Antacids are a group of drugs that have been on the market for • Osteomalacia

many years. They were initially first-line defense against peptic • Constipation
ulcer disease; however, the discovery of proton pump inhibitors • Fecal impaction
revolutionized the treatment of peptic ulcer disease. Currently, • Nausea
antacid use is restricted to relieve mild intermittent • Vomiting
gastroesophageal reflux disease (GERD) with associated • Abdominal cramps
heartburn. This activity reviews the indications, • Hypomagnesemia
contraindications, pharmaceutical action, adverse events, and • Hypophosphatemia
other key elements of antacid therapy in the clinical setting as
relates to the essential points needed by members of an Calcium Carbonate - The adverse reactions often seen with
interprofessional team managing the care of patients with this group of antacids are:
heartburn and mild GERD.
• Abdominal pain
Antacids are a group of drugs that have been on the market for • Anorexia
many years. They were initially first-line defense against peptic • Constipation
ulcer disease; however, the discovery of proton pump inhibitors • Acid rebound
revolutionized the treatment of peptic ulcer disease. Currently, • Nausea
antacid use is restricted to relieving mild • Vomiting
intermittent gastroesophageal reflux disease (GERD) • Flatulence
associated with heartburn. The estimated prevalence of • Xerostomia
heartburn at least once per week in North America ranges from • Headache
18% to 28%, with 25% of adults reporting heartburn daily. • Hypercalcemia
Antacids are medications that do not require a prescription; in • Hypophosphatemia
• Milk-alkali syndrome
other words, they are self-prescribed. Antacids are a
combination of various compounds with various salts of
calcium, magnesium, and aluminum as active ingredients. The Antacids can exhibit clinically significant interactions with
other medication a patient may be taking. Some examples
antacids act by neutralizing the acid in the stomach and by
include:
inhibiting pepsin, which is a proteolytic enzyme. Each of these
cationic salts has a characteristic pharmacological property that
• Using antacids concomitantly with acidic drugs (e.g.,
determines its clinical use. Antacids have therapeutic use
digoxin, chlorpromazine isoniazid) can result in
for the following:
impaired absorption of these acidic drugs, reducing
• Heartburn symptoms in GERD the blood concentrations of the drugs and impairing
their therapeutic effects.
• Duodenal and gastric ulcers
• Concurrent antacid use with some drugs (e.g.,
• Stress gastritis pseudoephedrine, levodopa) can result in increased
• Pancreatic insufficiency absorption of the drugs, leading to potential toxicity
• Non-ulcer dyspepsia or adverse events from increased serum concentration
• Diarrhea caused by bile-acid of these drugs.
• Biliary reflux • Antacids containing magnesium trisilicate and
• Constipation magnesium hydroxide can bind to drugs like
• Osteoporosis tetracycline and fluoroquinolone antibiotics,
impeding their absorption and therapeutic effects.
• Urinary alkalinization
• Sodium bicarbonate significantly affects urine acidity,
• Phosphate binding in chronic renal failure which can alter the renal elimination of some drugs by
Mechanism of Action the kidney; sodium bicarbonate inhibits the excretion
of basic drugs such as amphetamines and
The antacids reduce the acid reaching the duodenum by quinidine while increasing the excretion of acidic
neutralizing the acid present in the stomach. The main drugs like aspirin.
therapeutic objectives are:
The absolute contraindication is hypersensitivity to any
• Alleviating pain component of the formulation. Also, antacid agents require
• Relieving pylorospasms caution in patients with:
• Avoid digestion and corrosion by acid chyme
❖ Renal failure
Other mechanisms add to the ulcer healing properties of this
❖ Heart failure
class of drugs. The exact mechanism is still unclear, but it is
believed to be a combination of: ❖ Edema
• Ability to promote angiogenesis ❖ Cirrhosis
• Bind to bile acids ❖ Low-sodium diets
• Inhibit peptic activity ❖ Uremia

• Suppress Helicobacter pylori growth ❖ GI hemorrhages

❖ Hyperparathyroidism
Adverse effects are prominent in the infant and the elderly
populations. The chronic use of antacids in this population is ❖ Renal calculus
not a recommendation due to safety concerns.
❖ Achlorhydria
Aluminum Hydroxide - Aluminum use is associated with an No information is available regarding toxicities caused by
increased risk of toxicity in individuals with renal failure and aluminum- and calcium-containing antacids. However,
infants. It presents as: antacids are to be used cautiously in the high-risk population
mentioned above.
• Osteopenia
• Microcytic anemia
• Neurotoxicity