Antacids (drug interactions)
Antacids are compounds that neutralize stomach acid, providing relief from conditions like heartburn and indigestion. However, they can pose significant drug interactions that users should be aware of. For instance, antacids may bind to minerals and vitamins, reducing their absorption, particularly affecting folate and various minerals such as iron and zinc. This interaction can be notably concerning for individuals who regularly consume antacids and have low dietary intake of these nutrients.
Certain antacids, especially those containing aluminum, can lead to increased absorption of aluminum when taken with calcium citrate, presenting potential health risks. Additionally, the absorption of medications like aspirin can be diminished when combined with specific antacids, raising safety concerns, particularly for those with stomach ulcers or on anticoagulants. Other acidic medications, including some antibiotics and heart medications, may also have reduced effectiveness if taken alongside antacids. Conversely, some medications may have enhanced effects when used with antacids. Understanding these interactions is crucial for individuals who regularly use antacids, ensuring safe and effective use alongside other medications and dietary supplements.
Subject Terms
Antacids (drug interactions)
DEFINITION: Compounds that directly neutralize stomach acid
INTERACTIONS: Calcium citrate, folate, minerals
DRUGS IN THIS FAMILY: Aluminum carbonate (Basaljel), aluminum hydroxide (ALternaGEL, Alu-Cap, Alu-Tab, Amphojel, Dialume, Nephrox), aluminum hydroxide/magnesium carbonate (Duracid), aluminum hydroxide/magnesium hydroxide (Alamag, Almacone, Aludrox, Gaviscon Liquid, Gelusil, Kudrox, Maalox Advanced Regular Strength, Magalox, Mintox, Mylanta, Rulox), aluminum hydroxide/magnesium hydroxide/calcium carbonate (Tempo, Rolaids Ultra Strength), aluminum hydroxide/magnesium trisilicate (Alenic Alka, Gaviscon, Genaton, Foamicon), calcium carbonate (Alkets, Amitone, Chooz, Equilet, Gas-Ban, Mallamint, Mylanta Lozenges, Titralac, Tums), calcium carbonate/magnesium carbonate (Marblen, Mi-Acid Gelcaps, Mylanta Gelcaps, Mylagen Gelcaps), magnesium hydroxide (Milk of Magnesia, Phillips’ Chewable), magaldrate or aluminum magnesium hydroxide sulfate (Iosopan, Riopan), magnesium oxide (Mag-Ox, Maox, Uro-Mag), sodium bicarbonate (Bell/ans, Bromo Seltzer), sodium citrate (Citra pH), vonoprazan (Voquezna), calcium carbonate/magnesium hydroxide/simethicone (Rolaids Advanced)
Folate
Effect: Supplementation Possibly Helpful
Research suggests that antacids physically bind to folate and reduce its absorption by the body. However, the decrease in folate absorption is relatively small, and this interaction may be clinically significant only in persons who take antacids regularly and whose diets are low in folate content.
Minerals
Effect: Supplementation Possibly Helpful
Different types of antacids can interfere with the absorption of various minerals. Supplements containing the US Dietary Reference Intake (formerly known as the Recommended Dietary Allowance) of these minerals should be helpful, especially if one takes them at a different time of day than the antacid (a minimum of two hours before or after taking the antacid).
Any antacid can interfere with the absorption of iron, zinc, and possibly other minerals by neutralizing stomach acid. Aluminum-containing antacids can bind with phosphorus and interfere with its absorption, and this can further lead to calcium depletion.
Antacids that contain calcium may also compete for absorption with iron. Although calcium antacids may alter the absorption of magnesium, the clinical importance of this effect appears to be minimal. Calcium-containing antacids, when taken with zinc supplements, might substantially decrease zinc absorption. However, the presence of a meal appears to mitigate this effect. Finally, calcium antacids might also impair the absorption of manganese and chromium.
Citrate
Effect: May Increase Aluminum Absorption
Concerns have been raised that the aluminum in some antacids may be harmful. Because there is some evidence that calcium citrate supplements might increase the absorption of aluminum, one should not take calcium citrate at the same time of day as aluminum-containing antacids. Another option is to use other forms of calcium, or to avoid antacids containing aluminum.
Aspirin
Effect: May Decrease Aspirin Absorption
Taking aspirin with antacids that contain aluminum, magnesium hydroxide, or calcium carbonate reduces the body's ability to absorb the medication. This included Aspir-81, aspirin, aspirin low strength, and atorvastatin. Additionally, the FDA raised concerns about bleeding in the stomach when aspirin and antacids are taken together, as the medication thins the blood. This risk increases if the individual is prone to stomach ulcers, takes anticoagulant medication, or uses steroids.
Additional Interactions
Any drug that is naturally acidic becomes less effective when taken with antacids. These include drugs like digoxin (a heart medication), chlorpromazine (an antipsychotic), isoniazid (an antibiotic that treats mycobacterium tuberculosis), and the antibiotics tetracycline and fluoroquinolone. Conversely, antacids increase the effect of levodopa (a dopamine precursor) and pseudoephedrine (which treats nasal and sinus congestion).
Bibliography
"Antacid." Cleveland Clinic, 20 May 2022, my.clevelandclinic.org/health/drugs/23076-antacid. Accessed 15 Sept. 2024.
Ogawa, Ryuichi, and Hirotoshi Echizen. “Clinically Significant Drug Interactions with Antacids: An Update.” Drugs, vol. 71, no. 14, 2011, pp. 1839-64, doi:10.2165/11593990-000000000-00000.
Salisbury, Blake H., and Jamie M. Terrell. "Antacids." StatPearls, National Library of Medicine, www.ncbi.nlm.nih.gov/books/NBK526049. Accessed 15 Sept. 2024.
Spencer, H., and L. Kramer. “Antacid-Induced Calcium Loss.” Archives of Internal Medicine, vol. 143, 1983, pp. 657-58.
"Warning: Aspirin-Containing Antacid Medicines Can Cause Bleeding." U.S. Food and Drug Administration, 11 July 2022, www.fda.gov/consumers/consumer-updates/warning-aspirin-containing-antacid-medicines-can-cause-bleeding. Accessed 20 Sept. 2024.