Tums for Occasional Heartburn
Yes, Tums (calcium carbonate) is effective for occasional heartburn and provides rapid symptom relief, though antacids are the most rapidly acting agents and work best when symptoms are infrequent. 1
Efficacy and Mechanism
- Calcium carbonate antacids like Tums work by directly neutralizing esophageal acid, with the primary site of action being the lower esophagus rather than the stomach 2
- Both calcium carbonate and aluminum/magnesium hydroxide antacids significantly increase esophageal pH compared to placebo, providing measurable relief 2
- Calcium carbonate gum formulations (600-900 mg) provide sustained heartburn relief for up to 120 minutes following a meal 3
When Antacids Are Most Appropriate
- Antacids are the most rapidly acting agents for on-demand therapy when patients take medication only in response to symptoms 1
- The efficacy of antacids can be sustained by combining them with an H2-receptor antagonist or proton pump inhibitor for more persistent symptoms 1
- For short-course or as-needed use in patients with symptomatic esophageal syndrome without esophagitis, PPIs are more effective than H2-receptor antagonists, which are more effective than antacids alone 1
Important Limitations and Caveats
- Calcium carbonate may cause "acid rebound" in the stomach, where gastric pH can remain at or below baseline values after the initial neutralization effect wears off 2
- Duration of action in the esophagus is approximately 60 minutes for standard calcium carbonate tablets, which is shorter than aluminum/magnesium hydroxide formulations (82 minutes) 2
- Calcium carbonate requires gastric acid for optimal absorption and should be taken with food, making it less ideal for patients already taking acid-reducing medications 1, 4
When to Escalate Therapy
- If heartburn occurs frequently enough to require regular antacid use, patients should be transitioned to H2-receptor antagonists or PPIs rather than continuing chronic antacid therapy 5
- Effervescent ranitidine 150 mg twice daily is significantly more effective than as-needed calcium carbonate antacids for subjects with frequent heartburn, reducing symptom frequency after just 1 day and decreasing rescue antacid consumption by week 6 5
- Patients whose heartburn has not adequately responded to twice-daily PPI therapy should be considered treatment failures and require further evaluation with endoscopy 1
Practical Dosing Recommendations
- Tums provides 40% elemental calcium, with formulations ranging from 500-1500 mg calcium carbonate per tablet (200-600 mg elemental calcium) 1
- For optimal symptom relief, calcium carbonate should be taken at the onset of symptoms rather than prophylactically 1
- Maximum safe upper limit of total daily calcium intake is 2,500 mg per day; excessive antacid use can lead to hypercalcemia and milk-alkali syndrome, particularly in patients taking thiazides or with renal impairment 6
Alternative Considerations for Patients with GERD
- For patients with GERD who require calcium supplementation for other reasons (osteoporosis, etc.), calcium citrate is strongly preferred over calcium carbonate 4
- Calcium citrate does not require gastric acid for absorption and causes less gastrointestinal irritation, making it more suitable for patients with reflux or those taking PPIs 4
- Calcium carbonate is more likely to cause constipation, bloating, and worsening reflux symptoms compared to calcium citrate 4