Drugs in this Class
Aluminum Hydroxide Suspension (Alternagel Suspension)
Magaldrate Oral Suspension (Ron Acid Liquid)
Aluminum and Magnesium Hydroxide Oral Suspension (Alamag Suspension, Alumina and Magnesia Suspension, Mag-Al Suspension, Mylanta Ultimate Strength Suspension, Rulox Suspension)
Calcium Carbonate Tablets (Amitone Tablets, Calcarb Tablets, Caltrate 600 Tablets, Dicarbosil Tablets, Mallamint Tablets, Oyster Shell Calcium Tablets, Titralac Tablets, Tums Tablets)
Magnesium Gluconate Tablets (Mag-G Tablets, Magtrate Tablets)
Magnesium Hydroxide Oral Suspension (Milk of Magnesia, Milk of Magnesia-Concentrated, Phillips Milk of Magnesia)

Summarizing the Evidence

• Basically, most antacid products will effectively relieve GERD and some symptoms of PUD if taken in the appropriate doses (high doses are needed to control stomach acid). However, potency differs between products. This means that one teaspoonful of "Antacid A" may not equal one teaspoonful of "Antacid B." The potency of antacids is expressed in terms of milli-equivalents (mEq) of Acid-Neutralizing Capacity (ANC), which means the amount of stomach acid neutralized by the antacid per dose over a specified period of time. The neutralizing capacities (or ANC) of antacid products vary considerably, depending on the product's ingredient(s) amounts, formulation, and manufacturer.

• Antacids are typically not used by themselves to treat PUD. Stronger prescription medications are usually required to heal an ulcer. Antacids can be used for intermittent relief of stomach upset that can occur with an ulcer.

• Typically, combination antacid products containing aluminum-magnesium work best and have the least amount of side effects.

Dosing and Administration

• For self-management of occasional heartburn or mild upset stomach that can be associated with PUD, you should follow the directions written on the antacid product labeling. If heartburn symptoms or upset stomach become more frequent or last longer than 2 weeks, you may require higher doses and/or more frequent dosing (typically four times daily--after meals and at bedtime). Sometimes, these higher doses will exceed package label recommendations. Antacids used at higher than recommended doses can cause serious side effects. Therefore, you should contact you doctor or pharmacist for specific recommendations. Again, antacids alone will not cure PUD or heal an ulcer--stronger prescription medications will be needed to effectively treat PUD.

Tips for Antacid Selection & Usage

• Antacids are commonly used along with lifestyle modifications for add-on treatment of mild, occasional PUD symptoms.
• Antacids are available without a prescription and are relatively inexpensive when compared with other treatment options (e.g. H2-blockers, proton pump inhibitors, motility agents).
• Antacids are generally well-tolerated. The most common side effect for aluminum- and calcium-containing antacids is constipation. The most common side effect for magnesium containing antacids is diarrhea. By using combination products (e.g. aluminum-magnesium) the side effects may counterbalance each other (e.g. constipation vs. diarrhea).
• Talk to your doctor or pharmacist before selecting a nonprescription antacid to make sure there are no interactions present between other medical conditions you may have or between other medications you may be taking.
• Recommended doses printed on the antacid product labeling may not provide the desired ANC (acid-neutralizing capacity) needed to effectively control symptoms. Therefore, if your symptoms are not controlled with standard doses, contact your doctor for further recommendations on higher antacid doses or possibly switching to another drug category.
• Be aware of sodium content in antacid products, especially if you are on a sodium restricted diet, have heart disease, high blood pressure, fluid-retention, or kidney disease.
• Be aware of sugar content in various antacid products if you are a diabetic. Sugar free antacid products are available.
• Do not use antacids for more than 2 weeks unless under the advice and supervision of your physician. Report any bloody stools or vomiting "coffee-ground" like material immediately.

Generic Availability

• Most antacids are available without a prescription in less expensive store brand versions.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

Referfences:

1. Berardi RR, Kroon L, McDermott JH and Newton GD. Handbook of Nonprescription Drugs. 15th edition. Acid-Peptic Products. American Pharmaceutical Association; Washington DC. 2006.

2. Knodel LC, ed. Nonprescription Products: Formulations and Features '98-99. Acid-Peptic Products. American Pharmaceutical Association; Washington DC. 1998. pg: 162.

3. Berardi RR, Welage LS. Peptic Ulcer Disease. In: Pharmacotherapy A Pathophysiologic Approach. 6th ed. Dipiro JT, Talbert RL, Yee GC et al. (eds). McGraw-Hill. New York. 2005. pg. 629-648.

4. Drugdex Database. In: Thomson-Micromedex. Greenwood Village, CO. 2006.

5. Drug Facts and Comparisons. Wolters Kluwer Health. St. Louis, MO; 2007.

6. Cohen S. Peptic Ulcer. The Merck Manuals Online Library Edition. Last Updated 2007. Available from URL: http://www.merck.com/mmhe/sec09/ch121/ch121c.html Accessed March 2008.

Last Updated: March 2008

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It should not be construed to indicate that the use of the product is safe, appropriate, or effective for you. Consult your healthcare professional before taking any medication.

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