BabycareAdvice.com Articles: Antacid medications

Antacid medications have been around for such a long time that many people consider them to be harmless medications. This is NOT correct! Any medication can potentially cause unwanted side effects. In a small number of cases side effects may create even greater problems than the condition the medication was given to treat.

Stomach acid is NOT a mistake of nature that needs to be neutralized by the use of antacids. Stomach acid has many functions...

How antacids work

Different antacid medications work in different ways. Some have a single action, others have a combined action. The aim of each medication may be different. Antacid medications aim to do one or more of the following...

There are NUMEROUS antacid medications on the market, many are available over-the-counter. MOST are NOT SUITABLE to be given to infants. Below describes the action of antacid medications that are COMMONLY given to infants in the treatment of gastro-esophageal reflux disease (GERD).

Antacids that contain the drug simethicone (e.g. Mylicon®, Infacol®) are used to REDUCE THE AMOUNT OF GAS in the stomach. Simethicone is added to disperse foam by encouraging bubbles to join together, thereby making it easier for them to be brought up with a burp. Simethicone has NO significant effect on gas in the intestines.

Some antacids (such as Infant Gaviscon®) contain alginic acid, a gum which floats on the surface of stomach contents, which aims to provide a BARRIER to stop gastric fluids from being refluxed back into the esophagus. A fully upright position needs to be maintained to achieve the benefits of Gaviscon, laying down (as babies often do) decreases effectiveness. Once a popular medication in the treatment of gastro-esophageal reflux in infants, Gaviscon is RARELY recommended these days because of it's high sodium and aluminium content.

Antacids (e.g. Maalox®, Mylanta®) that NEUTRALIZE stomach acid are composed of a metal ion (aluminum, magnesium, calcium, sodium) which is linked to an alkali (hydroxide, carbonate, bicarbonate, trisilicate). The alkali determines how long the antacid will work, the metal ion determines how quickly it will work (as well as likely side effects). MOST antacids are made up of a MIXTURE of different ingredients, which aim to provide rapid but sustained relief and cancel out each other's side effects.

Ranitidine (Zantac®) works by restricting PRODUCTION of stomach acid. Ranitidine is a 'Histamine receptor antagonists'; basically this means it blocks histamine. It works on a pump in the stomach that releases acid when stimulated by histamine. By preventing histamine from stimulating this pump, Ranitidine reduces the amount of acid that is released into the stomach. Ranitidine is only available on a doctor's prescription.

Omeprazole (Prilosec®, Losec®) also restricts the PRODUCTION of stomach acid but in a slightly different way. Omeprazole is a 'Proton pump inhibitor'. It decreases the amount of acid in the stomach by binding to the gastric pump to block secretion of acid into the stomach. Omeprazole is only available on a doctor's prescription.

Lansoprazole (Prevacid®, Zoton®) is also a 'Proton pump inhibitor' which works in a very similar way to Omeprazole. Lansoprazole is only available on a doctor's prescription.

Please Note: The majority of antacid medications do not stop a baby from refluxing, rather the purpose of antacids is to neutralize or prevent production of stomach acid.

Advantages in using antacids

For babies, antacid medications are frequently prescribed in the treatment of heartburn, associated with gastro-esophageal reflux disease (GERD). Antacids are given to reduce the acidity of stomach contents which are refluxed into the esophagus (food pipe).

Antacid medications are CRUCIAL in the treatment of esophagitis; a condition where babies suffer EXTREME distress due to inflammation of the esophagus, caused by frequent exposure to stomach acid when it is regurgitated/refluxed from the stomach. A failure or struggle to gain weight or weight loss and feeding difficulties are common when a baby/child has esophagitis. In severe cases, ulceration and/or bleeding of the esophagus may also be present.

Problems associated with the use of antacids

Heartburn is a RARE occurrence in only a tiny number of infants with gastro-esophageal reflux disease and yet today antacid medications are commonly prescribed in an attempt to treat vague symptoms such as IRRITABILITY and WAKEFULNESS in healthy, thriving babies who happen to SPIT UP (or not spit up with the diagnosis of 'silent reflux').

Where the use of antacid medications FAIL to relieve irritability in healthy, thriving babies (which is OFTEN the case because heartburn is NOT the reason for irritability in the majority of babies who spit up) the disadvantages of using antacids will then far OUTWEIGH advantages of continued use.

Potential problems associated with frequent or long term use of antacid medications may include...

1. Poor digestion

An adequate supply of stomach acid is REQUIRED for protein digestion and mineral absorption. This acid helps the stomach to break down food before it enters the intestines. The use of antacid medication MAY cause food to enter the intestines before it is FULLY broken down by digestion. Stomach acid also facilitates the flow of bile and pancreatic enzymes, which further assist digestion of foods.

When babies are NOT able to get the full benefit from their foods due to poor digestion, even the best diet can be inadequate and growth may be affected.

2. Diarrhea

When food is poorly digested (due to any reason including reduced stomach acid) some food molecules remain too large to be absorbed into the blood stream. The undigested protein then passes into the large bowel, where it draws in extra fluid. Bacteria present in the bowel ferment the undigested protein creating excessive amounts of gas. This results in abdominal bloating, excess gas and frequent watery stools (diarrhea), all of which can cause discomfort and restlessness in infants.

3. Decreased absorptions of a variety of nutrients

Stomach acid is required for the best absorption of folic acid, ascorbic acid, beta carotene, iron, calcium, magnesium and zinc.

4. Increased risk of food allergies

According to Professor Erika Jensen-Jarolim and colleges at the University of Vienna, regular use of antacids can increase the risk of food allergies. Medications that reduce acid secretion OR neutralize the acidity within the stomach may be setting up a situation where harmless food proteins become potential allergens, which can then trigger an immune system response resulting in an allergic reaction.

Although Professor Jensen-Jarolim's study was conducted on adults using the medication ranitidine (Zantac), these findings have important implications for infants, who by the very nature of their young age have immature digestive and immune systems, which increase the risk of food allergies developing.

5. Reduced effectiveness with long term use

The stomach's job is to produce and hold digestive acid and enzymes. When antacids are used regularly, the stomach senses the reduction in stomach acid and over time increases it's rate of acid production. Taking antacid medications to reduce stomach acid can lead to the production of excessive acid.

6. Increased risk of gastro-intestinal infections

Our intestinal flora contains both good and bad microbes (bacteria, yeast etc). The RIGHT balance of acid and alkaline is necessary to SUPPORT the growth of good microbes (the kind that makes vitamins and antibiotics in our digestive tract). Changing this acid balance by the use of antacid medications reduces the amount of good microbes and encourages the growth of bad microbes (the ones that steal nutrients, produce gas, toxins and disease).

Stomach acid also has the function of killing bad microbes that can get into our system by the water and food (including milk) we eat and drink.

7. Bloating

Antacids containing sodium bicarbonate and calcium bicarbonate release carbon dioxide as they neutralize stomach acid. This may cause bloating in the stomach as well as cause an increased production of stomach acid.

8. Electrolyte imbalance

Antacids are classified on the basis of whether they are absorbed into the body or whether they remain in the gastro-intestinal tract. Some antacids that are absorbed may cause acid base and electrolyte disturbances.

9. Impaired kidney function

Given with a high milk diet LARGE doses of calcium carbonate (contained in some antacids) can produce an excessive rise in blood calcium levels, which can cause harmful effects on kidney function.

10. Phosphate depletion

Prolonged use of antacids containing aluminium (such as Maalox® or Mylanta®) have be associated with phosphate depletion.

11. Increased risk of rickets

Prolonged use of antacids containing aluminium has also been associated with rickets (thinning of the bones).

Potential side effects of antacid medications

Quite separate from the unfavorable effects of altering the natural balance of stomach acid (described above), harmful SIDE EFFECTS that are directly related to the chemical ingredients contained in antacid medications may occur.

Most side effects are only mild and will pass by themselves, more serious side effects RARELY occur but it's important to be aware that they do exist.

The effects on infants of the use of MANY antacid preparations (presently prescribed for infants) have NOT been fully evaluated in clinical studies. Hence side effects described below relate to studies on an ADULT population.

Medications containing simethicone: (Mylicon®, Infacol®) No recorded side effects.

Medications containing alginic acid: (Infant Gaviscon®): Constipation, diarrhea.

Antacids containing aluminum: (Mylanta®) Constipation, feeling of discomfort, loss of appetite, mood or mental changes, weakness, swelling or wrist or ankles, bone pain.

Antacids containing magnesium: Diarrhea, dizziness, loss of appetite, problems in urination (difficult, pain), irregular heartbeat, feeling of discomfort, mood or mental changes, weakness and tiredness.

Antacids containing sodium bicarbonate: Nausea and vomiting, slow breathing, problems in urination (frequent urge) headaches, loss of appetite, mood or mental changes (feeling nervous or restless), muscles pain, tiredness and weakness.

Medications containing Ranitidine, Omeprazole or Lansoprazole: (Zantac®, Prilosec®, Losec®, Prevacid®, Zoton®) Headache, diarrhea, constipation, upset stomach, vomiting, stomach pain, cough, dizziness or mild rash.

Special considerations before giving antacids to infants

IMPORTANT: The MAJORITY of antacid medications (as well as simethicone, which is commonly used in infant colic mixtures) has NOT been fully studied in clinical trials for use by infants. Due to the limited information on the safety of these products for infants, it is NOT recommended to use antacid without medical advice.

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