Tums Dosage and Usage for Heartburn and Indigestion
For acute heartburn or indigestion relief, chew 2 tablets of Tums (750 mg calcium carbonate per tablet, providing 600 mg elemental calcium total) as needed when symptoms occur, with a maximum of 5 chewable tablets in 24 hours and not exceeding 2 weeks of maximum dosage without physician supervision. 1
Dosing Specifications
- Standard dose: 2 chewable tablets (750 mg calcium carbonate each) 1
- Maximum daily limit: 5 chewable tablets per 24-hour period 1
- Duration limit: Do not use maximum dosage for more than 2 weeks without medical advice 1
- Administration: Chew tablets thoroughly for optimal effect 2, 3
Mechanism and Onset of Action
Calcium carbonate antacids work primarily in the lower esophagus rather than the stomach, which is the primary site where heartburn relief occurs 4. The chewed calcium carbonate:
- Rapidly neutralizes esophageal acid within 15-30 minutes of administration 4, 3
- Improves esophageal motility by increasing proximal esophageal contractile amplitude and enhancing acid clearance 2
- Provides symptom relief for approximately 60 minutes duration 4
Important Limitations and Caveats
Antacids like Tums are inferior to acid-suppressing medications for sustained heartburn management. The evidence hierarchy clearly shows:
- Proton pump inhibitors (PPIs) are more effective than H2-receptor antagonists, which are more effective than antacids for treating esophageal GERD syndromes 5
- Antacids provide only temporary relief and are best suited for intermittent, self-directed treatment of occasional heartburn episodes 6
- For frequent heartburn (symptoms lasting 4+ weeks), antacids alone are inadequate and patients should pursue H. pylori testing or empirical PPI therapy 5
Common Side Effects
- Constipation may occur with calcium carbonate use 1
- Acid rebound phenomenon: Calcium carbonate can paradoxically cause gastric pH to remain at or below baseline levels after the initial neutralization effect, potentially worsening symptoms 4
When to Escalate Beyond Antacids
If heartburn persists despite twice-daily PPI therapy, patients should be considered treatment failures and require endoscopic evaluation 5. For patients with:
- Ulcer-like dyspepsia (epigastric pain as predominant symptom): Full-dose PPI therapy (e.g., omeprazole 20 mg once daily) should be first-line, not antacids 5
- Troublesome dysphagia: Endoscopy with biopsy is indicated 5
- Symptoms unresponsive to empirical therapy: Consider switching from antacids to H2-receptor antagonists or PPIs 5
Comparative Effectiveness
Research demonstrates that aluminum/magnesium hydroxide formulations may be superior to calcium carbonate for some patients, with faster onset (41 of 83 subjects) and longer duration of action (82 minutes vs 60 minutes in the esophagus) 4. However, antacid gum formulations containing calcium carbonate provide more sustained relief (120 minutes) than traditional chewable tablets 3.