From the Guidelines
I strongly recommend against using Picot antacid for occasional relief of acid indigestion, heartburn, and upset stomach due to the potential for increased sodium intake and interference with other medications, as well as the availability of more effective treatments such as proton pump inhibitors and H2 antagonists. The provided evidence does not support the use of Picot antacid as a first-line treatment for acid indigestion, heartburn, and upset stomach. According to 1, calcium supplements, which are related to antacids, have a safety and side-effect profile that should be considered, and the decision to use them depends on the adequacy of dietary calcium intake and the balance between potential benefits and harms.
In terms of treatment for gastroesophageal reflux, 1 suggests that proton pump inhibitors are the most potent acid suppressants and are superior to H2 antagonists, while 1 provides guidance on the management of gastroesophageal reflux in children, including the use of antacids, H2 antagonists, and proton pump inhibitors. The evidence from 1 highlights the importance of considering the different formulations and dosages of these medications, as well as their potential limitations and side effects.
For example, H2 antagonists, such as cimetidine and nizatidine, have been shown to be effective in treating erosive esophagitis in children, but may have limitations, including the development of tachyphylaxis within 6 weeks of initiation of treatment, and potential links to liver disease and gynecomastia. Proton pump inhibitors, on the other hand, have been shown to be more effective than H2 antagonists in symptom relief and healing rates of erosive esophagitis.
Therefore, based on the available evidence, it is recommended to consider alternative treatments, such as proton pump inhibitors or H2 antagonists, for the management of acid indigestion, heartburn, and upset stomach, rather than relying on antacids like Picot. It is also important to consult with a healthcare provider to determine the best course of treatment, as they can help to assess the individual's specific needs and medical history, and provide guidance on the safe and effective use of these medications.
From the FDA Drug Label
Ask a doctor or pharmacist before use if you are now taking a prescription drug. Antacids may interact with certain prescription drugs. The FDA drug label does not answer the question.
From the Research
Antacid Composition and Function
- Antacids are commonly used self-prescribed medications that consist of calcium carbonate and magnesium and aluminum salts in various compounds or combinations 2.
- The effect of antacids on the stomach is due to partial neutralisation of gastric hydrochloric acid and inhibition of the proteolytic enzyme, pepsin 2.
Therapeutic Uses of Antacids
- Antacids have been used for duodenal and gastric ulcers, stress gastritis, gastro-oesophageal reflux disease, pancreatic insufficiency, non-ulcer dyspepsia, bile acid mediated diarrhoea, biliary reflux, constipation, osteoporosis, urinary alkalinisation and chronic renal failure as a dietary phosphate binder 2.
- However, the development of histamine H2-receptor antagonists and proton pump inhibitors has significantly reduced usage for duodenal and gastric ulcers and gastro-oesophageal reflux disease 2.
Drug Interactions with Antacids
- Antacid drug interactions are well noted, but can be avoided by rescheduling medication administration times 2.
- All antacids can produce drug interactions by changing gastric pH, thus altering drug dissolution of dosage forms, reduction of gastric acid hydrolysis of drugs, or alter drug elimination by changing urinary pH 2.
- Most antacids, except sodium bicarbonate, may decrease drug absorption by adsorption or chelation of other drugs 2.
- Specific examples of drug interactions with antacids include:
- Riociguat bioavailability is reduced by coadministration with aluminum hydroxide/magnesium hydroxide antacid or omeprazole 3.
- Lumiracoxib pharmacokinetics are not significantly affected by coadministration with omeprazole or aluminum hydroxide/magnesium hydroxide antacid 4.
- Tebipenem pivoxil hydrobromide pharmacokinetics are affected by coadministration with aluminum hydroxide/magnesium hydroxide/simethicone or omeprazole, with approximately 11% lower total exposure and 22-43% lower Cmax 5.
Adverse Effects of Antacids
- Most adverse effects from antacids are minor with periodic use of small amounts 2.
- However, when large doses are taken for long periods of time, significant adverse effects may occur, especially in patients with underlying diseases such as chronic renal failure 2.
- Adverse effects can be reduced by monitoring of electrolyte status and avoiding aluminum-containing antacids to bind dietary phosphate in chronic renal failure 2.