
Antacids contain earth metals, including calcium, sodium, magnesium, and aluminum, which react with hydrogen ions to help neutralize stomach acid. Taking too much of these drugs can increase the levels of these elements in the body, which can cause problems such as heart rhythm disturbances, diarrhea, or constipation.
Understanding the antacid
What are antacids and how do they work?
Stomach acid is essential for digesting food and killing bacteria, but too much can cause heartburn and other uncomfortable symptoms.
pH is a measure of the concentration of hydrogen ions in a solution, such as stomach acid. The lower the number, the more hydrogen ions there are and the more acidic the environment is. A pH level of 7 is neutral, less than 7 is acidic, and between 7 and 14 is basic or alkaline.
Antacids contain ingredients such as aluminum, calcium, magnesium, or sodium. These are all called alkaline earth metals, and they react with the acidic stomach acid to neutralize it, slightly increasing the pH and relieving symptoms such as a sour taste in the mouth, bloating, and pain in the chest or abdomen.
Types of antacids
This table lists the most common brand names of antacids available over the counter and on store shelves.
OTC Antacid Ingredients and Brand Names | |
---|---|
Active Ingredients | Included in brand name products |
Aluminum hydroxide | Gaviscon, Maalox, Milanta |
calcium carbonate | Tums, Alka Seltzer, Rolaid |
Magnesium hydroxide | Milk of Magnesia, Milanta |
Sodium bicarbonate | Alka Seltzer |
Magnesium trisilicate | Gaviscon |
You may see other medications on store shelves that advertise their ability to neutralize stomach acid or treat heartburn. These medications work differently than antacids, but ultimately have similar effects. Some are sold OTC, while others require a prescription.
- Proton pump inhibitors (PPIs) bind to proton pumps in the stomach wall, reducing stomach acid production and releasing hydrogen ions, making the environment more acidic. Examples include Prilosec (omeprazole) and Nexium (esomeprazole).
- Histamine-2 receptor antagonists, also known as H2 blockers, block histamine receptors that signal stomach cells to release more acid. Examples include Pepcid (famotidine) and Zantac (ranitidine).
guideline
Renal failure
Some antacids can cause kidney damage if used regularly over a long period of time. The kidneys filter out antacids from the body after they are taken. Damaged kidneys may not be able to filter these drugs effectively, which can lead to accumulation and damage.
Antacids that contain aluminum and magnesium, such as Maalox and Mylanta, can increase levels of these elements in your body, which can cause:
If you have kidney problems, you should generally avoid these antacids or take them only occasionally. It is best to talk to your healthcare provider about the safest options for managing heartburn and stomach acid.
heart disease
Although the relationship is still being studied, studies have shown that people who take PPIs (such as Prilosec or Nexium) long-term have a higher risk of cardiovascular disease, such as heart attack, than people who do not take PPIs. This is thought to be due to PPIs having a detrimental effect on proper endothelial function, which is necessary for efficient blood circulation.
In addition to PPIs, long-term, frequent use of antacids such as calcium carbonate can lower magnesium levels, which can cause heart rate problems, and increase calcium levels, which can promote plaque buildup in the arteries. For this reason, antacids should only be used occasionally. If you need to use them regularly, tell your healthcare provider.
Safer antacid options for heart health may be H2 blockers such as Pepcid or Zantac, but there aren't enough studies to confirm an improved safety profile.
Interaction
Is it safe to take antacids with other medications?
There are many important interactions between antacids and other medications that you should be aware of. It is also important not to take other medications within 2 to 4 hours of taking an antacid.
Reduced absorption:
- Some medications depend on an acidic environment to be properly absorbed, so reducing stomach acid can lower the levels of these medications in the body and make them less effective. Examples include digoxin, chlorpromazine, and isoniazid.
- Antacids containing magnesium can bind to some antibiotics, such as tetracycline, doxycycline, Levaquin (levofloxacin), and Cipro (ciprofloxacin), lowering antibiotic levels and making them less effective.
Increased absorbency:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Motrin (ibuprofen), and diabetes medications such as sulfonylureas (glucose-lowering agents) and Amaryl (glimepiride), may be absorbed at higher than normal levels when taken with antacids, increasing antacid levels and potentially causing side effects.
Can I mix antacids with alcohol?
In general, taking antacids with alcohol is safe when used in moderation. There is a well-studied link between long-term use and abuse of alcohol and gastritis, indigestion, heartburn, and other problems that require longer-term use of antacids, which can lead to additional problems.
side effect
Most antacids have overlapping potential side effects, including abdominal pain or cramps, nausea or vomiting, constipation or diarrhea. Additional, more serious side effects to be aware of for specific products include:
For aluminum hydroxide-based antacids:
Calcium carbonate-based antacids:
- Stomach upset: Gas
- xerosis: dry mouth
- headache
- Hypercalcemia: high calcium levels
- Hypophosphatemia: low phosphate levels
summary
Occasional heartburn or indigestion is normal and most people experience it. The stomach needs an acidic environment to digest food and keep bacteria at bay. Too much stomach acid can cause uncomfortable symptoms, and antacids can help to relieve this.
However, overuse of antacids can have dangerous side effects, so you should tell your healthcare provider and pharmacist your complete medication list. To avoid interactions between some common medications (including over-the-counter medications and supplements) and antacids.
If you need to use antacids more than 2-3 times a week, you should talk to your healthcare provider to determine the underlying cause and develop the safest treatment plan.