Tums 750mg for Heartburn Management
For immediate heartburn relief, Tums (calcium carbonate) 750mg provides rapid symptom control within 30-35 minutes and should be used as needed for episodic heartburn, with adults and children over 12 years taking 1-2 chewable tablets every 2-4 hours, not exceeding 5 tablets in 24 hours. 1
Mechanism and Onset of Action
Chewable calcium carbonate antacids work through multiple mechanisms: they rapidly neutralize esophageal acid, improve esophageal peristalsis by increasing proximal esophageal contractile amplitude, and enhance acid clearance from the esophagus 2, 3
Onset occurs within 30-35 minutes of chewing the tablet, with duration of action lasting 40-45 minutes in the esophagus 2
Chewing is essential for efficacy—swallowable calcium carbonate tablets have minimal effect on esophageal pH compared to chewable formulations, as the calcium released during chewing directly improves esophageal motor function 2, 3
Dosing and Administration
Adults and children ≥12 years: Chew and swallow 1-2 tablets (750mg each, providing 300mg elemental calcium per tablet) every 2-4 hours as needed 1, 4
Maximum daily dose: Do not exceed 5 tablets (3750mg calcium carbonate, 1500mg elemental calcium) in 24 hours 1
Duration limit: Do not use maximum dosage for more than 2 weeks without physician supervision 1
Children under 12 years: Consult a physician before use 1
Role in Treatment Algorithm
Tums should be positioned as immediate relief therapy, NOT first-line treatment for frequent heartburn:
For episodic heartburn (less than 2 days per week): Antacids like Tums are appropriate for on-demand self-treatment, providing relief in approximately 62% of episodes compared to 41% with placebo 5
For frequent heartburn (≥2 days per week): Proton pump inhibitors (PPIs) are first-line therapy and significantly more effective than antacids, with the American Gastroenterological Association strongly recommending PPIs over antacids for this indication 4, 6, 7
As adjunctive therapy: Antacids can be combined with PPIs or H2-receptor antagonists for breakthrough symptoms while awaiting the full effect of antisecretory therapy, as PPIs require 30-60 minutes before meals and may take several days for complete symptom control 4, 7
Clinical Efficacy Evidence
Antacid efficacy for individual heartburn episodes was definitively demonstrated in a randomized controlled trial showing 62% of episodes relieved with antacid versus 41% with placebo (p<0.05) 5
Comparative effectiveness: While antacids provide rapid relief, they are less effective than H2-receptor antagonists (which relieved 59-70% of episodes) and substantially less effective than PPIs for sustained symptom control 5, 4
Duration of relief is limited: The effect lasts only 40-45 minutes in the esophagus, requiring frequent redosing for ongoing symptoms 2
Common Pitfalls and Caveats
Constipation is the most common side effect and may occur with regular use 1
Do not use as monotherapy for frequent heartburn—patients with symptoms ≥2 days per week require antisecretory therapy (PPIs or H2RAs) rather than relying on antacids alone 4, 6
Calcium overload risk: In patients with chronic kidney disease, total calcium intake (dietary plus supplemental) should not exceed 2-3 times the age-specific dietary reference intake, making frequent Tums use potentially problematic 4
Tablets must be chewed, not swallowed whole—swallowable calcium carbonate formulations have minimal effect on esophageal pH 2
Two-week rule: If maximum daily dosing is needed for more than 2 weeks, the patient requires medical evaluation rather than continued self-treatment 1
When to Escalate Beyond Antacids
Refer for PPI therapy or medical evaluation if:
Heartburn occurs ≥2 days per week, as this defines frequent heartburn requiring antisecretory therapy rather than antacids 6, 7
Symptoms persist despite appropriate antacid use for 2 weeks at maximum dosing 1
Alarm symptoms develop (dysphagia, odynophagia, weight loss, GI bleeding, anemia) requiring immediate endoscopy 6, 7
Patient is over 50 years with new-onset symptoms, warranting endoscopic evaluation 6