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Antacids
Published in Charles Theisler, Adjuvant Medical Care, 2023
Antacids are medications that neutralize acid in the stomach. They are frequently used to treat heartburn or indigestion. Antacids such as Tums, Di-Gel, Dulcolax, Mylanta, etc., are different from acid reducers or block ers. Aluminum hydroxide gel in antacids (e.g., Equate) can combine with phosphorus to form a complex that is excreted in the feces. This is a valuable feature for reducing phosphate levels in hyperphosphatemia. However, aluminum-containing antacids can precipitate, leading to decreased absorption of vitamin A.1
Nutritional and Dietary Supplementation during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Antacids are classified based on their content: aluminum, calcium, magnesium, magaldrate, sodium bicarbonate, and combinations of any of these. Antacids are the most common over-the-counter and prescribed gastrointestinal medications used by pregnant women. Combinations of aluminum hydroxide and magnesium hydroxide are used in popular commercial preparations (e.g., Maalox, Mylanta, Riopan, and Gelusil). Calcium carbonate is also a very popular antacid (e.g., Tums, Titralac, Rolaids, and Chooz).
Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
Antacids: Antacids are generally considered safe in pregnancy (12) and are used by 30% to 50% of women for relief of reflux symptoms during pregnancy (13). Magnesium-, aluminum-, or calcium-containing antacids are not teratogenic in animal studies (13). There are limited data on the safety and efficacy of antacids during pregnancy. A large retrospective study showed an increased incidence of birth defects in women who used antacids along with many other medications in the first trimester (14); however, no particular antacid was specified, and these data have not been verified in another study. More recent analyses of pregnant women in both the United States and the Netherlands (15,16) indicate that antacid use is common; although no obvious increase in rare birth defects has been noted, small increases in common abnormalities such as spontaneous abortion, cleft palate, or low birth weight would be difficult to detect (15). The major immediate side effects of large doses of antacids include constipation induced by aluminum-containing antacids and diarrhea caused by magnesium-based preparations. The use of a combination of these medications usually resolves bowel-related problems. Antacids containing sodium bicarbonate should be avoided because it can precipitate metabolic alkalosis and volume overload (17).
Treatment of newly-diagnosed gastroesophageal reflux disease: a nationwide register-based cohort study
Published in Scandinavian Journal of Gastroenterology, 2019
Jonas Sanberg Ljungdalh, Katrine Hass Rubin, Jesper Durup, Kim Christian Houlind
In a British registry-based study, investigating patients affiliated with 1500 general practitioners in 1996, 11% of patients with a suspicion of GERD were referred for evaluation with endoscopy [31]. Of the patients undergoing endoscopy, 29.1–35.1% had previously been treated with H2-receptor antagonists and 21.7%–33.1% had previously been treated with PPI. This use of drugs compared to the results in our study, probably reflects that PPI-use has increased since 1996, most likely as a consequence of changed pricing. Of the patients undergoing endoscopy in the British study, 67% had esophagitis which is comparable with the degree of esophagitis in our study (66.3%). In the Olmsted County Cohort, only 5.4% of subjects reporting heartburn reported a visit at their general practitioner for that reason within the last year and 14.8% of these subjects, were referred to endoscopy [32]. Nine per cent of subjects experiencing heartburn or acid regurgitation reported daily use of antacids and 18% reported at least weekly use. PPI was not the prevalent pharmacological treatment, most likely because the study was published in 1997. Finally, the HUNT study reported an increasing prevalence of GERD, but did not include data on pharmacological or surgical treatment [33]. In general, not many registry-based studies on the treatment of GERD are available and to our knowledge, no other study investigates the disease within a nationwide population-based perspective.
Gastroesophageal reflux disease (GERD) in children
Published in Paediatrics and International Child Health, 2019
Children with GERD require potent acid suppression therapy for at least 12 weeks. It has been shown that PPIs are more potent and more effective than a histamine 2 receptor antagonist (H2RA). The healing rate of erosive oesophagitis with H2RA such as ranitidine (6–8 mg/kg/day, BID or TID) is 60–70% and with PPIs such as omeprazole (0.7–3.5 mg/kg/day, OD) is 90–100% [22,23]. PPIs should be taken 30 min before breakfast as they act best in activated parietal cells; a once-daily dose is adequate and there is no difference in efficacy between the various PPIs (omeprazole, lansoprazole, esomeprazole, rabeprazole, pantoprazole). Antacids can be used for symptomatic relief for a brief period but prolonged therapy is contra-indicated in children owing to the side-effects.
An update on the latest chemical therapies for reflux esophagitis in children
Published in Expert Opinion on Pharmacotherapy, 2019
Marc Bardou, Kyle J. Fortinsky, Nicolas Chapelle, Maxime Luu, Alan Barkun
The effectiveness of antacids in children has been studied in two small trials. Both trials found that antacids are successful in treating GER in large doses. They were found to be equally effective to H2RAs in healing esophagitis as well as improving symptoms of GER [38,39]. While the benefit of antacids is their relative safety compared to other medications such as PPIs, H2RAs, and prokinetics, they still have some associated risks. There have been reports of aluminum toxicity in preparations containing aluminum hydroxide, leading to osteopenia, microcytic anemia, and neurotoxicity [40]. Moreover, other preparations containing calcium can lead to milk-alkali syndrome, a syndrome of hypercalcemia, alkalosis, and renal failure [41].