About all

What are the side effects of tums: The request could not be satisfied


Are Antacids Really Safe For Long-term Use?

If you experience heartburn or chest pain and find yourself popping antacids more than two or three times a week, it is time to see your doctor. While antacids may relieve your symptoms, they won’t fix the root of the problem if you have an underlying health condition.

“First and foremost, it is very important for anyone experiencing any type of chest pain to talk with his or her physician prior to self-medicating to ensure symptoms are not a result of heart disease,” says Jay Prakash, M.D., a Piedmont gastroenterologist. “Symptoms of heartburn can be similar in nature to those of a heart attack. Therefore, it is extremely important to be evaluated by your doctor.”

The difference between antacids and acid reducers

Antacids neutralize stomach acid. Stomach acid helps the body break down and digest food, so it’s a good thing, but too much can cause uncomfortable symptoms. Depending on which brand you select, different antacid ingredients provide different benefits:

  • Alginic acid creates a foaming effect in the top of the stomach that helps prevent stomach acid from reaching the esophagus.

  • Simethicone decreases bubbles of gas in the stomach.

On the other hand, acid reducers decrease – rather than neutralize – the amount of stomach acid the body produces.

While both types of medication can be safe for long-term use, it is crucial to talk with your physician before taking them for more than two weeks. You need to get to the root of the problem to ensure you don’t have a serious health condition masking itself as indigestion.

Also, these medications can create complications if you have liver or kidney issues, and they can contain sodium, which may be problematic if you’re on a low-salt diet.

Three ways to prevent heartburn and reflux

Once you have been diagnosed with heartburn or acid reflux and not something more serious, Dr. Prakash recommends the following tips for reducing acid in your digestive tract.

  • Watch your diet. The most common acid-inducing foods include mint, caffeine, onions, garlic, tomatoes, citrus fruits, spicy foods and alcohol. However, people respond differently, so keeping a food journal can be helpful in determining your triggers.

  • Do not go to be bed within three hours of eating a meal. Acid in the stomach is generated within one hour of eating, so it is best not to lie down immediately following a meal. Let your body digest your food for two to three hours before lying down.

  • Do not wear clothing that constricts the abdomen. Tight clothing around the waist can put added upward pressure on the stomach, causing acid to back up into the esophagus.

“Bottom line, it is okay to take antacids once in a blue moon, but your goal should always be to make sure you are doing well, your esophagus is healing well and there is no underlying heart disease,” says Dr. Prakash.

Learn more about digestive health.

Need to make an appointment with a Piedmont physician? Save time, book online.

Do You Pop Tums Like Candy? The Important Reason to Cut Back

Yes, over-the-counter antacid pills (Tums or the generic alternative) aren’t harmful–they can help reduce acid in your stomach and help you feel better when you’ve encountered a meal that doesn’t agree with you. They also contain calcium, so that’s great too. But, too much antacid can have backfiring effects for health. I just learned about this and I wanted to share it with you…

I was listening to NPR recently, and a reporter was interviewing an immunologist about the recent listeria-tainted cantaloupe that have been in the news lately. The question asked: Why are people getting so sick from this bug, and what can we do to protect ourselves?

The expert mentioned something that shocked me: He said that antacids are known to increase our risk for stomach bugs and infection because we’re essentially neutralizing the acid in our stomach, which is our body’s first line of defense from harmful pathogens that we ingest everyday. Yes, our intestinal tracts also provide some immune protection, but we up our chances of getting sick when we’re constantly taking antacids. In a sense, those pills may be dulling our immune systems.

The point of this post isn’t to say that Tums, and other similar products are bad–far from the case. Take them if you need them, but rather, I hope you’ll think about the times that you’re popping Tums when you really don’t need to. Are you having full-fledged indigestion, or are you just taking a pill out of habit? Something to think about!

Do you take antacids often?

More reading:

Vitamins linked to higher death risk? What you need to know

Another reason to quit: Cigarettes up your risk for this horrid disease…

The cold-fighting food you should be eating this season…

More Ways to Get Glamour:

Chat with celebs, VIP fashion stars, beauty pros and more on our Facebook page

Download Glamour Magazine for your iPad–print subscribers, it’s now part of your subscription plan!

Enter the latest *Glamour sweepstakes! *

Follow us on Twitter

Hard to swallow: the problem with taking too many antacids | Health & wellbeing

Noah Fagan says he “used to go through antacids like sweets. I had a big list of foods I couldn’t eat. I’d take at least three antacids on average – going up to six on a bad day. This went on for at least seven years.”

If you have reached for a chalky tablet after a blow-out meal, you are not alone. So common is antacid use for heartburn and indigestion that the World Health Organization says more than $10bn (£8.2bn) worldwide is spent on them every year. In the UK, more than 40% of us use them – 2.8 million people reach for the market leader, Rennie, alone.

Indigestion is often caused by excess stomach acid and results in discomfort, pain, bloating, nausea or wind. With acid reflux, acid travels up the oesophagus to the throat, leaving an unpleasant, sour taste. Alexander Ford, a professor of gastroenterology at the University of Leeds, says: “The two main groups of antacids are those that contain an alkali which ‘neutralises’ acid, like Rennies; and those that are alginates, like Gaviscon, which form a ‘raft’ on top of stomach contents, preventing reflux up into the oesophagus.”

Antacids are perfectly safe when taken correctly. The problem is that many of us don’t. Who has read the small print and knows that you shouldn’t take aspirin or ibuprofen at the same time as Gaviscon, because it can affect the way the painkillers are absorbed by your body? That’s important to know if you take daily aspirin to lower the risk of stroke. Conversely, did you know that some antacids, such as Alka Seltzer, contain aspirin? That could be important, too – in 2016, the US Food and Drug Administration (FDA) issued a warning that excessive aspirin use can cause stomach bleeding.

Though antacids may alleviate symptoms in minutes, over-reliance on them may not only mask more serious issues but could even create them. Fagan, a 42-year-old architect from Bristol, says: “It was only while my wife was pregnant and suffering acid reflux herself that it got mentioned to our GP. It wasn’t a food issue at all, but a medical problem.”

Fagan was diagnosed with overactive acid production and started taking proton-pump inhibitors (PPIs), which act to reduce stomach acid production, rather than simply neutralising it. Now, Fagan rarely needs to take them. However, the duration of treatment can vary hugely, and this is important as long-term PPI use is linked to side-effects including pneumonia, hypocalcaemia and Clostridium difficile infections (leading to severe diarrhoea). One study even made a link between PPI use and early death. Some PPIs are available over the counter, which has led to concern that – like antacids – they will be overused and under-monitored. The FDA has issued warnings and the NHS notes that prolonged use should be avoided.

In fact, according to US research, the majority of people with recurring heartburn don’t seek medical advice at all, instead self-treating the symptoms for years. This may also have had a significant effect in skewing data – the researchers note that women are more likely to seek medical attention than men, “resulting in the false impression that nonerosive reflux disease and functional heartburn are primarily female disorders”.

For everyone, even innocuous-looking over-the-counter remedies should be used carefully. “In terms of using them ‘blind’, they are treating a symptom, not a disease,” says Ford. “If someone has had an endoscopy and this is normal, then it is reasonable to use them. In most young people with indigestion, there will not be a serious underlying cause, so they are probably OK. But in older people – above 50 or 55 years – the worry would be that people are using them to treat dyspepsia where the cause is unknown, as they might be masking the symptoms of a peptic ulcer or a stomach cancer. These people really should consult their GP.”

Bayer, which makes Rennie, says: “Bayer encourages people taking antacids to read the information provided with the product. Antacids will only manage the symptoms rather than curing a problem. As with all antacids available without a prescription, if symptoms persist for longer than 14 days in a row, then it is advisable to see a healthcare professional to check that there is no underlying cause.” This information is clearly stated on the packet, too – if we only read it.

For all indigestion sufferers, the message is consistent: if symptoms persist, see a doctor to rule out anything serious. If all is well, then you can try to reduce your reliance on antacids and alleviate symptoms by other means. Specific foods may be triggers, but generally it’s a good idea to avoid very spicy, greasy or fatty foods. Eating smaller but more frequent meals can help, as can losing weight if you are overweight. Try not to eat just before bed; allow for an hour or so before you lie down. You can also try raising your bed at one end, so that when you lie down, your head and chest are raised – enlisting gravity’s help in reducing the stomach acid travelling up to your oesophagus. And if you do use antacids, read the label.

Heartburn Medications: Weigh the Benefits and Risks

It’s easy to get the care you need.

See a Premier Physician Network provider near you.

Your heartburn medication could be working too well. By reducing acid in your stomach to squelch symptoms from acid reflux or GERD, it could be upsetting your stomach’s natural balance of acid that protects you from other ailments. This growing body of research is still taking shape, but it already has the attention of the U.S. Food & Drug Administration.

Taming acid reflux and GERD should continue to be your primary objective to avoid worsening symptoms and possibly esophageal cancer. However, sometimes less can be more in deciding what medication to take and how often to take it. 

Heartburn medications come in two forms – antacids and blockers. Antacids neutralize stomach acid. Blockers – h3 blockers and proton pump inhibitors (PPIs) – reduce stomach acid and can help your stomach and esophagus heal. Both may pose risks, but PPI blockers may produce more serious ones.

Talk with your health care provider about which medications may work best for you based on your medical history, symptoms and current health issues. Also, heartburn medications can interact or change the way your body absorbs other medications you’re taking.

If you have mild heartburn or feel your symptoms may be controlled without PPIs, talk with your doctor about other ways to douse the fire.

Side Effects and Risks from Antacids

Antacids can be a good treatment for heartburn that occurs once in a while. More common side effects may include constipation, diarrhea, allergic reaction or food sensitivity.

If you take too much or take antacids for longer than directed, you could get an overdose of calcium and experience nausea, vomiting, mental status changes or kidney stones.

If you take large amounts of antacids that contain aluminum, you may be at risk for calcium loss, which can lead to osteoporosis.

Be especially cautious with antacids and discuss taking them with your health care provider if you:  

  • Have kidney disease, heart disease or high blood pressure
  • Are on a low-sodium diet 
  • Are already taking calcium
  • Have had kidney stones
  • Have a history of stomach ulcers or bleeding disorders
  • Are older than 60 
  • Drink three or more alcoholic drinks per day

Aspirin-containing antacids can increase your risk of serious bleeding. If you take another medication that increases your risk of bleeding, such as an antiplatelet or anticoagulant drug, you shouldn’t take these antacids.

Risks from PPIs Like Nexium®, Prevacid® and Prilosec®

The acid in your stomach performs a variety of functions that are lost when taking PPIs. In addition to breaking down food, stomach acid also chemically changes some nutrients so they may be more easily absorbed. It also helps kill pathogens in your gut before they can cause illness.

Traditionally, PPIs have been viewed as safe medications with few drawbacks, namely nausea and headaches.  However, studies are showing that suppressing stomach acid secretion for long periods might have these unintended consequences:

  • PPI-associated pneumonia: Bacteria are more likely to multiply in the stomach’s less acidic environment and travel to the lungs if you inhale your stomach acid.
  • Higher risk for C. diff: Clostridium difficile is a bacterium capable of causing life-threatening cases of diarrhea and conditions like colitis, an inflammation of the colon lining.
  • Fracture risk: By lowering stomach acid levels, PPIs might affect your body’s absorption of calcium, which is necessary for healthy bones. Over time, this could lead to osteoporosis and fractures, especially in women.  

h3 blockers (e.g., Tagamet®, Pepcid® and Zantac®) are not without side effects, but they may provide a better option for some people since they do not reduce stomach acid as aggressively as PPIs.

Alternative Solutions for Controlling Acid Reflux 

Some patients may have little choice but to continue their current PPI medication due to more severe GERD symptoms or to prevent against stomach ulcers from NSAIDs (nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen), as with arthritis sufferers.

If you have mild heartburn or feel your symptoms may be controlled without PPIs, talk with your doctor about other ways to douse the fire. Consider lifestyle changes, less potent heartburn medications – h3 blockers or antacids – or reduced frequency of PPIs.

Occasional reflux can be treated effectively with antacids and lifestyle changes such as:

  • Avoiding trigger foods such as chocolate, coffee and fatty foods
  • Chewing gum, which can increase the production of saliva that can soothe an irritated esophagus and wash stomach acid back down into your stomach
  • Elevating the head of your bed for night time heartburn

As with all medications, never stop taking a prescription drug without consulting with your health care provider.

It’s easy to get the care you need.

See a Premier Physician Network provider near you.

Source: Harvard Health Letter, Harvard Medical School; Arthritis Foundation; U.S. National Library of Medicine, National Institutes of Health; Healthline; U.S. Food & Drug Administration

Antacids | Health Navigator NZ

Antacids are a group of medications that are used to lower acid levels in the stomach. Find out how to take them and possible side effects.

On this page, you can find the following information:

When are antacids used?

Antacids are often used to relieve symptoms of reflux disease (GORD), heartburn (dyspepsia) and peptic ulcer. Antacids help to relieve pain and discomfort but do not help to heal these conditions or prevent them from happening again.

There are lifestyle changes you can make to  that can help prevent symptoms from occurring. These include:

Antacids are usually used only when needed and are not often prescribed long-term. If you find that you need to take antacids regularly, every day for more than 1 or 2 weeks, talk to your doctor. 

Taking antacids may not be suitable if you have any of the following problems

  • Bringing up (vomiting) blood. This may be fresh blood but it can look like ground coffee (called coffee-ground vomit).
  • Blood in your stools (faeces). This may be look like blood, or it may just make your stools look black.
  • Unintentional weight loss.
  • Difficulty swallowing, including food getting stuck in your throat (oesophagus).
  • Ongoing tummy (abdominal) pain or vomiting.

If you have any of the symptoms listed above you should contact your doctor urgently.

How do antacids work?

Antacids work by neutralising (lowering) the acid in your stomach that is used to help digestion. This can reduce the symptoms of heartburn and relieve pain.

Some antacids also coat the surface of the oesophagus (the tube between your mouth and your stomach) with a protective barrier against stomach acid, or form a gel on the stomach’s surface which helps stop acid going into the oesophagus.

Examples of antacids

Antacids are available as chewable tablets or liquid. Liquids are more effective than tablets. They are sold as many brand names, but they have similar  ingredients, including:

  • aluminium hydroxide
  • magnesium carbonate
  • magnesium trisilicate

Sometimes extra ingredients are added to help treat other problems, such as:

  • simethicone to relieve flatulence
  • alginates to prevent acid flowing into your oesophagus.

Examples of antacids

  • Mylanta P®
  • Mylanta Original®
  • Mylanta Double Strength®
  • Mylanta Rolltabs®

  • Alu-tab®
  • Chewy Quick-Eze®
  • Quick-Eze®

How to take antacids

  • Dose: The dose of different antacids will be different – follow the dose instructions on the label or check with your doctor or pharmacist.
  • Antacids come as chewable tablets or liquid.
    • Chewable tablets: chew the tablets well; do not swallow them whole. 
    • Liquid: shake the liquid well before each dose so that the medicine is evenly mixed. 
  • Use only when needed. Antacids are best taken when symptoms occur or are expected, usually after meals and just before going to bed (about 4 times a day). It’s best to take antacids soon after eating because this is when you’re most likely to get indigestion or heartburn.

Cautions before taking antacids 

While most people can safely use antacids now and again, and they can be bought from supermarkets or over-the-counter from your pharmacy, they are not suitable for everyone. Some antacids are not suitable if you have an illness where you need to control how much salt (sodium) is in your diet, such as high blood pressure, heart failure, kidney disease or problems with your liver. This is because antacids have high levels of sodium, which could make you unwell. If any of these apply to you, it’s important that you tell your doctor or pharmacist before taking antacids.

Cautions while taking antacids

  • Other medicines: antacids can interfere with the absorption of other medicines, so you should not take these together. Generally, do not take other medicines within 2-4 hours of taking antacids.
  • Alcohol: this can irritate your stomach and make your symptoms worse.
  • Do not use antacids all the time: antacids are usually used every now and again and not usually prescribed regularly or long-term. If you find that you need to take antacids regularly, every day for more than 1 or 2 weeks, talk to your doctor.

Side effects

Like all medicines, antacids can cause side effects, although most people who take antacids do not have any. Common side effects are:

Side effects What should I do?

  • This can happen with magnesium-containing antacids 
  • Tell your doctor if troublesome

  • This can happen with aluminium-containing antacids 
  • Tell your doctor if troublesome

  • Bloating, gas or flatulence (wind)
  • Stomach cramps
  • Feeling sick (nausea)

  • Tell your doctor if troublesome

Learn more

The following links have more information on antacids. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Antacids Patient Info, UK


  1. Antacids and simeticone New Zealand Formulary
  2. Managing dyspepsia and heartburn in general practice – an update BPAC, 2011
  3. Managing gastro-oesophageal reflux disease (GORD) in adults BPAC, 2014

Doxycycline Fact Sheet.indd

%PDF-1.3 %
1 0 obj >]/Pages 3 0 R/Type/Catalog/ViewerPreferences>>> endobj 2 0 obj >stream
2013-02-07T10:22:18-06:002013-02-07T10:22:19-06:002013-02-07T10:22:19-06:00Adobe InDesign CS5 (7.0.4)uuid:6fc43654-6e5a-b740-a07f-df177d2199e2xmp.did:CE0D6A050B2068118C14FD3BF155C279xmp.did:01801174072068118A6D82ABF1C78554proof:pdf1

  • createdxmp.iid:01801174072068118A6D82ABF1C785542012-08-17T10:32:02-05:00Adobe InDesign 7.0
  • savedxmp.iid:03801174072068118A6D82ABF1C785542012-08-17T10:42:04-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:04801174072068118A6D82ABF1C785542012-08-17T10:42:04-05:00Adobe InDesign 7.0/metadata
  • savedxmp.iid:06801174072068118A6D82ABF1C785542012-08-17T10:43:46-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:08801174072068118A6D82ABF1C785542012-08-17T10:43:59-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:0A801174072068118A6D82ABF1C785542012-08-17T10:49:35-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:13AFDBED092068118A6D82ABF1C785542012-08-17T10:49:45-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:14AFDBED092068118A6D82ABF1C785542012-08-17T10:49:59-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:15AFDBED092068118A6D82ABF1C785542012-08-17T11:07:05-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:17AFDBED092068118A6D82ABF1C785542012-08-17T11:07:14-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:00801174072068118083BBEDCCF0654B2012-08-20T11:25:24-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:03801174072068118C14D6D31BC2AB082012-08-22T13:17-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:06801174072068118C14D6D31BC2AB082012-08-22T13:18:01-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:07801174072068118C14D6D31BC2AB082012-08-22T13:30:12-05:00Adobe InDesign 7.0/metadata
  • savedxmp.iid:08801174072068118C14D6D31BC2AB082012-08-22T13:30:12-05:00Adobe InDesign 7.0/
  • savedxmp.iid:6AF4905F092068118C14D6D31BC2AB082012-08-22T13:30:45-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:483702E4082068118083FCE5BE1B513B2012-08-22T14:22-05:00Adobe InDesign 7.0/metadata
  • savedxmp.iid:4B3702E4082068118083FCE5BE1B513B2012-08-22T14:22-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:03801174072068118C14E90F52FEFC602012-08-23T15:06:31-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:06801174072068118C14E90F52FEFC602012-08-23T15:27:33-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:09801174072068118C14E90F52FEFC602012-08-23T15:27:46-05:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:ED7F11740720681192B0F3C9BBDD725D2013-01-13T08:19:52-06:00Adobe InDesign 7.0/metadata
  • savedxmp.iid:F27F11740720681192B0F3C9BBDD725D2013-01-13T08:19:52-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:3662FA2B0820681192B0F3C9BBDD725D2013-01-13T08:25:01-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:3B62FA2B0820681192B0F3C9BBDD725D2013-01-13T08:25:04-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:3C62FA2B0820681192B0F3C9BBDD725D2013-01-13T08:26:04-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:EC8872540820681192B0F3C9BBDD725D2013-01-13T08:26:09-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:B46F243B082068118C14B456B2AFD4E62013-01-13T08:48:32-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:0552E482082068118C14B456B2AFD4E62013-01-13T08:59:52-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:EDB5ECEB092068118C14B456B2AFD4E62013-01-13T09:09:56-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:7C3C285A092068118083CA0D40C3C5842013-01-14T07:10:33-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:4729DF140B2068118083CA0D40C3C5842013-01-14T07:21:48-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:4C29DF140B2068118083CA0D40C3C5842013-01-14T07:22:02-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:47298EEB2B2068118083CA0D40C3C5842013-01-14T11:23:53-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:0251513A2E2068118083CA0D40C3C5842013-01-14T11:33:24-06:00Adobe InDesign 7.0/metadata
  • savedxmp.iid:0351513A2E2068118083CA0D40C3C5842013-01-14T11:33:24-06:00Adobe InDesign 7.0/
  • savedxmp.iid:11C586BE2E2068118083CA0D40C3C5842013-01-14T11:37:06-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:1CFDCBDB242068118083D6027FEC136F2013-01-14T16:15:20-06:00Adobe InDesign 7.0/metadata
  • savedxmp.iid:BAA03809252068118083D6027FEC136F2013-01-14T16:15:20-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:CA0D6A050B2068118C14FD3BF155C2792013-02-07T09:06:09-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:CB0D6A050B2068118C14FD3BF155C2792013-02-07T09:06:50-06:00Adobe InDesign 7.0/metadata
  • savedxmp.iid:CE0D6A050B2068118C14FD3BF155C2792013-02-07T09:06:50-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:0EA84E6A0C2068118C14FD3BF155C2792013-02-07T09:16:08-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:11A84E6A0C2068118C14FD3BF155C2792013-02-07T09:16:16-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:14A84E6A0C2068118C14FD3BF155C2792013-02-07T09:36:55-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:17A84E6A0C2068118C14FD3BF155C2792013-02-07T09:45:31-06:00Adobe InDesign 7.0/;/metadata
  • savedxmp.iid:7B1C5812142068118C14FD3BF155C2792013-02-07T10:22:14-06:00Adobe InDesign 7.0/;/metadata
  • xmp.iid:CB0D6A050B2068118C14FD3BF155C279xmp.did:BAA03809252068118083D6027FEC136Fxmp.did:01801174072068118A6D82ABF1C78554default1780application/pdf

  • Doxycycline Fact Sheet.indd
  • Adobe PDF Library 9.9FalsePDF/X-1:2001PDF/X-1:2001PDF/X-1a:2001 endstream endobj 3 0 obj > endobj 6 0 obj >/Font>/ProcSet[/PDF/Text]/Properties>/MC1>>>>>/TrimBox[0.0 0.0 612.0 792.ByOO!#!n+r

    Heartburn – Managing Side Effects


    Care During Chemotherapy and Beyond

    What Is Heartburn?

    Other terms:  Acid indigestion, gastric reflux, acid reflux,
    gastroesophageal reflux disease (GERD), nausea, upset stomach, dyspepsia, sour stomach.

    Heartburn (gastric reflux or indigestion) is caused by
    reflux or back flow of food from the stomach into the esophagus which results in
    a burning discomfort that radiates from the stomach upwards.  Healthy individuals
    experience heartburn.  In fact, ten percent of adults suffer from this daily
    and 30% have monthly heartburn symptoms.  Stress,
    smoking, certain foods, caffeine, medications, and other medical conditions can
    aggravate it.  Luckily, there are many things that you as a patient can do
    to lessen or stop this bothersome symptom.

    Sometimes indigestion and nausea are feelings caused by being constipated. 
    Let your doctor or nurse know if you are having difficulty moving your bowels.

    Sometimes you may feel indigestion, gastric reflux, or heartburn from
    chemotherapy and may require an anti-nausea medicine in addition to one of the medications
    recommended for heartburn. So, keep a record of when you experience these symptoms
    and relay them to your health care professional.

    Things You Can Do To Manage Heartburn or Gastric Reflux:

    • Stop smoking.
    • Limit your caffeine intake (i.e. pop/soda, coffee, chocolate, and teas).
    • If you are overweight, losing weight may reduce or help relieve your symptoms.
    • Elevate the head of your bed when sleeping or lying down.
    • Do not eat two to three hours prior to going to bed.
    • Reduce fatty foods in your diet (i.e. deep fried foods).
    • Avoid foods and drinks that cause you heartburn. For example, chocolate, citrus
      fruits (oranges, grapefruits), mints, coffee, and alcohol tend to cause indigestion/heart
    • Eliminate or limit alcohol intake.  It is usually advised to limit alcohol
      intake to one drink a day.
    • Take medications for the heartburn as prescribed by your doctor and let him/her
      know if they are not helping.
    • If it is okay with your doctor, you may try one of the over the counter antacids,
      these contain the following compounds alone or in combination; calcium carbonate,
      aluminum hydroxide, magnesium hydroxide, magladrate. Common names for these are
      Maalox®, Mylanta®,
      Rolaids®, or Tums®).
    • Other common medications that are now available over-the-counter include famotidine
      (Pepcid®) and ranitidine (Zantac®). 

    Drugs That May Be Prescribed By Your Doctor for Heartburn:

    If your heartburn symptoms are not relieved by your lifestyle changes, your doctor
    may prescribe one of the following kinds of medications:  (some of these medications
    are also available in over-the-counter strength if you are taking any over-the-counter
    medications be sure to discuss these with your health care professional).

    h3 blockers – These medications compete with histamine
    at the h3 receptors on certain cells on the lining of the stomach and into the small
    intestine.  This decreases gastric acid secretions. 

    • A few examples of these heartburn drugs that may be prescribed
      include cimetidine (Tagamet®), famotidine (Pepcid®), nizatidine (Axid®),
      or ranitidine (Zantac®).

    Proton-pump inhibitor – These medications suppress gastric
    acid secretions by inhibiting the enzyme pump process, which is the final step in
    the production of gastric acid secretions. 

    • Short term use to treat active ulcers.
    • Examples include omeprazole (Prilosec®), lansopraxole
      (Prevacid®), esomeprazole (Nexium®),
      pantoprozole (Protonix®) or rabeprazole (Aciphex®).
    • If your doctor suspects you have an ulcer caused by an infection with h pylori,
      he/she may prescribe a combination of drugs to include one of the above drugs and
      an antibiotic to take for a couple weeks.

    When to Contact Your Doctor or Health Care Provider:

    • You continue to have heartburn or gastric reflux despite
      following the above recommendations for patients.
    • Your symptoms do not improve or worsen with the medication prescribed for you.
    • You notice a decrease in appetite, difficulty eating/swallowing, and weight loss
      along with your heartburn.
    • Call your doctor right away if you notice blood in your bowel movements or if you
      cough or vomit blood.
    • Sometimes indigestion and nausea are feelings caused by being constipated. 
      Let your doctor or nurse know if you are having difficulty moving your bowels.
    • Sometimes you may feel indigestion from chemotherapy and may require an anti-nausea
      medicine in addition to one of the above heartburn medications.
      So, keep a record of when you experience these symptoms and relay them to your doctor
      or nurse.

    Note: We strongly encourage you to talk with your health care professional
    about your specific medical condition and treatments. The information contained
    in this website is meant to be helpful and educational, but is not a substitute
    for medical advice.

    Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org

    8 Agents affecting the secretory function

    Agents affecting the gastrointestinal tract

    F U NK C IU


    Ulcer formation is associated with an imbalance between protective and aggressive factors

    The gastric mucosa is endowed with high regenerative potency.

    Duodenal mucosa has a slightly lower restorative potency.

    The glandular apparatus of the stomach is completely renewed every 5 days.

    The mucous membranes of the stomach and duodenum have a universal mechanism of protection against self-digestion by acidic gastric juice.

    Recommended files

    The defense mechanism includes :

    – mucus gel,

    – secretion of bicarbonate ( maintains a neutral pH level in the area immediately adjacent to the epithelium),

    – adequate blood flow,

    – method to the rapid repair of the mucous membrane ( due to a special

    phospholipid contained on the epithelial membrane of the integumentary epithelium ).

    Most essential components of protection: exposure to mucus gel and secretion of bicarbonate.

    Mucus is secreted by mucus-forming cells of the surface epithelium in the stomach and duodenum and forms a thin layer of viscous water-insoluble gel.

    The main components of mucus are high molecular weight glycoproteins.

    Bicarbonate – by superficial epithelial cells and retained by mucus gel.

    Cytoprotection is maintained

    – by adequate blood flow ( provides replacement of dead cells ),

    – by the presence of intracellular substances with protective properties (the main ones are

    among which are prostaglandins).

    Aggressive factors.

    – Hypersecretion of pepsin and hydrochloric acid

    – Impaired neutralization of hydrochloric acid.

    – Violation of protective mechanisms ( prostaglandins, blood flow ).

    – Genetic factors.

    – Damage to blood vessels and microcirculation.

    – Smoking.

    The main forms of peptic ulcer:

    1) Ulcer of the body of the stomach 2) Ulcer of the duodenal bulb.

    The main link of the pathogenetic chain of both forms is chronic gastritis type B.

    The formation of chronic gastric ulcer is promoted by:

    – maladjustment to acid-peptic effects

    – Helicobacter pylori invasion ( Helicobacter – bacteria found on the surface

    antral mucosa

    General principles of peptic ulcer treatment.

    The main task of is to quickly stop the exacerbation and reduce the number of relapses of the disease.

    Stages of pharmacotherapy

    1. Era of anticholinergics (50s). Antispasmodics, ganglion blockers, atropine-like drugs.

    2. Era of basic funds (70s).

    Means providing a high rate of ulcer healing.

    H2-histamine blockers, proton pump blockers, prostaglandins, sucralfate, de-nol.

    3. The era of anti-helicobacter therapy .

    Means for eradication (extermination) Helicobacter pylori .

    Eradication – non-detection of a microbe 4-6 weeks after stopping therapy.

    Currently, a comprehensive method of treating peptic ulcer disease has been adopted.

    A group of drugs that reduce the acidity of the stomach contents due to chemical interaction with hydrochloric acid of gastric juice.

    Principles of classification

    1. Preparations of systemic and local action.

    Systemic drugs increase plasma alkaline reserves.

    Topical preparations do not change the systemic acid-base state.

    Systemic action: Sodium bicarbonate

    2. Absorbable and non-absorbable preparations.

    Absorbable preparations only neutralize hydrochloric acid.

    Non-absorbable – neutralize, bind and adsorb.

    Absorbable: Sodium bicarbonate,

    Calcium carbonate, Magnesium oxide – to a lesser extent.

    With long-term use of non-absorbable antacids in large doses, side effects may develop.

    3. Anionic and cationic.

    According to the types of the region of the molecule important for the interaction with the acid.

    Anionic: Sodium bicarbonate, Calcium carbonate

    Cationic: Aluminum hydroxide, Magnesium hydroxide

    Most antacids are powders that are poorly or insoluble in water, but not mineral soluble in acids.

    Interaction with contents in the gastrointestinal tract :

    – reaction with hydrochloric acid of gastric juice

    – subsequent reaction of the formed products with pancreatic bicarbonate and

    intestinal secretions.

    Mechanism of action of antacids

    1) Decrease in the activity of aggressive factors

    ( binding of hydrochloric acid, adsorption of pepsin, bile acids ).

    2) Strengthening the protective capabilities of the mucous membranes of the gastroduodenal zone

    ( cytoprotective effect, qualitative improvement of the process of scarring of ulcers ).


    – Rapid interaction with acid

    – Binding of a large amount of acid

    – Maintaining the pH of the stomach in the range of 3-6

    Antacids can affect the bioavailability and pharmacokinetics of many drugs

    Sodium bicarbonate

    9000 :

    NaHCO 3 + HCl à NaCl + H 2 O + CO 2

    The advantage of the preparation is in the instant acid neutralization.

    The drug can cause secondary secretion due to the irritating effect of carbon dioxide

    and a sharp change in the pH of the medium to 7 and above (secretory rebound).

    In the intestine :

    The reaction product does not interact with bicarbonate of intestinal and pancreatic juices.

    However, if there is a normal interaction with the acid of gastric contents, then

    after taking soda, such neutralization is excluded.

    An excess of endogenous alkali and unreacted sodium bicarbonate are absorbed and

    increase the alkaline reserve of plasma (this is the reason for the systemic action of of the drug).

    Prolonged use of of the drug can lead to alkalosis, which is accompanied by

    nausea, vomiting, headaches, in severe cases – tetanic convulsions.

    Sodium load.

    In the stomach : CaCO 3 + 2HCl à CaCl 2 + H 2 O + CO 2

    Acts relatively quickly and effectively.Stronger than other antacids.

    In the intestine : CaCl 2 + NaHCO 3 à CaCO 3 + NaCl + HCl

    The reaction product interacts with bicarbonate of intestinal and pancreatic juices.

    Calcium has an inhibitory effect on intestinal motility (constipation).

    Causes distension of the stomach.

    Magnesium oxide

    In the stomach : MgO + 2HCl à MgCl 2 + h3O

    In the intestine : MgCl 2 + NaHCO3 à MgCO 3 + NaCl + HCl

    acid changes the main state.Laxative effect.

    In the stomach : Mg (OH) 2 + HCl à MgCl 2 + H 2 O

    In the intestine : see magnesium oxide Relatively fast acting.

    Aluminum hydroxide

    In the stomach : Al (OH) 3 + HCl à AlCl 3 + 3H 2 O:

    Gel dosage forms with an enveloping and adsorbing effect.

    AlCl 3 undergoes hydrolysis and the pH of gastric juice slowly increases to 3.5 – 4.5.

    In the intestine : insoluble and non-absorbable phosphates and carbonates are formed, and the chlorine anion is reabsorbed. The acid-base state is not disturbed.

    Inhibits gastrointestinal motility , lengthens the period of evacuation from the stomach. Acts slowly.

    Forms complex long-acting conglomerates.

    Magnesium trisilicate

    In the stomach : 2MgO.3SiO 2 . (H 2 O) n + 4HCl à 2MgCl 2 + 3SiO 2 + (H 2 O) n + 2

    Transitions into a gel-like state. The resulting silica gel has adsorbing properties.

    Slowly neutralizes hydrochloric acid and partially adsorbs it and pepsin due to the

    large surface area. The reaction stops at pH = 5 (ie the drug is a buffer antacid)

    In the intestine : see magnesium oxide.

    Combined preparations.

    Vikair Tablets: Sodium bicarbonate + Magnesium carbonate

    Bismuth nitrate basic (astringent and antiseptic effect)

    powder Calamus rhizome (stimulation of appetite and digestion)

    Powder Buckthorn bark (laxative effect) 941003 9000 Tolin + Rutin (anti-inflammatory effect)

    Kellin (antispasmodic effect)

    Almagel Gelatinous liquid:

    Aluminum hydroxide + Magnesium hydroxide

    D-sorbitol (choleretic and laxative effect) action)

    Phosphalugel Gel: Aluminum phosphate, Pectin, Agar-agar (adsorbing effect)

    Mixture Bourget (Na 2 CO 3 , Na 3 PO 4 , Na 2 SO 4 ).

    Maalox Tablets and suspension: Aluminum hydroxide + Magnesium hydroxide

    Well balanced combination with high neutralizing power.

    Tams Tablets. Contains calcium carbonate and magnesium carbonate.

    Gastal Tablets. Contain Aluminum hydroxide, magnesium carbonate, magnesium hydroxide.

    Protab Chewable Tablets. Contain aluminum hydroxide, magnesium hydroxide, sorbent.

    Carbaldrate Suspension, lozenges.Sodium salt of dihydrooxyaluminum carbonate.

    Hydrotalcide Tablets, chewable, suspension. Aluminum magnesium hydroxide carbonate hydrate.

    Simaldrat Tablets, suspension. Contains magnesium aluminosilicate hydrate.

    Effects of combined preparations:

    – Neutralization of HC1 and adsorption of pepsin – a decrease in the proteolytic activity of gastric juice.

    – Adsorption of bile acids

    – Coating effect

    – Gastroprotective effect


    1) Acute and chronic gastritis and duodenitis .

    2) Peptic ulcer of the stomach and duodenum .

    3) Gastroesophageal reflux disease.

    4) Prevention of stress ulcers in intensive care

    (burns, craniocerebral trauma, abdominal surgery) .

    5) Non-ulcer dyspepsia syndrome (heartburn, discomfort, nausea, pain.) evacuation of food contents).

    -For the night.

    Side effects of antacids:

    With prolonged use of antacids in high doses and with chronic renal failure, side effects are possible.

    1) Intestinal dysfunctions – most common

    2) Formation of sodium chloride Preparations containing sodium bicarbonate react with hydrochloric acid to form sodium chloride, which is well absorbed.

    This should be taken into account when treating patients with congestive heart failure, arterial hypertension, and kidney disease.

    3) Hypercalcemia when taking large doses calcium carbonate .

    In response to hypercalcemia, the production of parathyroid hormone decreases, as a result of which the excretion of phosphorus is delayed and there is a threat of tissue calcification.

    4) Formation of kidney stones .

    Silicon can be excreted in urine, which promotes stone formation.

    5) Hypophosphatemia when taking aluminum preparations.

    Aluminum containing antacids form insoluble aluminum phosphate salts in the small intestine, impairing the absorption of phosphates.

    Hypophosphatemia is manifested by malaise, muscle weakness (with significant phosphate deficiency – osteomalacia and osteoporosis).

    6) Aluminum intoxication can be manifested by

    damage to bone tissue and brain, nephropathy.

    Aluminum intoxication is possible when using dialysis solutions, some infant formula, parenteral nutrition, serums, for the preparation of which aluminum or aluminum-containing filters were used.

    Severe side effects from the use of aluminum-containing drugs are often irreversible – dementia, especially in newborns, children and the elderly.)

    Aluminum-containing antacids are not recommended for longer than 2 weeks.

    7) Metabolic alkalosis

    Develops with the use of large doses of sodium bicarbonate .

    It is manifested by vomiting, leading to further alkalinization of the plasma.


    The secretory and motor activity of the stomach determines the initial stages of food processing and its transport to the more distal gastrointestinal tract.

    Secretory activity of the stomach: 2-3 liters of gastric juice

    In the gastric mucosa there are three types of cells , producing the main elements of the secret:

    – main cells (responsible for the production of pepsinogen),

    – parietal cells = parietal (secrete hydrochloric acid),

    – mucous cells of the cervical glands and surface epithelium

    (produce mucoid components of the secretion).

    The secretion of acid in the stomach is under the control of three main agonists :

    histamine, acetylcholine, gastrin.

    The general end point of action is through the proton pump.

    The general property of antisecretory drugs is a decrease in the intensity of formation of gastric juice, primarily hydrochloric acid.


    By blocking cholinergic receptors of parietal and gastrin-producing cells, the drugs eliminate vagal cholinergic effects on the secretion of .

    Under the influence of anticholinergics, the motor function of the gastrointestinal tract changes :

    – the tone decreases

    – the amplitude and frequency of peristaltic contractions decrease,

    – the sphincters relax

    The effect is associated with blockade of terminal cholinergic neurons of intramural plexuses.

    Bacarbon Tablets: Belladonna extract + Sodium bicarbonate

    Bellalgin Tablets: Belladonna extract + Sodium bicarbonate + Analgin + Anestezin

    are also used as antisecretory, hypersecretory, dyssecretory

    Side effects: numerous (see Cholinergics).

    Addiction develops quickly, after which the healing effect is lost.

    Short-term (0.5-2 hours).

    M 1 – cholinolytics :

    They block mainly M1 cholinergic receptors located in the nerve plexuses of the stomach, and not on the parietal cells themselves and smooth muscle elements.

    In this regard, influences to a greater extent the secretion of , and not the motor function of the stomach. The drug significantly reduces the basal secretion.

    Pirenzepine = Gastrocepin

    The drug accelerates the healing of duodenal ulcers and stomach ulcers.

    Poorly penetrates the brain – there are no central effects (poor lipoidotropy).

    Effect after 2 hours and up to 12 hours.

    There is a gastroprotective effect (increased mucus production).


    More active antisecretory agent than gastrocepin (25 times).

    However, it sharply inhibits the secretion of the salivary glands (this limits the use).

    Oral solution 50 ml in vials with a pipette.

    Acts mainly on the M-cholinergic receptors of the digestive tract.

    Reduces the secretion of hydrochloric acid and reduces the peptic activity of gastric juice.

    Reduces the tone of smooth muscles in the gastrointestinal tract, promotes gastric emptying.

    Application : For vomiting (common for babies and children),

    for febrile conditions, for acute gastroenteritis,

    for functional diseases of the colon.

    H 2 – histamine blockers

    Block receptors in a competitive manner .

    Therefore, the degree of affinity of the drug for the receptor is very important.

    Histamine blockers of the 3rd generation have a significantly higher affinity for the receptor – it is possible to prescribe in lower doses. Do not penetrate into the central nervous system.

    Bind mainly with H 2 receptors of parietal cells of the gastric mucosa .

    -Suppress basal secretion of HC1,

    and stimulated secretion (in response to food intake, gastrin, vagus stimulation).

    Better for suppressing nocturnal secretion.

    – Increase the production of prostaglandin E 2 in the gastric mucosa and

    in the duodenum, mediating the cytoprotective effect.


    – elimination of symptoms of the disease (pain, heartburn)

    – acceleration of healing of erosions and ulcers on the mucous membrane of the stomach and duodenum

    But there is no anti-relapse effect of drugs, ricochet syndrome may occur.

    Associated with

    -hypergastrienmia arising in response to the suppression of gastric acidity)

    -blockade H 2 – histamine blockers on mast cell receptors, helping to release g

    from them.

    When canceling, it is important to gradually reduce the dosage and protect with other antisecretory agents.

    Enter: -parenteral (drip, bolus), -internally (more often)

    Bioabsorption -ranitidine, famotidine 50%, – cimetidine 70%

    Pass through the placental barrier


    in the liver.

    Cimetidine is exposed, less ranitidine, famotidine is not.

    – beta-blockers, – theophylline, – indirect anticoagulants, – sedatives

    cumulation is possible due to inhibition of the function of the microsomal oxidative system in the liver.

    Indications for use :

    1. Peptic ulcer of the stomach and duodenum as part of complex therapy.

    2. Anti-relapse therapy.

    3. Treatment of hyperacid gastritis, exophagitis.

    4. Emergency therapy for bleeding ulcers of the stomach, duodenum, esophagus.

    Side effects: Expressed when using cimetidine, other drugs are rare.

    The effects are associated with the fact that H 2 receptors are widely represented in the body:

    parietal cells, central nervous system, uterus, leukocytes, heart, blood vessels.

    Drugs penetrate the placental barrier and breast milk.

    – Changes in blood composition (thrombocytopenia, leukopenia),

    – Muscle and joint pain,

    – In large doses, when administered intravenously, can cause a significant decrease in blood pressure,

    severe bradycardia, arrhythmias.

    – prolonged artificial change in the stomach environment predisposes to carcinogenesis.

    After cancellation, “rebound syndrome” is possible.

    Cimetidine with long-term use in large doses.

    can reduce the secretion of gonadotropic hormones and increase the level of prolactin

    (causes gynecomastia, galactorrhea, delayed puberty in boys)

    Therapeutic drug

    Cimetidine (histodil, tagamet) 1000 mg (200×3 + 4003 9000 per night) Ranitidine (zantac, ranisan, histac) 300 mg (150×2 or 300 at night)

    Famotidine (quamatel, lecedil) 40 (20×2 or 40 at night)

    Nizatidine (axid) 300 mg (150×2 or 300 per night)

    Roxatidine (Roxane) 150 mg (75×2 or 150 at night

    Ebrotidine new generation (antisecretory, gastroprotective and antihelicobacter properties)

    Blockers proton pump

    The most active inhibitors of hydrochloric acid secretion.

    The most effective remedies for the treatment of peptic ulcer disease.

    The general final pathway of secretion stimulation is realized at the level of the outer membrane of parietal cells using a volatile pump for the exchange of potassium ions for hydrogen ions.

    Proton pump – protein in the cytoplasmic vesicles in the tubules of the parietal cell and in the microvilli of the secretory tubules.


    It is explained by the fact that there are no structures like parietal cells.

    “At the exit” from the cytoplasm (in the apical tubules) of the lining cells of the gastric glands,

    in an acidic medium preparations are protonated (active ionized form).

    The ionized form is noncompetitive and irreversibly binds to the enzyme that determines the release of acid through the secretory membrane (H / C-ATPase of the apical membrane).

    Widely used.

    Inactive precursors that are activated in an acidic environment.

    Pass through the blood into the parietal cells.

    They are weak bases and accumulate in the secretory tubules,

    in an acidic medium of which they are activated (sulfenic acids and sulfenamides are formed).

    These metabolites bind to cysteine ​​residues H + , K + -ATPase.

    This causes irreversible inactivation of H + , K + -ATPase and stops the secretion of H + ions.

    Therapeutic dose (20 mg x 7 days) inhibits HCl production by more than 95%. Recovery occurs 4-5 days after the cancellation

    (half-recovery period is 30-48 hours).

    After cancellation, no “rebound” is noted

    Functional cumulation

    Dose-dependent suppression of acid secretion remains

    after the disappearance of the substance from the plasma

    Indications for use


    Peptic ulcer disease (anti-relapse treatment).

    The drugs are effective for: – ulcers resistant to H 2 – blockers

    – reflux disease (in combination with prokinetics)

    Reflux esophagitis – appears with chronic exposure to the gastric mucosa

    9000 , paknkreaticheskogo juice, bile.

    Characterized by persistent heartburn, pain behind the xiphoid process associated with the act of swallowing.

    In case of ulcerative lesions, vomiting of blood occurs.

    Proton pump inhibitors inhibit all types of secretion HCI (stable effect after 4 days).

    Side effects are not expressed.


    Gastrointestinal tract: Nausea, diarrhea, constipation, abdominal pain (up to 9%)

    Potential risk of prolonged increase in gastric pH (bacterial colonization of the gastrointestinal tract, risk of tumor formation.

    Features: -Antisecretory activity is 2-10 times higher than that of H 2 -blockers.

    -Used in antihelicobacter therapy regimens.

    Clinical efficacy

    PH> 3 within 8-10 hours Antacids, M 1 -cholinolytics

    PH> 3 within 12-18 hours H2-histamine blockers, proton pump inhibitors

    Application features

    drugs are activated in an acidic environment, they must be taken before meals or with food, i.e.Because food stimulates the production of hydrochloric acid.

    Co-administration of drugs that reduce acidity reduces the effect.

    The maximum effect is achieved only after several doses of the drug, since not all molecules of H + , K + -ATPases and parietal cells work simultaneously.

    When prescribed once a day, 2-5 days are required.


    Preparations of different chemical structures with different mechanisms of action.

    Protect mucosal cells from aggressive influences, create conditions for the healing of ulcers. Preparations of colloidal bismuth:

    In an acidic medium form with proteins , covering the mucous membrane, glycoprotein-bismuth complex . There are more such proteins on the eroded surface.

    A strong film is formed on the damaged surface , protecting against aggressive factors

    In addition, have a bactericidal effect on Helicobacter pylori.

    Form of issue : tablets (chewed), gel, suspension.

    3-fold reception (in the morning 30 minutes before meals, 2 hours after dinner, before bedtime). 4-6 weeks.

    Not more than 2 months (due to the accumulation of bismuth in the tissues), complications may develop.

    Can form non-absorbable complexes with tetracycline, antacids, milk.

    Side effects Rarely, when used for a long time.

    Constipation.Encephalopathy – contains aluminum (with chronic renal failure).


    Sulfated disaccharide in complex with aluminum hydroxide.

    Polymerizes in gastric juice, forms a polyanion carrying negative charges.

    Forms strong bonds with positively charged radicals of mucosal proteins.

    Very high viscosity. The film remains in the stomach for up to 8 hours.

    Most actively binds to proteins of the eroded surface.

    Does not affect the secretion of hydrochloric acid and pepsin. Adsorbs pepsin and bile acids.

    Promotes increased formation of prostaglandins in the gastric mucosa.

    Reception 0.5 – 1.0 before meals for 1 hour, since it is inactivated in an acidic environment, and at night.

    Stimulating protective properties of the mucous membrane

    The mechanism of action of is based on a change in the quantity and quality of the mucous layer, which leads to

    increased resistance to acid-peptic aggression and reduces the reverse diffusion of H +.

    The viscosity of mucus increases, the life of mucocytes increases, the protective layer thickens.

    Structural and pharmacological similarities with aldosterone (side effects).

    Assign in courses, in 3 doses, 4-5 weeks.


    Tissue physiological regulators are formed in many tissues and cells

    In case of peptic ulcer, gastritis, there is always mucosal irritation, cell damage.

    Inflammation develops (“arachidonic acid cascade” and the formation of prostaglandins)

    Prostaglandin E2 and prostacyclin are most essential for the mucous membrane .

    Functions of prostaglandins in the mucosa:

    – stimulation of mucocytes of the gastric glands with an increase in the secretion of protective mucus and bicarbonate.

    – inhibition of the secretion of hydrogen ions by the lining cells

    – expansion of the vessels of the deep layers of the mucous and submucous membranes with an increase

    of microcirculation and an increase in the stability of the vascular wall

    • Increase in the quantity and quality of protective mucus, secretion of bicarbonate

    • mucous membrane

    • Antisecretory effect (in higher doses)

    “Cytoprotective” effect: prevention (reduction) of mucosal damage under the action of thermal, chemical and mechanical damaging factors, stress (a more precise term is “histoprotective” effect)

    Application : treatment and prevention of erosive and ulcerative lesions of the gastroduodenal region, in particular when taking NSAIDs

    Side effects : gastrointestinal motility disorders

    Tablets.During meals, 2-4 times a day, in courses for 4 weeks.

    As an independent means of therapy, it is rarely used – due to side effects

    (cramping abdominal pain, nausea, vomiting, diarrhea, abortion).

    Stimulating own protective properties of the stomach


    Increase in mucocyte activity (increase in the synthesis and secretion of mucus, a protective layer).

    Qualitative changes in mucus (composition of glycoproteins, viscosity).


    Mineralocorticoid effect (sodium, water retention, increased blood pressure).

    Currently used only as a gel for stomatitis.


    1. Means preventing and eliminating acid-peptic aggression.

    2. Means that increase the protective properties of the mucous membrane.

    3. Antihelicobacter.

    Decolonization (eradication) agents Helicobacter pylori

    in the gastroduodenal mucosa.


    (Means for eradication Helicobacter pylori )

    Helicobacter pylori

    bacterial mucosa

    under a layer of integumentary mucus.

    The microbe can secrete mucinase , while the mucus becomes less viscous, loses its protective properties.

    It also produces the enzyme urease, that breaks down urea, as a result of which a cloud of ammonia formed

    protects the microbe from the bactericidal action of hydrochloric acid.


    – causes chronic inflammatory gastritis

    – enhances the secretory response of the stomach, which leads to the formation of peptic ulcers.

    General rules for the implementation of the most complete eradication Helicobacter pylori :

    1. Antimicrobial drugs require combined use

    It provides

    -increased efficiency due to the effect on different molecular targets in the body


    -reduced the risk of pathogen resistance to one of the drugs If the basis of the scheme are bismuth-containing drugs, add to them

    metronidazole and amoxicillin, tetracycline.

    2. Antimicrobial effect of antibiotics enhances the suppression of acid production (especially proton pump inhibitors).

    Metronidazole Bactericidal.

    Effective antimicrobial and antiprotozoal agent .

    The mechanism of action of is due to the high oxidative reactivity of the nitro group.

    The drug is a “prodrug”.

    Antimicrobial effect is exerted by its metabolite, which is formed in the microorganism due to the restoration of the nitro group of the drug under the influence of the ferruginous-sulfur complex of ferredoxin.(analogue of flavoproteins in bacterial and protozoal cells).

    The reduced metabolite interacts with various macromolecules of the microbe cell, including DNA, proteins, membrane phospholipids, which causes a bactericidal effect.

    The combination with amoxicillin reduces the risk of developing resistance to metronidazole.

    Metronidazole has a sensitizing effect on ethanol , causing something like an alcoholic antabuse reaction (nausea, vomiting, headache), so you should refrain from taking alcoholic beverages while taking metronidazole.

    Amoxicillin Semisynthetic penicillin of the aminopenicillin family.

    Possesses acid resistance , bactericidal effect, sensitivity to penicillinase.

    Disrupts the synthesis of the bacterial cell wall .

    The drug binds to a specific receptor (penicillin-binding protein),

    as a result of which there is a violation of the process of transpeptidation (enzyme transpeptidase) and proteoglycan synthesis.

    As a result, autolytic enzymes (hydrolases) of the cell wall are activated, which leads to its damage and the death of bacteria. That is, has a bactericidal effect of .

    Clarithromycin Semi-synthetic antibiotic-macrolide (erythromycin group)

    Has a bacteriostatic and bactericidal effect.

    Disrupts bacterial protein synthesis by interacting with the 50S-subunit of ribosomes.

    Tetracycline Antibiotic of the chloramphenicol group.

    Has a bacteriostatic effect due to the violation of protein synthesis.

    The drug binds to a receptor on the 30S-subunit of ribosomes.

    Preparations of colloidal bismuth

    They have antibacterial effect , disrupting the ability of bacteria to bind to the epithelium. They have a “film-forming” protective effect.

    Increases the secretion of protective mucus and bicarbonate. Decreases the activity of pepsin.


    Pilorid (ranitidine + bismuth citrate)

    Helicocin (amoxicillin + metronidazole)

    Pilobact (clarithromycin + omeprazole + tinidazole)


    1 Component

    1 First line antiretroviral therapy


    1 First line therapy 9002

    Omeprazole (0.02) or

    Lanzoprazole (0.03) or

    Pantoprazole (0.04) or

    Rabeprazole (0.01) or

    Esomeprazole (0.02)

    2 times a day

    Antimicrobial component:

    Clarithromycin (0.5×2) + amoxicillin (1.0×2) or

    Clarithromycin (0.5×2) + metronidazole (0.5×2)

    First line therapy: triple therapy

    Antisecretory component:

    Ranitidine bismuth citrate (0.4×2)

    Antimicrobial component:

    Clarithromycin (0.5×2) + 1.0 ) or

    Clarithromycin (0.5×2) + metronidazole (0.5×2)

    Second-line therapy: quadrotherapy (if the first course is ineffective)

    Antisecretory component:

    Proton pump inhibitor in a standard dose 2 times a day

    Antimicrobial component:

    Bismuth subsalicylate / subcitrate (0.120×4) + metronidazole ( 0.5×3) + tetracycline (0.5×4)

    Scheme example: 7 days

    1) Omeprazole 0.02 2 times a day Flemoxin solutab (amoxicillin) 1.0 2 times a day

    Fromilid 0.5 2 times per day

    2) Ranitidine Clarithromycin (0.5×2) + amoxicillin (1.0×2) or

    bismuth citrate (0.4×2) Clarithromycin (0.5×2) + metronidazole (0.5×2)

    Information in the lecture “1 …The need for automation of chemical and technological processes “will help you.



    -Use of local dosage forms

    -Combination with misoprostol

    selective COX inhibitors 2 (meloxicam, celecoxib.)

    Juvenile nasopharyngeal angiofibroma in a child

    Any part of the human body, including children, can be subject to various tumor lesions.A formation such as juvenile angiofibroma sometimes develops in the nose.

    What is juvenile nasopharyngeal angiofibroma?

    This is a benign neoplasm located in the nasopharynx of children and adolescents. A characteristic dislocation of pathology is the back of the nose, where the adenoids are located. Angiofibromas rapidly increase in size and are aggressive. A progressive tumor is prone to destruction of the surrounding bone structure. Neoplasia spreads to neighboring areas: the cranial base, cranial cavity, orbits of the eye, and is prone to bleeding, which makes it especially dangerous.Juvenile nasopharyngeal angiofibroma (JNA) is a loose tumor mass containing an interlacing of blood vessels.

    How common is juvenile nasopharyngeal angiofibroma in childhood?

    JNA belongs to the group of rare formations that can occur at any age, even in the elderly. It mainly affects children and adolescents from 7 to 19 years old. According to statistics, the disease affects mainly boys and men, which is presumably due to the increased expressiveness of androgen receptors.Another provoking factor is called hormonal imbalance, so the peak incidence occurs during puberty. Of all head tumors, JNA accounts for no more than 0.5%, or one registered case per 150 thousand people.

    What are the symptoms of juvenile nasopharyngeal angiofibroma in children?

    Pathology most often manifests with painless nasal congestion, usually on the one hand, and the development of otitis media. The clinical picture with the growth of angiofibroma looks like this:

    • Headaches accompanied by nosebleeds.
    • Rhinorrhea.
    • Attacks of acute headaches without bleeding from the nose.
    • The child’s face swells, swells up
    • The eyeball bulges out with a strong increase in education.
    • Eustachian tube malfunctioning.
    • Covers the ears.
    • Difficulty in nasal breathing.
    • The face is deformed.
    • Decreases in visual acuity.

    A tumor spreading to the skull region leads to paralysis of the cranial nerve, secondary reflex, vascular disorders occur.If the neoplasia grows slowly, the child may not feel strong manifestations of the symptoms of the disease, which makes it difficult to detect it in time and worsens the chances of a favorable outcome. Sometimes even a nasal congestion that does not pass indicates the development of such a pathology as JNA. Therefore, it is better for parents to play it safe and show the child to a competent specialist for a high-quality examination.

    How is juvenile nasopharyngeal angiofibroma treated in a child?

    To avoid errors in diagnosis and treatment, which can lead to irreversible consequences, worsening of the condition and even death, contacting the Israeli clinic Tel Aviv Medical Center (Ichilov) will help.The choice of treatment is based on a full examination conducted by a leading specialist. Diagnostics includes the following stages:

    • General examination with checking the condition of the nasal cavity and taking anamnesis.
    • Hormone test.
    • Rhinoscopy to detect nasal swelling and assessment of the mucous membrane.
    • Instrumental, imaging research methods – MRI, CT, angiography, X-ray, epipharyngoscopy.

    Diagnostics provides enough information about the development and characteristics of the course of the disease, and helps to form the most appropriate treatment plan.

    • The main method of removing the tumor mass from the nasopharynx is surgery. A tumor resection surgery restores nasal breathing, improving the quality of life. At TAMS, procedures are carried out by the world’s best pediatric surgeons, which eliminates the risk of complications or relapses. In most cases, the operation is performed by the most experienced specialist Dr. Yair Gorchak.To avoid increased bleeding, embolization of the vessels supplying the angiofibroma is performed before the operation.In our clinic, the preference is given to less traumatic methods of surgical treatment, after which there are no anatomical or functional disorders, and the period of hospitalization and recovery is significantly reduced.
    • If the tumor is detected at a late stage and has spread to neighboring structures, radiation therapy is performed. In Tel Aviv Medical Center, it is performed by Dr. Ospovat Ina, who will select the intensity of focused radiation that is most acceptable for the child’s body.Radiotherapy, which reduces the volume of tumor mass, is carried out both before and after surgery. It is also sometimes indicated to carry out hormone therapy to restore hormonal balance.

    What is the survival rate for juvenile nasopharyngeal angiofibroma in children?

    We can talk about a favorable prognosis if the tumor was detected at an early stage and did not have time to involve the cranial cavity and the brain in the pathological process. Otherwise, the chances of recovery are reduced.This does not apply to treatment at Tel Aviv Medical Center, where, according to statistics, among all European clinics, there is an order of magnitude higher rate of fully healed children with diagnosed juvenile nasopharyngeal angiofibroma. At TAMS, treatment tactics are selected strictly individually, taking into account all the characteristics of the child and the disease.

    Narrow-profile specialists with tremendous experience in successfully combating JNA in pediatrics are involved in the development of optimal treatment tactics.Experts of related profiles constantly interact, conduct consultations, and participate in procedures. Their close location in the same building allows you to quickly adjust the treatment program, monitor the result of the operation and the state of the child’s body, and prevent adverse reactions. TAMS uses a unique treatment protocol, the frequency of the stages of which doctors strictly follow. In our clinic, operations are performed on young patients who have arrived from the CIS countries, where local hospitals have not been able to achieve effectiveness in the treatment of juvenile angiofibroma.

    Why is Tel Aviv Medical Center chosen for the treatment of juvenile nasopharyngeal angiofibroma in a child?

    • Tumor formations located in hard-to-reach places, in dangerous proximity to vital structures, are dealt with by doctors who specialize in the treatment of juvenile nasopharyngeal angiofibroma and have a wealth of experience in this.
    • The use of unique, gentle techniques that allow you to accurately and painlessly remove formations from the nose, without disturbing the anatomical structure, without touching healthy tissues.
    • High-tech equipment that makes it possible to identify the pathological process at the initial stage, to perform dangerous surgical procedures under the control of navigation systems, reducing their time.
    • First-class medical care in full and at loyal rates, cozy rooms, friendly atmosphere, attentive and caring staff.
    • TAMS Rehabilitation Center, where you can recover from surgery, consolidate the result of treatment, get specialist help, including psychological support.

    What are antacids (list)?

    In therapeutic practice, doctors often prescribe antacids to patients. These drugs have the ability to reduce the acidity of the environment. The most widely used drugs are in the treatment of diseases of the digestive system (hyperacid gastritis, gastroesophageal reflux disease). What are the indications, contraindications and what is the mechanism of action of these drugs?

    Types and scope of antacids

    Antacids are drugs that are used for acid-related diseases. This group of drugs has been known for a very long time. The first antacids were used in medicine over 100 years ago. Medicines from this group have the following features:

    • are able to neutralize hydrochloric acid, normalizing the pH;
    • have a cytoprotective effect, protecting cells from the aggressive effects of acids;
    • are able to absorb bile acids;
    • have an enveloping effect.

    In most cases, antacids are an adjunct to basic treatment.These are medications for symptomatic therapy. Unlike other drugs that correct acidity, antacids have a faster and more pronounced effect. The therapeutic effect is achieved due to the presence of magnesium, aluminum or calcium compounds in their composition.

    Classification of antacids

    The list of antacids used today is very wide. There are 2 large groups of antacids: non-absorbable and absorbable. The second group includes products such as baking soda, burnt magnesia, magnesium carbonate, Rennie, Tams, calcium carbonate.

    Representatives of this group have a quick effect, but it is short-lived. In the process of neutralizing the acid, carbon dioxide is released, which often leads to bloating (flatulence) and belching. Absorbable antacids are not used to treat gastroesophageal reflux disease. A possible side effect of these drugs is the rebound phenomenon, in which a secondary acidification occurs.

    The most effective are nonabsorbable antacids.This group includes “Fosfalugel”, “Almagel”, “Maalox”, “Topalkan”, “Gastracid”, “Gaviskon”. There are antacids that combine the main active ingredient with auxiliary components. Most of the nonabsorbable antacids are combined. They are poorly absorbed in the gastrointestinal tract.

    These medicines neutralize hydrochloric acid and pepsin, envelop the gastric mucosa, protecting it from the effects of hydrochloric acid, and inhibit the activity of Helicobacter pylori bacteria.

    The therapeutic effect lasts up to 4 hours. Neutralization begins a few minutes after taking the medicine. Antacids can be treated on an outpatient basis.

    They should be taken 1-1.5 hours after a meal. Most often, treatment involves taking the drug 4 times a day. It is not advisable to use antacids at the same time as other medicines.

    Indications and contraindications for use

    Antacids are taken orally in the form of gels, suspensions or tablets.This group of drugs is used for the following pathological conditions:

    • dyspepsia;
    • gastroesophageal reflux;
    • gastric ulcer during an exacerbation;
    • duodenal ulcer during an exacerbation;
    • duodenitis;
    • enteritis;
    • hiatus hernia;
    • inflammation of the esophageal mucosa against the background of gastric reflux;
    • intestinal functional disorders;
    • epigastric discomfort after drinking alcohol.

    Antacids can be used prophylactically to prevent inflammation of the stomach during the use of drugs from the NSAID group. “Almagel A” can be included in the complex scheme of diabetes mellitus treatment. Absorbable drugs are practically not used. Antacids are well tolerated, however, there are some limitations in their use.

    An antacid such as Almagel is contraindicated in Alzheimer’s disease, impaired renal excretory function and individual intolerance.The drug is not prescribed for children under 1 month of age. “Gaviscon” should not be taken by persons who have hypersensitivity to the main components of the drug.

    Antacid preparation “Maalox” should not be used under the following conditions:

    • severe renal failure;
    • hypophosphatemia;
    • sucrose deficiency;
    • fructose intolerance.

    Maalox is only suitable for persons over 15 years of age. Contraindications to taking “Fosfalugel” are individual intolerance and renal failure.

    Possible adverse reactions

    Subject to the treatment regimen prescribed by the doctor, side effects when taking antacids are very rare. They are possible with the uncontrolled use of drugs. Magnesium antacids can cause diarrhea. In case of an overdose, they may impair renal function and a decrease in heart rate. Aluminum-based antacids can cause hypophosphatemia. If medications are taken in the presence of renal failure, then encephalopathy and softening of the bones are possible.With prolonged use of drugs based on magnesium against the background of urolithiasis, the patient’s condition may worsen and the formation of stones may increase.

    These are common adverse effects. Reception of “Phosphalugel” in rare cases can lead to constipation. This is most often seen in the elderly. When using “Gaviscon”, the development of allergic reactions is possible.

    Reception of “Maalox” in rare cases can cause nausea, vomiting, stool disturbance and taste sensitivity.Thus, the most effective are nonabsorbable antacids. They are widely used to treat adults and children who are acidic.



    According to the University of Maryland Medical Center, 10 out of 100 Americans will suffer from ulcers in their lifetime 3. Many over-the-counter medications are available to relieve pain and speed up the healing process.Each medicine has a different function, although the medicines serve the same purpose: pain relief and acid digestion. You can choose acid neutralizers, acid blockers, and medications that completely stop acid production.

    Is this an emergency?

    Seek emergency help immediately if you experience severe medical symptoms.


    Antacids are a quick remedy for pain caused by ulcers. They don’t last long, and antacids don’t solve the problem.However, antacids such as tams, rolaids, and magnesia milk are inexpensive and work quickly — usually within minutes. These medicines work by neutralizing the acid with a mineral or electrolyte. * * For example, Drugs.com discusses the use of oyster shells as an antacid due to its calcium component 1. You can usually buy antacids at a gas station or convenience store, making them a great choice for those on the go.

    • Antacids are a quick remedy for pain caused by ulcers.
    • However, antacids such as tams, rolaids, and magnesium milk are inexpensive and act quickly — usually within minutes.

    Acid blockers

    Another category of OTC ulcer drugs is h3 blockers. Both Zantac and Pepsid, which used to be a prescription only, are effective h3 blockers that you can buy at any pharmacy. According to the Mayo Clinic, these drugs work by blocking acid secretion in the digestive tract and can take one to two hours to provide relief 2.However, the relief provided by h3 blockers will last longer than antacids. Like antacids, you can take acid blocking drugs with or without food.