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20-September-2008 09:55:47 - Antacid This article is missing citations or needs footnotes. Using inline citations helps guard against copyright violations and factual inaccuracies. December 2007 Look up antacid in Wiktionary, the free dictionary. A bottle of antacid tablets A bottle of antacid tablets An antacid is any substance, generally a base or basic salt, which counteracts stomach acidity. In other words, antacids are stomach acid neutralizers. Contents 1 Action mechanism 2 Indications 3 Side effects 4 Interactions 5 Problems with reduced stomach acidity 6 Drug names 7 References Action mechanism Antacids perform a neutralization reaction, i.e. they buffer gastric acid, raising the pH to reduce acidity in the stomach. When gastric hydrochloric acid reaches the nerves in the gastrointestinal mucosa, they signal pain to the central nervous system. This happens when these nerves are exposed, as in peptic ulcers. The gastric acid may also reach ulcers in the esophagus or the duodenum. Other mechanisms may contribute, such as the effect of aluminum ions inhibiting smooth muscle cell contraction and delaying gastric emptying. Indications Wyeth amphojel tablets of aluminum hydroxide. Wyeth amphojel tablets of aluminum hydroxide. Antacids are taken by mouth to relieve heartburn, the major symptom of gastroesophageal reflux disease, or acid indigestion. Treatment with antacids alone is symptomatic and only justified for minor symptoms. Peptic ulcers may require H2-receptor antagonists or proton pump inhibitors. The utility of many combinations of antacids is not clear, although the combination of magnesium and aluminium salts may prevent alteration of bowel habits. Side effects Excess calcium from supplements, fortified food and high-calcium diets, can cause the milk alkali syndrome, which has serious toxicity and can be fatal. In 1915, Bertram Sippy introduced the Sippy regimen of hourly ingestion of milk and cream, the gradual addition of eggs and cooked cereal, for 10 days, combined with alkaline powders, which provided symptomatic relief for peptic ulcer disease. Over the next several decades, the Sippy regimen resulted in renal failure, alkalosis, and hypercalemia, mostly in men with peptic ulcer disease. These adverse effects were reversed when the regimen stopped, but it was fatal in some patients with protracted vomiting. Milk alkali syndrome declined in men after effective treatments for peptic ulcer disease. But during the past 15 years, it has been reported in women taking calcium supplements above the recommended range of 1200 to 1500 mg daily, for prevention and treatment of osteoporosis, and is exacerbated by dehydration. Calcium has been added to over-the-counter products, which contributes to inadvertent excessive intake. The New England Journal of Medicine reported a typical case of a woman who arrived in the emergency department vomiting and altered mental status, writhing in pain. She had consumed large quantities of chewable antacid tablets containing calcium carbonate Tums. She gradually recovered.1 Compounds containing calcium may also increase calcium output in the urine, which might be associated with renal stones.2 Calcium salts may cause constipation. Other adverse effects from antacids include: Carbonate: regular high doses may cause alkalosis, which in turn may result in altered excretion of other drugs, and kidney stones. A chemical reaction between the carbonate and hydrochloric acid may produce carbon dioxide gas. This causes gastric distension which may not be well tolerated. Aluminum hydroxide: may lead to the formation of insoluble aluminium-phosphate-complexes, with a risk for hypophosphatemia and osteomalacia. Although aluminium has a low gastrointestinal absorption, accumulation may occur in the presence of renal insufficiency. Aluminium-containing drugs may cause constipation. Magnesium hydroxide: has laxative properties. Magnesium may accumulate in patients with renal failure leading to hypermagnesemia, with cardiovascular and neurological complications. See Milk of magnesia. Sodium: increased intake of sodium may be deleterious for arterial hypertension, heart failure and many renal diseases. Interactions Altered pH or complex formation may alter the bioavailability of other drugs, such as tetracycline. Urinary excretion of certain drugs may also be affected. Problems with reduced stomach acidity Reduced stomach acidity may result in an impaired ability to digest and absorb certain nutrients, such as iron and the B vitamins. Since the low pH of the stomach normally kills ingested bacteria, antacids increase the vulnerability to infection. It could also result in reduced bioavailability of some drugs. For example, the bioavailability of ketoconazole antifungal is reduced at high intragastric pH low acid content. Drug names Examples of antacids brand names may vary in different countries. Aluminium hydroxide Amphojel, AlternaGEL Magnesium hydroxide Phillips' Milk of Magnesia Aluminum hydroxide with magnesium hydroxide Maalox, Mylanta Aluminum carbonate gel Basaljel Calcium carbonate Alcalak, TUMS, Quick-Eze, Rennie, Titralac, Rolaids Sodium bicarbonate Bicarbonate of soda, Alka-Seltzer Hydrotalcite Mg6Al2CO3OH16 · 4H2O; Talcid Bismuth subsalicylate Pepto-Bismol Magaldrate with Simethicone Pepsil References ^ Gabriely, I.; Leu, J. P.; Barzel, U. S. May 1, 2008. Clinical problem-solving, back to basics. New England Journal of Medicine 358 18: 1952-6. doi:10.1056/NEJMcps0706188. PMID 18450607. Retrieved on 2008-05-29. ^ Cooke, N.; Teitelbaum, Ss; Avioli, L. V. 1978. Antacid-induced osteomalacia and nephrolithiasis. Archives of Internal Medicine 138 6: 1007-9. doi:10.1001/archinte.138.6.1007. PMID 646554. Retrieved on 2008-05-29. v d e Major drug groups Gastrointestinal tract/metabolism A stomach acid Antacids, H2 antagonists, Proton pump inhibitors Antiemetics Laxatives Antidiarrhoeals/Antipropulsives Anti-obesity drugs Anti-diabetics Vitamins Dietary minerals Blood and blood forming organs B Antithrombotics Anticoagulants, Antiplatelets, Thrombolytics Antihemorrhagics Cardiovascular system C cardiac therapy/antianginals Cardiac glycosides, Antiarrhythmics, Cardiac stimulant Antihypertensives Diuretics Vasodilators Beta blockers renin-angiotensin system ACE inhibitors, Angiotensin II receptor antagonists, Renin inhibitors Antihyperlipidemics Skin D Emollients Cicatrizant Antipruritics Reproductive system G Hormonal contraception Fertility agents SERMs Sex hormones Endocrine system H Corticosteroids Sex hormones Thyroid hormones Antithyroid agent Infections and infestations J, P Antibiotics Antivirals Vaccines Antifungals Antiparasitic Antiprotozoals, Anthelmintics Malignant and immune disease L Anticancer agents Immunostimulators Immunosuppressants Muscles, bones, and joints M Anabolic steroids Anti-inflammatories NSAID Antirheumatics Corticosteroids Muscle relaxants Brain and nervous system N Anesthetics General, Local Analgesics Anticonvulsants Mood stabilizers Psycholeptic Anxiolytics, Antipsychotics, Hypnotics/Sedatives Psychoanaleptic Antidepressants, Stimulants/Psychostimulants Respiratory system R Bronchodilators Decongestants H1 antagonists Other ATC V Antidotes Contrast media Radiopharmaceuticals Dressing v d e Drugs for acid related disorders: Antacids A02A Magnesium Magnesium carbonate - Magnesium oxide - Magnesium peroxide - Magnesium hydroxide - Magnesium silicate Aluminium Aluminium hydroxide - Algeldrate - Aluminium phosphate - Dihydroxialumini sodium carbonate - Aluminium acetoacetate - Aloglutamol - Aluminium glycinate Calcium Calcium carbonate - Calcium silicate Retrieved from http://en..org/wiki/Antacid Categories: Gastrointestinal system drugsHidden categories: Articles with statements since December 2007 | All articles with statements Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Català Česky Deutsch Español Hrvatski Nederlands Português РуÑ?Ñ?кий SlovenÄ?ina SlovenÅ¡Ä?ina СрпÑ?ки / Srpski Srpskohrvatski / СрпÑ?кохрватÑ?ки Suomi Svenska ไทย Türkçe УкраїнÑ?ька This page was last modified on 15 August 2008, at 20:01
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