Content for catalog BNF expired on 2018-04-15

BNF

1.1.1 Antacids and simeticone

Additional information

 

interactions (Antacids, Calcium Salts).

Antacids (usually containing aluminium or magnesium compounds) can often relieve symptoms in ulcer dyspepsia and in non-erosive gastro-oesophageal reflux (see also section 1.1); they are also sometimes used in functional (non-ulcer) dyspepsia but the evidence of benefit is uncertain. Antacids are best given when symptoms occur or are expected, usually between meals and at bedtime, 4 or more times daily; additional doses may be required up to once an hour. Conventional doses e.g. 10 mL 3 or 4 times daily of liquid magnesium–aluminium antacids promote ulcer healing, but less well than antisecretory drugs (section 1.3); proof of a relationship between healing and neutralising capacity is lacking. Liquid preparations are more effective than tablet preparations.

Aluminium- and magnesium-containing antacids (e.g. aluminium hydroxide, and magnesium carbonate, hydroxide and trisilicate), being relatively insoluble in water, are long-acting if retained in the stomach. They are suitable for most antacid purposes. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids may be constipating; antacids containing both magnesium and aluminium may reduce these colonic side-effects. Aluminium accumulation does not appear to be a risk if renal function is normal.

The acid-neutralising capacity of preparations that contain more than one antacid may be the same as simpler preparations. Complexes such as hydrotalcite confer no special advantage.

Sodium bicarbonate should no longer be prescribed alone for the relief of dyspepsia but it is present as an ingredient in many indigestion remedies. However, it retains a place in the management of urinary-tract disorders (section 7.4.3) and acidosis (section 9.2.1.3 and section 9.2.2). Sodium bicarbonate should be avoided in patients on salt-restricted diets.

Bismuth-containing antacids (unless chelates) are not recommended because absorbed bismuth can be neurotoxic, causing encephalopathy; they tend to be constipating. Calcium-containing antacids (section 1.1.2) can induce rebound acid secretion: with modest doses the clinical significance is doubtful, but prolonged high doses also cause hypercalcaemia and alkalosis, and can precipitate the milk-alkali syndrome.

Simeticone (activated dimeticone) is added to an antacid as an antifoaming agent to relieve flatulence. These preparations may be useful for the relief of hiccup in palliative care. Alginates, added as protectants, may be useful in gastro-oesophageal reflux disease (section 1.1 and section 1.1.2). The amount of additional ingredient or antacid in individual preparations varies widely, as does their sodium content, so that preparations may not be freely interchangeable.

See also section 1.3 for drugs used in the treatment of peptic ulceration.

Hepatic impairment

In patients with fluid retention, avoid antacids containing large amounts of sodium. Avoid antacids that cause constipation because this can precipitate coma. Avoid antacids containing magnesium salts in hepatic coma if there is a risk of renal failure.

Renal impairment

In patients with fluid retention, avoid antacids containing large amounts of sodium. There is a risk of accumulation and aluminium toxicity with antacids containing aluminium salts. Absorption of aluminium from aluminium salts is increased by citrates, which are contained in many effervescent preparations (such as effervescent analgesics). Antacids containing magnesium salts should be avoided or used at a reduced dose because there is an increased risk of toxicity.

Interactions

Antacids should preferably not be taken at the same time as other drugs since they may impair absorption. Antacids may also damage enteric coatings designed to prevent dissolution in the stomach. See also Appendix 1 (antacids, calcium salts).

Low Na+

The words ‘low Na+’ added after some preparations indicate a sodium content of less than 1 mmol per tablet or 10-mL dose.

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