Antacids reduce acidity by neutralizing (counteracting)
acid, reducing the acidity in the stomach, and reducing the amount of acid that
is refluxed into the esophagus or emptied into the duodenum. Antacids also work
by inhibiting the activity of pepsin, a digestive enzyme produced in the
stomach that is active only in an acid environment and, like acid, is believed
to be injurious to the lining of the stomach, duodenum, and esophagus.
Antacids are mild alkaline substances which reduce excess gastric acidity,
resulting in an increase in PH of the stomach and duodenum.
An ideal antacid should not have any side effects other than
its main action of neutralizing gastric acid.
An ideal antacid should satisfy the following criteria:
The antacid should be insoluble in water and has
fine particle form
The ant acid should buffer in the PH range of
The reaction of the antacid should not cause a
large evolution of gas.
The antacid should probably inhibit pepsin
It should not have a constipating or Laxative
It should not cause, if absorbed, systemic
alkalosis (in this condition the pH of the body fluids and tissues is high).
A prolonged and effective neutralizing action
following an acceptable dose
It should not cause precipitation of phosphate I
the gastrointestinal tract and depletion of phosphorus in the body.
It should not also interfere with the absorption
of food particles or other drugs such as tetracycline from the gut.
It should not also delay the absorption of drugs
which are weak acids or speed up the absorption of basic drugs. This happens
when the pH of the gastric contents is raised.
It should be palatable and inexpensive
In the case of antacids, the acid neutralizing capacity is
important. The neutralizing capacity of an antacid substance is expressed in
milli equivalents of hydrochloric acid. Every antacid should have a
neutralizing capacity of 5 mEq of hydrochloric acid per dosage unit. This is
enough to raise the PH in an essential empty stomach to 3.5.
Classification of antacids:
Antacids which locally neutralize the hyperacidity are
broadly grouped into:
(absorbable) antacids: These are soluble, systemically can be readily
absorbable. Systemic antacids can cause metabolic alkalosis after absorbing of
their cationic moiety (positively charged ion molecules) with long, excessive
Sodium bicarbonate, which is soluble, readily absorbable and
capable of producing systemic electrolytic alterations and alkalosis and even
absorption of Na+ ions, is not suitable for patient with hypertension, heart
problem, liver failure or pregnant woman.
Calcium carbonate is also a potent antacid. However, with
this drug, systemic absorption of calcium can occur. Sometimes hypercalcaemia
plus the systemic alkalosis caused by calcium can also results in the
2) Non systemic
(non-absorbable) antacids: They are insoluble and poorly absorbed
systemically. Thus they do not exert any appreciable systemic effect. Non
systemic antacids are physically, physiochemically, chemically acting. Their
cationic moiety forms unabsorbable, insoluble basic compounds in the intestine.
This group is further classified based on the compounds used as antacids:
a) Aluminum containing antacids: Examples: aluminum
hydroxide gel, aluminum phosphate.
containing antacids: Examples are heavy
and light magnesium carbonate, milk of magnesia, heavy magnesium oxide,
magnesium tri silicate.
c) Calcium containing antacids: Examples are calcium
carbonate, tri basic calcium phosphate.
Rationale behind the combination
therapy of antacids
• It is usually classified as non-systemic antacid.
• It does not interfere with electrolyte balance and not
completely suppress the peptic digestion.
• However, the formation of aluminium chloride result of
reaction between aluminium hydroxide and hydrochloride acid responsible for the
astringent and constipation effect.
• Besides, it interferes with absorption of phosphate.It
reacts in the small bowel with phosphate to form insoluble salts and is thus
absorbed only to a very limited extent.
• Magnesium hydroxide is also a type of non- systemic
antacid that interferes with the absorption of folic acid and iron.
• It may induce diarrhea that causing loss of potassium ion
in our body.
• It has a long history of use but has become less popular
because of its tendency to cause systemic effects.
• It is absorbed from the gastrointestinal tract and a
slight alkalosis develops, with the production of alkaline urine.
Calcium carbonate is
also a potent antacid.
• Systemic absorption of calcium can occur
• Sometimes hypercalcaemia plus the systemic alkalosis
caused by calcium can also results in the milk-alkali syndrome.
• Like most other antacids it increases the gastric acid
output when ingested a meal.
Some antacid may combine with simethicone (Decrease surface
tension, thereby reduce bubble formation – Added to prevent reflux); it is
useful to prevent flatulence result from the production of carbon dioxide gas.
Every single compound among antacid have some side effect
especially when used for longer period or used in elderly patients. On this
basis the following combinations are in regular clinical use.
To avoid certain side effects associated with antacids,
combinations of antacids are used such as.
1. Magnesium and
aluminium hydroxides (Magaldrate)
2. Magensium and
aluminium hydroxides, dimethicone (Dioval Forte Tabs)
3. Magnesium and
aluminium hydroxides,methylpolysiloxane (Gelusil MPS)
hydroxide gel, magnesium trisilicate (Gelusil)
hydroxide gel, Magnesium hydroxide, magnesium trisilicate (Gelusil M)
dried alu, hydroxide gel, methylpolysiloxane, sod. carboxymethyl cellulose
Side effects of long term antacid
a) If pH raises too high rebound acidity to neutralize the
b) Antacids which absorbed systemically exert alkaline
effect on body’s buffer system.
c) Some antacids cause constipation while others have
d) Sodium containing antacids are problem for patients on
sodium restricted diet. e) Absorb drugs and form insoluble complexes so that
are they not absorbed.
Mechanism of action of antacids:
Al(OH)3(s) + 3 HCl(aq) —–> AlCl3(aq) + 3 H2O(l)
CaCO3(s) + 2 HCl(aq) —–> CaCl2(aq) + H2O(l) + CO2(g)
MgCO3(s) + 2 HCl(aq) —–> MgCl2(aq) + H2O(l) + CO2(g)
Mg(OH)2(s) + 2 HCl(aq) —–> MgCl2(aq) + 2 H2O(l)
NaHCO3(aq) + HCl(aq) —–> NaCl(aq) + H2O(l) + CO2(g)
Aluminium Hydroxide Gel
Synonyms: Aluminium Hydroxide Suspension; Aluminium
Hydroxide Gel contains not less than 3.5 per cent and not more than 4.4 per
cent w/w of Al2O3.
Aluminium Hydroxide Gel is an aqueous suspension of hydrated
aluminium oxide together with varying quantities of basic aluminium carbonate
and bicarbonate. It may contain Glycerin, Sorbitol, Sucrose or Saccharin as
sweetening agents and Peppermint Oil or other suitable flavours. It may also
contain suitable antimicrobial agents.
white, viscous suspension, translucent in thin layers; small amounts of clear
liquid may separate on standing.
Preparation: For preparing this a
hot solution of potash alum is added slowly to a hot solution of sodium
carbonate and not vice versa. The precipitate of aluminum hydroxide is washed
thoroughly with hot water till it is free from sulphate. The gel is then
adjusted to the required volume with distilled water.
3NaCO3 + 2KAl (SO4)2+ 3H2O → 3NaSO4+ K2SO4+2Al(OH)3 +3CO2
sodium carbonate solution is added to potash alum solution, then it is
difficult to wash out the sulphate completely. Due to adsorption by aluminum
hydroxide, some carbonate may be present.
In washing the precipitate of aluminum hydroxide hot water
not boiling water should be used as latter it may tend to decompose the
aluminum hydroxide. It is to be remembered that a hydroxide is formed instead
of aluminum carbonate. The reason is that aluminum carbonate is highly unstable
it decomposes to give aluminum hydroxide and carbon di oxide
Storage: Store at a temperature not exceeding 30°C. Do
Aluminium hydroxide is used as antacid in the management of peptic ulcer,
gastritis, gastric hyperacidity. It is also used as skin protectant and mild
Milk of magnesia: Magnesium Hydroxide
Synonym: Magnesium Hydroxide Mixture, Milk of Magnesia; Cream of Magnesia,
Magnesium Hydroxide Oral Suspension is an aqueous suspension of hydrated
It may be prepared from a suitable grade of Light Magnesium
Magnesium Hydroxide Oral Suspension contains not less than 7.0 per cent and not
more than 8.5 per cent w/w of hydrated magnesium oxide, calculated as Mg(OH)2.
white, uniform suspension, which does not separate readily on standing
Preparations: There are two methods of preparations
(a) Hydration method and (b) Hydration and Precipitation
(a) Hydration method:
Light magnesium oxide is hydrated with water to produce
MgO + H2O → Mg(OH)2.
This method is followed by industries and in Milk of
Draw backs of this
• This method
produces highly viscous preparation that is difficult to pour out.
• The pH of the
preparation is 10. This produces an alkaline taste that is unpleasant. So 0.1%
citric acid is added to reduce the alkalinity and improve the taste.
Industrially this method is used because this method does not require
(b) Hydration and Precipitation
It involves four Steps:
Step I: A calculated solution of sodium hydroxide is
triturated with calculated amount light magnesium oxide to form a smooth cream.
It is diluted with water.
Step II: The so formed cream is mixed with calculated
magnesium sulfate solution with stirring.
MgSO4 + 2NaOH →
Mg(OH)2+ Na2CO3. MgO + H2O →Mg(OH)2
Step III: After some time the magnesium hydroxide will
settle. The supernatant liquid is decanted and the precipitation is washed with
purified water. Again the supernatant liquid is decanted. This process is
continued until the preparation is free from sulfate.
Step IV: The precipitation is mixed with chloroform water to
give the final preparation. Step V. Finally the required strength of milk of
magnesia suspension is prepared as per I.P
• The product is neither very viscous nor sediment quickly.
• Produce a salty taste that is more pleasant than the
product obtained from hydration method alone.
Medicinal uses of
milk of magnesia use: As laxative, mild antacids, antiperspirant, dandruff
cure, redness reliever, oil absorber and acne buster
protected from moisture. Do not keep in a refrigerator.
limit: It contains not less than 99% and not more than 101% of NaHCO3
white, crystalline powder or small, opaque, monoclinic crystals. It gradually
forms sodium carbonate on heating in the dry state or in solution.
Method of Preparation:
1. By passing
strong brine containing high concentrations of ammonia through a carbonating
tower where it is saturated with carbon dioxide under pressure. The ammonia and
carbon dioxide reacts to form ammonia bicarbonate which is allowed to react
with NaCl to precipitate NaHCO3 which is separated by filtration.
NH3 + H2O + CO2 →
NH4HCO3 + NaCl →
2. It can also be
prepared by covering sodium carbonate crystals with water and passing carbon
dioxide to saturation.
Na2CO3 + H2O + CO2 →
acid base acidimetric titration
It is based on direct acid base acidimetric titration.
Sodium bicarbonate being basic in nature is estimated by titrating against
standard acid like hydrochloric acid or sulphuric acid, where neutralization
between acid and base takes and end point is determined by using methyl orange
as indicator until the colour changes from yellow to red.
Note: in this
titration we cannot use phenolphthalein as indicator because of formation of
carbonic acid towards end point.
NaHCO3 + H2SO4 / HCl
→ Na2SO4/ NaCl + CO2 + H2O
It is used as systemic antacid, and in electrolyte replacement.