Antacids are among the most commonly used over-the-counter (OTC) medication after pain, cough, cold and smoking cessation drugs. We all experience indigestion at some point or the other in life. And for some of us, heartburn and indigestion are a daily occurrence. Antacids are a quick, inexpensive and easily accessible remedy. As an over-the-counter product its use is fairly unrestricted despite warnings on package inserts. It is therefore possible that some of the digestive symptoms that you may be experiencing may in fact be due to the overuse of antacids.
Safety of Antacids
Although antacids are thought of as being safe medication, they are not without side effects. However, moderate and proper use of antacids are unlikely to lead to side effects in most people. It is for this reason that antacids are often seen as being safe. But what about long term use of antacids or overuse? In the long term, most people will tend to overuse a drug that is helping to relieve their symptoms beyond the directions of use on the package without seeking medical advice. It is in these instances that symptoms and conditions of antacid overuse become apparent. These side effects can be localized to the digestive system but may extend to affect many other organs and systems of the body.
Types of Antacids
All antacids work in a similar way. It alters the pH of the stomach acid. In other words it makes stomach acid less acidic. By doing so, antacids are able to reduce the irritation to the stomach, esophagus or duodenum caused by the gastric acid. It is the symptoms of this irritation that prompts many of us to use antacids for conditions like gastroesophageal reflux disease (acid reflux), gastritis and peptic ulcer disease (PUD). Some antacids may in addition coat the esophagus and stomach thereby minimizing contact between the stomach acid and the inner lining of the gut.
There are different types of antacids which vary by the active ingredient. All function in essentially the same way. However, due to this variation in the active ingredient, symptoms of antacid overuse may differ to some extent. The four main types based on the active ingredient includes:
- Aluminum-containing antacids
- Calcium-containing antacids
- Magnesium-containing antacids
- Sodium bicarbonate-containing antacids
Constipation and Diarrhea
Constipation is one of the most common symptoms of antacid use. It is mainly seen with aluminum and calcium types of antacids. The constipation is especially severe in people who overuse antacids. It is not a transient symptom. Constipation continues indefinitely for the duration of antacid use. In other words it becomes chronic constipation.
Although these patients can look at changing over to other types of antacids, it is advisable to change the type of drug altogether like switching over to acid-suppressing drugs such as proton pump inhibitors. Less commonly antacids may cause diarrhea. It is mainly the magnesium-containing antacids which are responsible for diarrhea. Unlike with constipation, the diarrhea is usually short-lived but can return with continued use of the antacid. It may sometimes be related to infections as discussed below.
There are a number of muscle problems that can arise with antacid overuse. This includes muscle twitching, pain or even weakness. The reasons for these muscle symptoms with antacid overuse varies. One of the main ways is that antacids in large quantities may also the blood electrolyte levels. This includes changes with blood calcium, magnesium and phosphate.
Since the muscles and the nerves controlling it utilizes these electrolytes for their normal function, alterations in the electrolyte levels may therefore affect the muscles and its nerves. The severity of the symptoms depends on the quantity of antacids that are used and the duration over which it is utilized.
Slower breathing is one of the more serious symptoms of antacid overuse. It arises when antacids like sodium bicarbonate or calcium carbonate alters the blood pH. These antacids tend to cause alkalosis which is a rise in the blood pH. The body attempts to compensate for the more alkaline blood by altering the breathing rate.
Carbon dioxide causes the formation of carbonic acid which can lower the blood pH. By slowing the breathing rate, the body allows for the build up of carbon dioxide and therefore carbonic acid to compensate for the alkalinity of the blood. It can be a problem in people with respiratory, cardiovascular and kidney problems. If antacids are discontinued, this alteration in breathing rate will gradually restore the blood pH to within the normal range. The breathing rate should therefore return to normal.
Stomach acid serves an important purpose. Not only does it help with the digestion of food, it also protects the body by destroying microbes that is contained within food and drink. Excessive and frequent neutralization of stomach acid particularly soon after eating or drinking can therefore allow microbes to survive in the gut. In this way one of the body’s defense mechanisms is weakened.
A number of different invading microbes that survive past the stomach can then cause a range of diseases. The more commonly seen infections in these cases is gastrointestinal illnesses which are often marked by abdominal pain and diarrhea. However, the infection may not be limited to the gut. A range of microbes may enter through the mouth and if not destroyed in the stomach it can cause infections in many different organs or even lead to systemic infections.
Antacid overuse can cause a range of symptoms such as nausea, headaches and lightheadedness or even dizziness. Many of these symptoms are related to the alteration of blood electrolyte levels and changes in blood pH. If a person who is using excessive amounts of antacids is also taking other medication, then drug interactions may arise which can be the cause of any of these symptoms.
Another common symptom is a chalky taste in the mouth. This is a direct effect of the antacid coating and remaining in the mouth after consumption. Since antacids are alkaline in nature, it tends to have a chalky taste. However, this abnormalities in taste may also be directly related to the systemic effects of antacids. Less common symptoms includes excessive thirst, abdominal cramps, white spots in the stool, abnormalities in urination, mood changes, fatigue and weight loss in some instances.
Antacid (oral route) side effects. Mayo Clinic
Antacids for GERD. WebMD
Taking antacids. NIH.gov