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Clinician’s Corner: Antacids

Before we had drugs Proton Pump Inhibitors (Prilosec, Protonix and others) and H2RA (Tagamet, Petpcid and Zantac), antacid therapy was all that was available for stomach ulcers. Most patients always had a bottle of Maalox (mag/alum hydroxide) or Mylanta in their medicine cabinets, work lockers and even in their car.

The standard regimen included one ounce (30ml) one hour before each meal, one ounce after each meal and at bedtime.  Patients could go through 7 ounces of antacid per day, and many bought a couple of bottles at a time.

Indications for antacid therapy: Antacids today should be only used short term. Antacids work quickly to treat ulcer pain and heal ulcer.  They neutralize gastric acid, which in turn increases Lower Esophageal Sphincter (LES) tone. The LES tone is important to keep the gastric contents from “splashing up” into the esophagus. Antacids have a rapid onset (5-15min) short duration (30-60minutes).  They are ideal for immediate relief of gastrointestinal distress.

Mechanism: reduces concentration and total load of acid in gastric contents. The hydroxide ions or the carbonate ions neutralize the hydrogen ions (H+)

Active ingredients of antacid therapy

  • Aluminum hydroxide: Aluminum hydroxide plus hydrochloric acid produces aluminum chloride and water.
  • Magnesium hydroxide: Magnesium hydroxide plus hydrochloric acid produces magnesium chloride and water.
  • Calcium carbonate: Calcium carbonate plus hydrochloric acid produces calcium chloride, water and carbon dioxide
  • Sodium bicarbonate: Sodium bicarbonate plus hydrochloric acid produces sodium chloride, water and carbon dioxide

Simethicone is frequently included in antacid formulations as an “anti-gas” agent:

Mechanism: silicon polymers that reduces surface tension of gas bubbles imbedded in the intestinal mucosa.  Simethicone is often added to antacids to reduce gas pain. The gas bubbles then coalesce and then are more easily eliminated through belching (upper GI) of flatulence (lower GI)

Children: less than 24 months: 20mg 4 times daily

Age 2-12: 40mg 4 times daily

Adults: 40-360mg after meals and at bedtime as needed

Go ahead and ask! So, if you eat a little too much this holiday season, feel free to consult your Thompson Pharmacist for the most appropriate antacid therapy.  We have a wide selection of liquid antacids, that work quickly, and more convenient chewable antacid tablets.  At Thompson Pharmacy…it’s all for YOU!