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Clinician’s Corner: Antacid Warnings

Last week’s column seemed like a chemistry lesson, lets get down to the information that impacts you our patient! All the reactions had one thing in common, generation of a chloride salt: aluminum chloride, magnesium chloride, calcium chloride or sodium chloride.  Many of our patients can experience adverse effects from these salts.

Warnings/precautions/adverse effects of antacid therapy.

  • Use calcium carbonate, and magnesium antacids cautiously in patients with kidney problems.
  • Sodium bicarbonate (baking soda) should not be used in high blood pressure, heart failure, kidney disease and ankle swelling. Do not use for ulcers. Zegerid OTC contains both omeprazole and sodium bicarbonate. Sodium bicarbonate “protects the omeprazole from stomach acid”, but still it is sodium bicarbonate!
  • Use antacids cautiously in elderly where there is decreased stomach and bowel activity.
  • Aluminum containing antacids cause constipation. Use with caution with patients suffering with dehydration or intestinal obstruction.  Caution in dialysis patients.
  • Chronic administration of calcium carbonate should be avoided because of excess calcium levels, and because calcium ions cause further stimulation of acid secretion. Calcium carbonate causes constipation.
  • Magnesium containing antacids may cause diarrhea.
  • Low phosphorus and bone thinning can occur with long term use of aluminum hydroxides, but can occur with short term use in malnourished patients like alcoholics.

Drug interactions with antacid therapy:

  • Tetracyclines & fluoroquinolones (Cipro, Levaquin) are BOTH bound by antacids. Separate tetracyclines by 2 hours, and fluoroquinolones by 4 hours.
  • Enteric coated drugs (Like Enteric coated aspirin): coating is destroyed by antacid exposure.
  • Antacids interfere with absorption of some prescription drugs that require acid for absorption. Separate these drugs from antacids by 2 hours. Ask your Thompson Pharmacist to check your medication list.
  • Separate from Levothyroxine (Synthroid) by 4 hours. This is a very common drug interaction.

After reviewing all the potential drug: antacid interactions be sure to consult your Thompson Pharmacist if you use antacid therapy and take multiple prescription drugs.

Go ahead and ask—at Thompson Pharmacy it’s all for YOU