Antacids

Antacids are medicines that neutralize stomach acid. They are used for the symptomatic treatment of heartburn, acid belching, or acid-related stomach pain.

What is an antacid?

Antacids are medicines that neutralize stomach acid. They are used for the symptomatic treatment of heartburn, acid belching, or acid-related stomach pain.

The group of antacids includes various drugs. In the past, sodium hydrogen carbonate was often used. In the 1970s, aluminum hydroxide gels or magnesium hydroxide gels were increasingly used. Calcium and magnesium carbona mixtures were also used as antacids for the first time. The active ingredient almasilate, which contains aluminum magnesium silicate hydrate, also caught on.

Today aluminum hydroxide gels are still used. They are also known as algedrat. Algedrat can be combined with calcium carbonate or with magnesium hydroxide. In combination with the active ingredient simeticon, it is administered in the case of larger gas accumulations in the stomach and intestines. Other drugs that belong to the group of antacids are carbaldrate, dexlansoprazole, magaldrate, oxetacaine, smectite or alginic acid.

The acid-binding agents are administered when the stomach is too acidic. They are supposed to relieve acid-related complaints such as acid belching or heartburn. The antacids start to work after a short time. However, it only lasts a few hours.

Pharmacological effect

The stomach acid consists of hydrochloric acid in a strong dilution. Positively charged hydrogen ions are responsible for the low gastric pH value. The acid-binding antacids, on the other hand, contain many negative ions. These bind to the positively charged protons and neutralize them. The acids are balanced by the basic reaction.

One substance that can neutralize stomach acid is sodium hydrogen carbonate. Only non-toxic reaction products such as CO2 and water are created. The remedy is now considered out of date, but is still contained in many products for acid-related stomach ailments or heartburn. Sodium hydrogen carbonate increases the pH value inside the stomach very quickly to values ​​above 7. This increases the release of the hormone gastrin. Gastrin is made in the gastrointestinal tract and stimulates the production of stomach acid.

After taking sodium hydrogen carbonate, the pH value drops reactively. Sodium hydrogen carbonate is therefore not as effective as, for example, aluminum hydroxide gels. Medicinal substances containing aluminum, such as algedrat, bind gastric acid in the stomach and neutralize it. Inflammations in the gastrointestinal tract can heal better this way. Algedrat also strengthens the tissue and mucous membrane layers of the gastrointestinal tract by releasing aluminum ions. Inflammation and injuries can then not occur so easily. In addition, the drug ensures the connection of phosphates so that they can be excreted better. This means that the mucous membranes are less irritated.

The antacid alginate is made from brown algae. The drug creates a physical barrier between the mucous membranes and stomach acid. Together with calcium carbonate or potassium hydrogen carbonate, alginic acid forms a foam that spreads over the contents of the stomach. This will prevent reflux with heartburn.

Medical application & use

Antacids are used to bind acid in the gastrointestinal tract. They are supposed to protect the stomach from over-acidification and alleviate the consequences of over-acidification of the stomach. Typical sequelae are acid regurgitation and heartburn.

Heartburn is the main symptom of reflux disease. In this condition, stomach contents or stomach acid flow up from the stomach up into the esophagus. Because the mucous membranes of the esophagus are much more sensitive than the lining of the stomach, there is an unpleasant burning sensation behind the breastbone. The irritation can also cause laryngitis with a chronic cough to develop.

Antacids can neutralize stomach acid, reducing the effects. The drugs are administered orally. The dosage depends on the active ingredient. Preparations with the medicinal substances magaldrate and hydrotalcite have the highest acid-binding capacity. The antacids work very quickly, but rarely last longer than two to three hours. Acid-binding agents should be taken two hours after a meal or right before bed. It should be noted that antacid therapy is purely symptomatic. It does not treat the causes of the increased acid production in the stomach.

In the past, antacids were also used to treat stomach ulcers. In the meantime, however, they are increasingly being replaced by proton pump inhibitors or H2 receptor antagonists in treatment. These do not neutralize the gastric acid, but directly inhibit the gastric acid production and therefore work more effectively and for longer.

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Risks & side effects

Sodium hydrogen carbonate should no longer be used as an antacid. On the one hand, there is a rapid reactive increase in acid production after ingestion and, on the other hand, the drug is completely absorbed. If higher doses are taken or if they are taken over a long period, hypernatremia, metabolic alkalosis or hypertension may develop.

Aluminum hydroxide antacids can cause constipation. Magnesium hydroxide, on the other hand, stimulates the intestinal activity and can therefore have a laxative effect. Most finished products, however, contain both compounds, so that the laxative and constipating effects are balanced.

Recent studies show that the aluminum salts from antacids are absorbed with aluminum hydroxide. Since it has not yet been fully clarified what effects the salts have in the human body, the daily intake should be limited. It should also be noted that antacids can reduce the absorption of other medications. Therefore, the preparations should be taken several hours apart.