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{{Short description|Substance that relieves stomach problems}} |
{{Short description|Substance that relieves stomach problems}} |
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{{About|the medication used to relieve heartburn|the acid produced by ants, known in many languages as "ant acid"|Formic acid}} |
{{About|the medication used to relieve heartburn|the acid produced by ants, known in many languages as "ant acid"|Formic acid}} |
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{{Distinguish|text=acid suppression therapy with [[proton-pump inhibitor|PPIs]] or [[H2 receptor antagonist|H2RAs]], which reduces acid production}} |
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{{Use dmy dates|date= |
{{Use dmy dates|date=January 2024}} |
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[[Image:Antacid-L478.jpg|thumb|[[Calcium carbonate]] antacid tablets]] |
[[Image:Antacid-L478.jpg|thumb|[[Calcium carbonate]] antacid tablets]] |
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An '''antacid''' is a substance which [[neutralization (chemistry)|neutralizes]] [[gastric acid|stomach acidity]] and is used to relieve [[heartburn]], [[indigestion]] or an upset stomach.<ref name="Overviewcookie">{{Cite book|title=Dyspepsia and Gastro-Oesophageal Reflux Disease: Investigation and Management of Dyspepsia, Symptoms Suggestive of Gastro-Oesophageal Reflux Disease, or Both|last=Internal Clinical Guidelines Team. (UK)|date=2014|publisher=National Institute for Health and Care Excellence (UK)|series=National Institute for Health and Care Excellence: Clinical Guidelines|location=London|pmid=25340236}}</ref> Some antacids have been used in the treatment of [[constipation]] and [[diarrhea]].<ref name=" |
An '''antacid''' is a substance which [[neutralization (chemistry)|neutralizes]] [[gastric acid|stomach acidity]] and is used to relieve [[heartburn]], [[indigestion]], or an upset stomach.<ref name="Overviewcookie">{{Cite book|title=Dyspepsia and Gastro-Oesophageal Reflux Disease: Investigation and Management of Dyspepsia, Symptoms Suggestive of Gastro-Oesophageal Reflux Disease, or Both|last=Internal Clinical Guidelines Team. (UK)|date=2014|publisher=National Institute for Health and Care Excellence (UK)|series=National Institute for Health and Care Excellence: Clinical Guidelines|location=London|pmid=25340236}}</ref> Some antacids have been used in the treatment of [[constipation]] and [[diarrhea]].<ref name="pmid30252305">{{cite book | vauthors = Salisbury BH, Terrell JM | chapter = Antacids | title = StatPearls | date = 2020 | pmid = 30252305 | chapter-url = http://www.ncbi.nlm.nih.gov/books/NBK526049/ | access-date = 24 November 2020 | publisher = StatPearls Publishing | url-status = live | place = Treasure Island (FL) | archive-url = https://web.archive.org/web/20211105005803/https://www.ncbi.nlm.nih.gov/books/NBK526049/ | archive-date = 5 November 2021 }}</ref> Marketed antacids contain [[Salt (chemistry)|salts]] of [[aluminum]], [[calcium]], [[magnesium]], or [[sodium]].<ref name="pmid30252305" /> Some preparations contain a combination of two [[Salt (chemistry)|salts]], such as [[magnesium carbonate]] and [[aluminum hydroxide]] (e.g., [[hydrotalcite]]).<ref>{{Cite web|title=Aluminum hydroxide and magnesium carbonate Uses, Side Effects & Warnings|url=https://www.drugs.com/mtm/aluminum-hydroxide-and-magnesium-carbonate.html|access-date=24 November 2020|website=Drugs.com|archive-date=20 May 2021|archive-url=https://web.archive.org/web/20210520014232/https://www.drugs.com/mtm/aluminum-hydroxide-and-magnesium-carbonate.html|url-status=live}}</ref> |
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==Medical uses== |
==Medical uses== |
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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 treatment|symptomatic]] and only justified for minor symptoms.<ref name=AHRQ>U.S. Department of Health & Human Services. Agency for Healthcare Research and Quality 23 September 2011 |
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 treatment|symptomatic]] and only justified for minor symptoms.<ref name=AHRQ>{{cite web | publisher = U.S. Department of Health & Human Services. Agency for Healthcare Research and Quality | date = 23 September 2011 | url = http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=756 | title = Consumer Summary – Treatment Options for GERD or Acid Reflux Disease: A Review of the Research for Adults | archive-url = https://web.archive.org/web/20141011121858/http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=756&pageaction=displayproduct | archive-date = 11 October 2014 }}</ref> Alternative uses for antacids include constipation, diarrhea, hyperphosphatemia, and urinary alkalization.<ref name="pmid30252305" /> Some antacids are also used as an [[Adjuvant therapy|adjunct]] to pancreatic enzyme replacement therapy in the treatment of [[Exocrine pancreatic insufficiency|pancreatic insufficiency]].<ref>{{cite journal | vauthors = Graham DY | title = Pancreatic enzyme replacement: the effect of antacids or cimetidine | journal = Digestive Diseases and Sciences | volume = 27 | issue = 6 | pages = 485–490 | date = June 1982 | pmid = 6282548 | doi = 10.1007/BF01296725 | s2cid = 10640940 }}</ref> |
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Non-particulate antacids ([[Trisodium citrate|sodium citrate |
Non-particulate antacids ([[Trisodium citrate|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.<ref name="pmid28045707">{{cite journal | vauthors = Apfelbaum JL, Agarkar M, Connis RT, Coté CJ, Nickinovich DJ, Warner MA | collaboration = American Society of Anesthesiologists Committee on Standards and Practice Parameters | title = 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 | journal = Anesthesiology | volume = 126 | issue = 3 | pages = 376–393 | date = March 2017 | pmid = 28045707 | doi = 10.1097/ALN.0000000000001452 }}</ref> |
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==Side effects== |
==Side effects== |
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Conventional effervescent tablets contain a significant amount of [[sodium]] and are associated with increased odds of adverse cardiovascular events according to |
Conventional effervescent tablets contain a significant amount of [[sodium]] and are associated with increased odds of adverse cardiovascular events according to a 2013 study.<ref>{{cite journal | vauthors = George J, Majeed W, Mackenzie IS, Macdonald TM, Wei L | title = Association between cardiovascular events and sodium-containing effervescent, dispersible, and soluble drugs: nested case-control study | journal = BMJ | volume = 347 | pages = f6954 | date = November 2013 | pmid = 24284017 | pmc = 3898660 | doi = 10.1136/bmj.f6954 | doi-access = free }}</ref> Alternative sodium-free formulations containing [[Magnesium|magnesium salts]] may cause diarrhea, whereas those containing [[calcium]] or [[Aluminium|aluminum]] may cause [[constipation]].<ref name="Garg_2022">{{cite journal | vauthors = Garg V, Narang P, Taneja R | title = Antacids revisited: review on contemporary facts and relevance for self-management | journal = The Journal of International Medical Research | volume = 50 | issue = 3 | pages = 3000605221086457 | date = March 2022 | pmid = 35343261 | pmc = 8966100 | doi = 10.1177/03000605221086457 }}</ref>{{Rp|location=Table 2}} Long-term use of antacids containing [[Aluminium|aluminum]] may increase the risk of developing [[osteoporosis]].<ref name="MedlinePlus">{{cite web | publisher = U.S. Department of Health and Human Services, National Institutes of Health, U.S. National Library of Medicine | date = 7 November 2014 | url = https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000198.htm | work = Medline Plus | title = Taking Antacids | archive-url = https://web.archive.org/web/20160705125204/https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000198.htm |archive-date=5 July 2016 }}</ref> [[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.<ref>{{cite journal | vauthors = Texter EC | title = A critical look at the clinical use of antacids in acid-peptic disease and gastric acid rebound | journal = The American Journal of Gastroenterology | volume = 84 | issue = 2 | pages = 97–108 | date = February 1989 | pmid = 2644821 }}</ref><ref>{{cite journal | vauthors = Hade JE, Spiro HM | title = Calcium and acid rebound: a reappraisal | journal = Journal of Clinical Gastroenterology | volume = 15 | issue = 1 | pages = 37–44 | date = July 1992 | pmid = 1500660 | doi = 10.1097/00004836-199207000-00010 | s2cid = 10897187 }}</ref> |
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==Properties of antacids== |
==Properties of antacids== |
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When an excess amount of acid is produced in the [[stomach]], the natural [[Mucous membrane|mucous barrier]] that protects the lining of the stomach can |
When an excess amount of acid is produced in the [[stomach]], the natural [[Mucous membrane|mucous barrier]] that protects the lining of the stomach can degrade, leading to [[pain]] and [[irritation]].<ref>{{cite journal | vauthors = McColl KE | title = The elegance of the gastric mucosal barrier: designed by nature for nature | journal = BMJ Journals | volume = 61 | issue = 6 | pages = 787–788 | date = October 2011 | doi = 10.1136/gutjnl-2011-301612}}</ref> There is also potential for the development of [[Gastroesophageal reflux disease|acid reflux]], which can cause pain and damage to the [[esophagus]].{{Citation needed|date=January 2024}} Antacids contain [[alkaline]] ions that [[Neutralization (chemistry)|chemically neutralize]] stomach [[gastric acid]], reducing damage to the stomach lining and [[esophagus]], and relieving pain.<ref name="Overviewcookie" /> Some antacids also inhibit [[pepsin]], an [[enzyme]] that can damage the [[esophagus]] in [[Acid Reflux|acid reflux]].<ref name="pmid30252305"/><ref>{{cite journal | vauthors = Bardhan KD, Strugala V, Dettmar PW | title = Reflux revisited: advancing the role of pepsin | journal = International Journal of Otolaryngology | volume = 2012 | pages = 646901 | date = 2012 | pmid = 22242022 | pmc = 3216344 | doi = 10.1155/2012/646901 | doi-access = free }}</ref> |
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Antacids do not directly inhibit acid [[secretion]], and thus are distinct from acid-reducing drugs like [[H2 antagonist|H<sub>2</sub>-receptor antagonist]]s or [[proton pump inhibitor]]s.<ref name="AHRQ" /> Antacids do not kill the bacteria ''[[Helicobacter pylori]]'', which causes most [[gastric ulcer|ulcers]].<ref name="AHRQ" /> |
Antacids do not directly inhibit acid [[secretion]], and thus are distinct from acid-reducing drugs like [[H2 antagonist|H<sub>2</sub>-receptor antagonist]]s or [[proton pump inhibitor]]s.<ref name="AHRQ" /> Antacids do not kill the bacteria ''[[Helicobacter pylori]]'', which causes most [[gastric ulcer|ulcers]].<ref name="AHRQ" /> |
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==Types== |
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Antacids are mainly classified into two categories: |
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* Systemic (absorbable) antacids: They are [[water soluble]] and systemically absorbed and pass into the [[bloodstream]]. e.g. [[sodium bicarbonate]] or [[sodium citrate]] |
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* Non-systemic (non-absorbable) antacids: They are [[insoluble]] and not absorbed into systemic circulation. They only act in the [[stomach]] e.g. [[magnesium carbonate]] or [[calcium carbonate]]<ref>MrlabTest - Antacids. URL: [https://www.mrlabtest.com/medication/antacids.htm https://www.mrlabtest.com/medication/antacids.htm]. Accessed on: November 27, 2024.</ref> |
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== Interactions == |
== Interactions == |
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[[File:Basic structure of tetracycline chelating a metal.svg|thumb|Structural depiction of tetracycline metal chelation, where 'M' is a metal such as those found in antacids]] |
[[File:Basic structure of tetracycline chelating a metal.svg|thumb|Structural depiction of tetracycline metal chelation, where 'M' is a metal such as those found in antacids]] |
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Antacids are known to [[Drug interaction|interact]] with several [[Oral administration|oral medications]], including [[Quinolone antibiotic|fluoroquinolone]] and [[tetracycline]] [[antibiotic]]s, [[iron]], [[itraconazole]], and [[prednisone]].<ref name=" |
Antacids are known to [[Drug interaction|interact]] with several [[Oral administration|oral medications]], including [[Quinolone antibiotic|fluoroquinolone]] and [[tetracycline]] [[antibiotic]]s, [[iron]], [[itraconazole]], and [[prednisone]].<ref name="Ogawa_2011">{{cite journal | vauthors = Ogawa R, Echizen H | title = Clinically significant drug interactions with antacids: an update | journal = Drugs | volume = 71 | issue = 14 | pages = 1839–1864 | date = October 2011 | pmid = 21942976 | doi = 10.2165/11593990-000000000-00000 | s2cid = 36875514 }}</ref> Metal [[chelation]] is responsible for some of these interactions (e.g. [[fluoroquinolones]], [[tetracyclines]]), leading to decreased absorption of the chelated drug. Some interactions may be due to the [[pH]] increase observed in the [[stomach]] following antacid [[ingestion]], leading to increased absorption of weak acids, and decreased absorption of weak bases.{{Citation needed|date=January 2024}} Antacids also cause an increase in [[pH]] of the [[urine]] (alkalization), which may cause increased [[blood]] concentrations of weak bases, and increased [[excretion]] of weak acids.<ref name="Patel_2020">{{cite journal | vauthors = Patel D, Bertz R, Ren S, Boulton DW, Någård M | title = A Systematic Review of Gastric Acid-Reducing Agent-Mediated Drug-Drug Interactions with Orally Administered Medications | journal = Clinical Pharmacokinetics | volume = 59 | issue = 4 | pages = 447–462 | date = April 2020 | pmid = 31788764 | pmc = 7109143 | doi = 10.1007/s40262-019-00844-3 }}</ref> |
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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 [[ |
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 [[medication]]s by at least two hours,<ref>{{Cite book |last=Australian Medicines Handbook Pty Ltd |title=Australian Medicines Handbook 2022 |year=2022 |isbn=978-0-6485158-6-9 |location=Adelaide, SA}}</ref> however this method has not been well studied for drugs affected by [[Urine|urine alkalization]].<ref name="Ogawa_2011" /> |
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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|pH sensitive]].<ref name=" |
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|pH sensitive]].<ref name="Patel_2020" /> |
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==Formulations== |
==Formulations== |
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Antacids may be [[Formylated|formulated]] with other [[active pharmaceutical ingredient|active ingredients]] such as [[simethicone]] to control [[Flatulence|gas]], or [[alginic acid]] to act as a physical barrier to acid.<ref> |
Antacids may be [[Formylated|formulated]] with other [[active pharmaceutical ingredient|active ingredients]] such as [[simethicone]] to control [[Flatulence|gas]], or [[alginic acid]] to act as a physical barrier to acid.<ref>{{cite web | publisher = International Foundation for Functional Gastrointestinal Disorders, Inc. (IFFGD) | url = http://www.iffgd.org/site/manage-your-health/diet-treatments/antacids | title = Antacids | archive-url = https://web.archive.org/web/20160506182546/http://www.iffgd.org/site/manage-your-health/diet-treatments/antacids | archive-date = 6 May 2016 | work = IFFGD Publication #520 | vauthors = Thompson WG | date = 12 September 2014 }}</ref> |
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=== Liquids === |
=== Liquids === |
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Several liquid antacid preparations are [[marketed]]. Common liquid preparations include [[Magnesium hydroxide|milk of magnesia]] and magnesium/aluminum [[ |
Several liquid antacid preparations are [[marketed]]. Common liquid preparations include [[Magnesium hydroxide|milk of magnesia]] and magnesium/aluminum [[combination]]s. 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.<ref>{{cite journal | vauthors = Barnett CC, Richardson CT | title = In vivo and in vitro evaluation of magnesium-aluminum hydroxide antacid tablets and liquid | journal = Digestive Diseases and Sciences | volume = 30 | issue = 11 | pages = 1049–1052 | date = November 1985 | pmid = 4053915 | doi = 10.1007/BF01315602 | s2cid = 8133980 }}</ref> |
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=== Tablets === |
=== Tablets === |
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==== Chewable tablets ==== |
==== Chewable tablets ==== |
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[[Chewable tablet|Chewable]] tablets are one of the most common forms of antacids, and are readily available over |
[[Chewable tablet|Chewable]] tablets are one of the most common forms of antacids, most frequently made from [[carbonate]] or [[hydroxide]] [[Salt (chemistry)|salts]], and are readily available over the counter. Upon reaching the [[stomach]], the powdered antacid salts bind to [[hydronium]] (H<sup>+</sup>) ions, producing [[chloride]] salts, carbon dioxide, and water. This process reduces the concentration of H<sup>+</sup> ions in the stomach, raising the pH and neutralizing the acid.<ref name="Garg_2022" />{{Rp|location=Figure 1}} Common carbonate salts available in tablet form include those of calcium, magnesium, aluminum, and sodium.<ref name="Ogawa_2011" /> |
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Some common |
Some common American brands are [[Tums]], Gaviscon chewable tablets, and [[Maalox]] chewable tablets.<ref>{{Cite web |title=Maalox Antacid Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing |url=https://www.webmd.com/drugs/2/drug-19216/maalox-antacid-oral/details |access-date=24 June 2022 |website=WebMD |archive-date=24 June 2022 |archive-url=https://web.archive.org/web/20220624114050/https://www.webmd.com/drugs/2/drug-19216/maalox-antacid-oral/details |url-status=live }}</ref> |
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==== Effervescent tablets ==== |
==== Effervescent tablets ==== |
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Effervescent tablets are tablets which are designed to dissolve in [[water]], and then release [[carbon dioxide]].<ref>{{cite news| |
Effervescent tablets are tablets which are designed to dissolve in [[water]], and then release [[carbon dioxide]].<ref>{{cite news| vauthors = Dubogrey I |title=Putting the Fizz into Formulation|url=http://www.samedanltd.com/magazine/11/issue/204/article/3622|work=European Pharmaceutical Contractor|issue=Autumn|date=2013|access-date=17 April 2017|archive-date=28 August 2021|archive-url=https://web.archive.org/web/20210828151212/http://www.samedanltd.com/magazine/11/issue/204/article/3622|url-status=dead}}</ref><ref>{{cite web | url = http://www.newdruginfo.com/pharmacopeia/bp2003/British%20Pharmacopoeia%20Volume%20III/Monographs/Formulated%20Preparations%20Genearal%20Monographs/TABLETS.htm | title = Tablets | work = British Pharmacopeia | date = 2003 | archive-url = https://web.archive.org/web/20130103012204/http://www.newdruginfo.com/pharmacopeia/bp2003/British%20Pharmacopoeia%20Volume%20III/Monographs/Formulated%20Preparations%20Genearal%20Monographs/TABLETS.htm | archive-date = 3 January 2013 }}</ref><ref>{{cite book|title=International Pharmacopoeia 2006|url=https://archive.org/details/bub_gb_s_sBKJNf184C|access-date=1 July 2013|year=2006|publisher=World Health Organization|isbn=978-92-4-156301-7|pages=[https://archive.org/details/bub_gb_s_sBKJNf184C/page/n993 966]}}</ref> Common ingredients include [[citric acid]] and [[sodium bicarbonate]], which react when in contact with water to produce [[carbon dioxide]]. Effervescent antacids may also contain [[aspirin]],<ref>{{cite web|url=http://www.alkaseltzer.ie/en/about-alka-seltzer/|title=Alka Seltzer Directions of use, Sodium & Aspirin content – Alka Seltzer relief from Headaches, Migraine & Upset stomach|work=alkaseltzer.ie|access-date=17 April 2017|archive-url=https://web.archive.org/web/20150429145428/http://www.alkaseltzer.ie/en/about-alka-seltzer/|archive-date=29 April 2015|url-status=dead}}</ref> [[sodium carbonate]], or [[tartaric acid]].<ref name=Blair>{{cite encyclopedia | vauthors = Blair GT, DeFraties JJ | title = Kirk-Othmer Encyclopedia of Chemical Technology | encyclopedia = Kirk Othmer Encyclopedia of Chemical Technology | year = 2000 | pages = 1–19 | doi = 10.1002/0471238961.0825041802120109.a01 | chapter = Hydroxy Dicarboxylic Acids | isbn = 978-0471238966 }}</ref> Those containing aspirin may cause further [[gastric]] irritation and [[ulceration]] due to [[aspirin]]'s effects on the [[Mucus|mucous]] membrane of the [[stomach]].<ref>{{cite journal | vauthors = Graham DY, Smith JL | title = Aspirin and the stomach | journal = Annals of Internal Medicine | volume = 104 | issue = 3 | pages = 390–398 | date = March 1986 | pmid = 3511824 | doi = 10.7326/0003-4819-104-3-390 }}</ref> |
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== Brand names == |
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Common [[Brand|brands]] include [[Alka-Seltzer]], Gaviscon, and [[Eno (drug)|Eno]]. |
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Some [[brand]]s include [[Alka-Seltzer]], Gaviscon, [[Tums]], Gelusil and [[Eno (drug)|Eno]].<ref>{{Cite web |date=30 March 2023 |title=Which OTC Meds Treat Heartburn? |url=https://www.webmd.com/heartburn-gerd/treating-heartburn-over-counter-medicine |url-status= |access-date=8 January 2024 |website=WebMD}}</ref><ref>{{cite web |title=Eno – Summary of Product Characteristics at eMC |url=https://www.medicines.org.uk/emc/medicine/21528 |access-date=2 September 2016 |website=Electronic Medicines Compendium |quote=Last updated 1 January 2016}}</ref><ref>{{cite web |title=Gelusil - Uses, Side Effects, and More |url=https://www.webmd.com/drugs/2/drug-14836/gelusil-antacid-and-anti-gas-oral/details |access-date=27 February 2024}}</ref> |
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==References== |
== References == |
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{{Reflist}} |
{{Reflist}} |
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== External links == |
== External links == |
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{{Wiktionary inline|antacid}} |
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{{Major Drug Groups}} |
{{Major Drug Groups}} |
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{{Antacids}} |
{{Antacids}} |
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{{Portal bar|Medicine}} |
{{Portal bar|Medicine}} |
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{{Authority control}} |
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[[Category:Antacids| ]] |
[[Category:Antacids| ]] |
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Latest revision as of 16:49, 27 November 2024
An antacid is a substance which neutralizes stomach acidity and is used to relieve heartburn, indigestion, or an upset stomach.[1] Some antacids have been used in the treatment of constipation and diarrhea.[2] Marketed antacids contain salts of aluminum, calcium, magnesium, or sodium.[2] Some preparations contain a combination of two salts, such as magnesium carbonate and aluminum hydroxide (e.g., hydrotalcite).[3]
Medical uses
[edit]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
[edit]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]
Properties of antacids
[edit]When an excess amount of acid is produced in the stomach, the natural mucous barrier that protects the lining of the stomach can degrade, leading to pain and irritation.[12] There is also potential for the development of acid reflux, which can cause pain and damage to the esophagus.[citation needed] Antacids contain alkaline ions that chemically neutralize stomach gastric acid, reducing damage to the stomach lining and esophagus, and relieving pain.[1] Some antacids also inhibit pepsin, an enzyme that can damage the esophagus in acid reflux.[2][13]
Antacids do not directly inhibit acid secretion, and thus are distinct from acid-reducing drugs like H2-receptor antagonists or proton pump inhibitors.[4] Antacids do not kill the bacteria Helicobacter pylori, which causes most ulcers.[4]
Types
[edit]Antacids are mainly classified into two categories:
- Systemic (absorbable) antacids: They are water soluble and systemically absorbed and pass into the bloodstream. e.g. sodium bicarbonate or sodium citrate
- Non-systemic (non-absorbable) antacids: They are insoluble and not absorbed into systemic circulation. They only act in the stomach e.g. magnesium carbonate or calcium carbonate[14]
Interactions
[edit]
Antacids are known to interact with several oral medications, including fluoroquinolone and tetracycline antibiotics, iron, itraconazole, and prednisone.[15] Metal chelation is responsible for some of these interactions (e.g. fluoroquinolones, tetracyclines), leading to decreased absorption of the chelated drug. Some interactions may be due to the pH increase observed in the stomach following antacid ingestion, leading to increased absorption of weak acids, and decreased absorption of weak bases.[citation needed] Antacids also cause an increase in pH of the urine (alkalization), which may cause increased blood concentrations of weak bases, and increased excretion of weak acids.[16]
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,[17] however this method has not been well studied for drugs affected by urine alkalization.[15]
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.[16]
Formulations
[edit]Antacids may be formulated with other active ingredients such as simethicone to control gas, or alginic acid to act as a physical barrier to acid.[18]
Liquids
[edit]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.[19]
Tablets
[edit]Chewable tablets
[edit]Chewable tablets are one of the most common forms of antacids, most frequently made from carbonate or hydroxide salts, 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.[15]
Some common American brands are Tums, Gaviscon chewable tablets, and Maalox chewable tablets.[20]
Effervescent tablets
[edit]Effervescent tablets are tablets which are designed to dissolve in water, and then release carbon dioxide.[21][22][23] Common ingredients include citric acid and sodium bicarbonate, which react when in contact with water to produce carbon dioxide. Effervescent antacids may also contain aspirin,[24] sodium carbonate, or tartaric acid.[25] Those containing aspirin may cause further gastric irritation and ulceration due to aspirin's effects on the mucous membrane of the stomach.[26]
Brand names
[edit]Some brands include Alka-Seltzer, Gaviscon, Tums, Gelusil and Eno.[27][28][29]
References
[edit]- ^ a b c d Salisbury BH, Terrell JM (2020). "Antacids". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 30252305. Archived from the original on 5 November 2021. Retrieved 24 November 2020.
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Last updated 1 January 2016
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External links
[edit]
The dictionary definition of antacid at Wiktionary
Major chemical drug groups – based upon the Anatomical Therapeutic Chemical Classification System | |
|---|---|
| gastrointestinal tract / metabolism (A) | |
| blood and blood forming organs (B) | |
| cardiovascular system (C) | |
| skin (D) | |
| genitourinary system (G) | |
| endocrine system (H) | |
| infections and infestations (J, P, QI) | |
| malignant disease (L01–L02) | |
| immune disease (L03–L04) | |
| muscles, bones, and joints (M) | |
| brain and nervous system (N) |
|
| respiratory system (R) | |
| sensory organs (S) | |
| other ATC (V) | |
