Antacid therapy for mild dyspepsia
Symptomatic relief of heartburn, acid regurgitation and occasional epigastric discomfort by acid-neutralizing agents. Suitable for occasional episodes; symptoms more than twice a week require workup.
ICD-10 K304 drugs
Also known as: Antacids for heartburn
Drugs used for this condition
- BCalcium carbonateSecond line · Mineral supplements. CalciumFor occasional heartburn and acid regurgitation, calcium carbonate as an antacid rapidly neutralizes acid and relieves symptoms. The effect is short-lived (30–60 minutes). Symptoms more than twice a week require workup (GERD, H. pylori, functional dyspepsia) and consideration of a PPI. Antacid use beyond 2 weeks without effect is reassessed.
- BMagnesium hydroxideFirst line · Magnesium-based antacid and osmotic laxativeMagnesium hydroxide neutralizes stomach acid within minutes, so it is used for occasional heartburn and acid regurgitation. The AEMPS ficha técnica sets the dose precisely: adults and adolescents from 12 years take 2.5 to 5 ml per intake, up to 12.5 ml a day. An antacid is not taken for longer than two weeks without a doctor – persistent heartburn means reflux disease, sometimes an ulcer or a tumour, and NICE guideline CG184 asks for the cause to be worked out in such cases rather than the symptom muffled. Magnesium antacids have their own quirk: they loosen the bowel, and with frequent use diarrhea becomes the main complaint. The product is contraindicated in severe renal impairment – magnesium accumulates and causes hypermagnesemia.
- BSodium alginateSecond line · Anti-reflux agent forming a protective raftFor heaviness and burning after a big meal, alginate works as an antacid with an addition: calcium carbonate and sodium bicarbonate neutralize acid while the gel covers the contents from above. The AEMPS ficha técnica advises taking it after meals and at bedtime, chewing the tablet and avoiding large amounts of milk – calcium from the tablet and calcium from milk add up. Two weeks is the ceiling for self-treatment: persistent dyspepsia may hide an ulcer, Helicobacter pylori infection or a tumour, and NICE CG184 asks for investigation in such cases rather than a continued course. The ficha separately warns about calcium build-up: prolonged high doses cause hypercalcemia, nephrocalcinosis and milk-alkali syndrome, particularly with renal impairment.
- CSodium bicarbonateThird line · Systemic alkalinizing agent, antacidAn effervescent bicarbonate tablet clears heartburn within minutes – that is how Alka-Seltzer and its relatives work. The AEMPS ficha técnica describes the indication narrowly: relief of heartburn and acid regurgitation in adults and adolescents from 12 years, one tablet after meals or when discomfort appears, at most 6 tablets a day. Then come caveats that other antacids do not have. The gas distends the stomach, belching brings acid back, and the ficha names the rebound effect directly among adverse reactions. The sodium load is noticeable for people with hypertension and a tendency to edema. The tablet is not taken right after a heavy meal and drinking: carbon dioxide released into a full stomach has in rare cases led to perforation of the wall. If heartburn lasts beyond 14 days, an examination is needed rather than the next pack.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit