Review of modern antacids. Clinical pharmacology of modern antacids The drug has antacid properties

Sometimes they are taken symptomatically, one-time, to instantly eliminate pain, belching, and heartburn.

In addition to the main drawback (they do not eliminate the cause, but only reduce the symptoms of the disease), antacids also have contraindications:

  • pregnancy.

The effects of absorbable and insoluble antacids are different. When and in what cases one group or the other is preferred depends on the therapeutic goals.

Features of the use of absorbable antacids


Previously, regular baking soda was widely used to relieve heartburn. Today it has been proven that such treatment has many disadvantages and is impractical.

Systemic antacids act quickly and briefly. The simplest remedy that can be bought not only at the pharmacy, but also at the grocery store is soda. Many patients, without hesitation, with abdominal pain or heartburn, make themselves a solution and drink it. There seems to be relief immediately. The pain subsides, heartburn disappears. This remedy, like other systemic antacids, is effective, but it has side effects:

  1. When absorbed antacids interact with hydrochloric acid, carbon dioxide is formed. It causes distension of the stomach, irritates the mucous membrane and promotes the development of “rebound” (reactivates gastric secretion). Provokes the development of gastroesophageal reflux.
  2. Systemic antacids do not last long. They do not eliminate the cause of unpleasant symptoms.
  3. Long-term use causes alkalosis. They are absorbed into the blood and disrupt its acid-base balance. Alkalosis is manifested by nausea, weakness,...
  4. Most systemic antacids contain sodium. It is not advisable to take it in patients with heart or kidney failure. It promotes the appearance of edema.
  5. Antacids with calcium are taken by excluding dairy products from the diet. Otherwise, milk-alkali syndrome (hypercalcemia with alkalosis) will develop. Calcium promotes the formation and reduces the excretion of parathyroid hormone.
  6. Sodium bicarbonate in combination with magnesium oxide alkalinizes urine. As a result, phosphates precipitate, and phosphate stones form in the urinary tract and in the kidney.

It is advisable to take systemic antacids once, when you need to quickly relieve pain symptom. For long-term use, in the complex treatment and prevention of acid-dependent conditions, insoluble antacids are recommended.


Features of the use of non-absorbable antacids

They do not cause the same side effects as soluble antacids, since they are not absorbed and do not enter the bloodstream. In addition to the absence of the risk of developing alkalosis, non-absorbable antacids have a number of advantages over systemic ones:

  • reduce proteolytic activity gastric juice;
  • bind lysolecithin, bile acids, protecting the mucous membrane from damage;
  • improve microcirculation;
  • promote regeneration of the mucous membrane.

Non-absorbable antacids eliminate the symptoms of acid-dependent conditions and promote the healing of ulcers, but they also have side effects. Long-term use, especially uncontrolled, leads to various complications:

  1. When taking medications containing aluminum, the absorption of phosphates in the intestine is reduced. Hypophosphatemia occurs, leading to osteomalacia. Most often, this effect is observed in patients who do not give up alcohol (even in small quantities) and in patients with renal failure.
  2. Medicines containing magnesium lead to diarrhea, and medicines containing aluminum lead to diarrhea. It is more advisable to take combined aluminum-magnesium antacids.

Insoluble antacids are long-acting drugs. In pharmacies they are sold in the form of tablets, suspensions, and gels. Liquid medications act faster, but tablets are more convenient when used multiple times throughout the day.

The possibility of a rapid therapeutic effect, primarily in the elimination (reduction of intensity) of heartburn and pain, after taking antacid drugs per os has long attracted the attention of doctors and researchers. This quality of antacid drugs distinguishes them from drugs of other classes, including H 2 -blockers of histamine receptors and proton pump inhibitors, the use of which in the treatment of patients can significantly reduce acid formation in the stomach, but their effect occurs somewhat later, and the financial cost is much higher .

The main point of application of antacid drugs is the neutralization of hydrochloric acid secreted by the parietal cells of the gastric mucosa. According to the observations of some researchers, when taking antacid drugs in usual therapeutic dosages, the acidity level is no more than 5 (the drugs neutralize only excess acidity of gastric juice), however, when the acidity level decreases to 1.3-2.3, these drugs neutralize 90% of gastric juice. juice, and at a value of 3.3 - 99% gastric juice.

Antacids They have been used for quite a long time in the treatment of patients suffering from various gastroenterological diseases, primarily acid-related diseases. Currently, a large group of diseases are classified as acid-dependent. upper sections gastro- intestinal tract, regardless of whether the factor of acid aggression is central or only additional, leading to the occurrence and progression of these disorders. Among acid-related diseases, the most common are gastric and duodenal ulcers, gastroesophageal reflux disease (GERD), non-ulcer (functional, essential) dyspepsia (NFD), pancreatitis, ulcers associated with non-steroidal anti-inflammatory drugs (NSAIDs), Zollinger-Ellison syndrome. Some researchers also include ulcers, which can occur with hyperthyroidism, as acid-related diseases. In our opinion, these disorders can also include an idiopathic hypersecretory state, peptic ulcers of gastroenteroanastomosis, which occur in some patients after gastrectomy, and, to some extent, Cushing's ulcers, as well as ulcers that appear with celiac enteropathy.

When treating patients suffering from acid-dependent diseases, various antacid drugs are used, which differ from each other to a greater or lesser extent, primarily in composition, speed of onset of the therapeutic effect, duration and effectiveness of the effect. These qualities of drugs depend to some extent on their form (tablet, gel, suspension). However, most modern antacid drugs have something in common - a decrease in concentration hydrogen ions in the stomach, resulting from the neutralization of hydrochloric acid; in addition, the neutralizing effect causes a decrease in peptic activity. In addition, in the stomach, antacid drugs bind bile acids and lezolecithin, providing an enveloping effect. Some of the antacid drugs (in particular, those containing aluminum hydroxide) also have a cytoprotective effect, which consists in enhancing the secretion of mucus and the synthesis of prostaglandins. It also turned out that antacid drugs are able to bind epithelial growth factor and fix it in the area of ​​the ulcer, stimulating cell proliferation, angiogenesis and tissue regeneration.

Taking into account the antagonistic effect of magnesium intravenously injected into the stomach on acid hypersecretion caused by calcium carbonate, products containing a mixture of calcium carbonate and magnesium oxide hydrate were created. However, such antacid drugs do not eliminate the stimulating effect of calcium carbonate on acid secretion in the stomach. In addition, antacid preparations containing calcium carbonate, when interacting with hydrochloric acid in the stomach, cause the formation of a significant amount of carbon dioxide, which leads to the appearance or intensification of flatulence, and in the presence of cardia insufficiency, including those combined with a hernia hiatus diaphragm, - belching.

The stimulatory effect of some antacid drugs on gastric acid secretion is partly associated with alkalization of the gastric antrum, the release of gastrin and possibly other neurohormonal factors, and partly with the direct effect of these antacid drugs on the parietal cells of the gastric mucosa.

Repeated attempts have been made to somehow classify antacid drugs (absorbable and non-absorbable, local and systemic, anionic and cationic, combined and monocomponent). The most common types are absorbable and non-absorbable antacid drugs. The absorbable group usually includes drugs such as sodium bicarbonate (soda), basic magnesium calcium carbonate - a mixture of Mg(OH) 2, 4MgCO 3, H 2 O, magnesium oxide (burnt magnesia), basic calcium carbonate - CaCO 3, Bourget's mixture (Na sulphate, Na phosphate and Na bicarbonate), Rennie's mixture (calcium carbonate and magnesium carbonate), Tams mixture (calcium carbonate and magnesium carbonate). These antacid drugs are characterized by the relative speed of onset of the therapeutic effect (the disadvantage is the short duration of neutralization of hydrochloric acid). Typically, these drugs, having a systemic effect, increase the alkaline reserves of the plasma, changing the acid-base balance, and neutralize (with local action) hydrochloric acid in the stomach, which in some cases can lead to “acid rebound” syndrome due to the persistent appearance of hypersecretion of acid in the stomach after taking such antacid drugs. In particular, these antacid drugs include calcium carbonate, which, soon after administration, begins to stimulate the secretion of acid in the stomach - accelerated neutralization of hydrochloric acid in the stomach, activates an increase in its secretion by the parietal cells of the gastric mucosa. In this regard, calcium carbonate is now very rarely used in the treatment of patients.

The group of non-absorbable antacid drugs most often includes drugs such as phosphalugel (aluminum salt of phosphoric acid), the so-called aluminum-magnesium antacid drugs (Maalox, Almagel Neo, Taltsid, Protab, Magalfil, etc.) and aluminum-magnesium antacid drugs with the addition of alginate (topalcan). General Feature primary action this group of drugs (when entering the stomach) has an adsorbing effect on hydrochloric acid with its subsequent neutralization. Unlike absorbable antacid drugs, non-absorbable antacid drugs have a longer-lasting antisecretory (neutralizing) effect (up to 2-3 hours), do not cause changes in acid-base balance and do not lead to an increase in the pH of the gastric contents above the neutral value, without causing “acid acid” syndrome. ricochet."

Modern antacid preparations differ among themselves and in the composition of cations (magnesium, calcium, aluminum), which largely determines their basic properties (neutralizing, adsorbent, enveloping, astringent and cytoprotective effects).

Unlike monocomponent antacids, combined antacid preparations consist of several components and have various properties, depending on the composition. Sometimes aluminum-containing preparations are isolated (phosphalugel, maalox, almagel, gelusil varnish, talcid, etc.), one of the significant advantages of which, along with the neutralization of hydrochloric acid in the lumen of the stomach, is the protection of the mucous membrane of the esophagus and stomach from the effects of the acid-peptic factor. Combined antacid drugs, especially those containing aluminum, have different mechanisms of action, including a combination that neutralizes hydrochloric acid and increases the protective properties of the mucous membrane, i.e., apparently, they also have a cytoprotective effect.

When assessing the effectiveness of antacid drugs, their acid-neutralizing ability and duration of action are most often taken into account. This fact is very important: the duration of antacid exposure is one of the main factors in assessing the therapeutic effectiveness of antacid drugs used in the treatment of patients. It is known that antacid drugs, due to their ability to be adsorbed on the gastric mucosa, cause a persistent acid-neutralizing effect, allowing them to exhibit buffer properties at a level of 2.4 pH.

The acid neutralizing activity of different antacid drugs ranges from less than 20 mmol/15 ml of antacid drug to 100 mmol/15 ml. The acid-neutralizing ability (activity) of antacid drugs is usually understood as the amount of a specific antacid drug in grams or mmol/l required to achieve a pH level of 50 ml of 0.1 N hydrochloric acid solution to 3.5.

Shortest duration Among antacid drugs, those associated with the calcium carbonate group have a somewhat longer action, with the magnesium group, and even longer with the phosphorus group (up to 90 minutes). Other data are known about the duration of action of antacid drugs, in particular those containing aluminum phosphate, which have an antacid effect due to their absorption on the gastric mucosa, which extends the duration of their buffering capacity at a pH value of 2.4 to 120 minutes.

According to a number of researchers, combinations of aluminum and magnesium hydroxides, as well as calcium and magnesium carbonates, mainly exhibit only neutralizing activity, which also includes accelerated passage of food through the stomach. A study of the properties of some antacid drugs, according to intragastric computer pH-metry, using a 3-electrode pH probe, showed that the shortest time from the start of administration of the antacid drug to the increase in pH (on average 8.9 minutes) was found in Maalox, the longest time - for Almagel (on average 13.5 minutes) compared to Remagel, Phosphalugel, Megalac; The average duration of the alkalizing effect (alkaline time - from the beginning of the pH increase to the return to the initial level) for antacid drugs ranged from 28 minutes for Almagel to 56 minutes for Maalox. At the same time, Remagel, Phosphalugel and Megalac occupied an intermediate position between Almagel and Maalox. Analysis of pH grams showed that the maximum pH values ​​after taking various antacid drugs differed slightly.

Therapy with antacids

Antacids can be used successfully in drug therapy all acid-dependent diseases in the following cases: 1) as monotherapy in the initial stages of these diseases; 2) as additional funds(for example, when treating patients with histamine H2 receptor blockers or prokinetics); 3) as a symptomatic means to eliminate (reduce intensity) heartburn and pain in the chest and/or epigastric region, both during the treatment of patients, combining their use with other drugs, and during the period of remission (including as therapy “ on demand"); 4) during the screening phase before the start of the intended treatment, when selecting patients for randomized studies to study the effectiveness and safety of certain medications or schemes for their use (as a rule, the use of antacids is allowed according to the protocols of these studies), as well as directly during such studies as emergency therapy in cases where the effectiveness and safety of prokinetics, H 2 -blockers of histamine receptors, proton receptor inhibitors are being studied. pump or so-called cytoprotective drugs.

In such cases, the undoubted advantage of antacid drugs is taken into account - the rapid elimination (reduction of intensity) of heartburn (burning) behind the sternum and / or in the epigastric region and others gastrointestinal symptoms caused by the disease itself, for which patients are being treated, by taking medications and intoxication.

One of the antacid drugs that periodically attracts the attention of researchers and doctors is phosphalugel (colloidal aluminum phosphate in the form of an oral gel containing 8.8 g in one sachet). Phosphalugel is often classified as a non-absorbable antacid drug. Most of the aluminum phosphate gel is insoluble, but at a pH less than 2.5, the phosphalugel turns into water-soluble ammonium chloride, some of which is able to dissolve, after which further dissolution of the aluminum phosphate is suspended. A gradual decrease in the acidity level of gastric contents to pH 3.0 does not lead to the occurrence of “acid rebound”: the use of phosphalugel in the treatment of patients does not lead to the appearance of secondary hypersecretion of hydrochloric acid.

One of the advantages of phosphalugel is its acid-neutralizing ability depends on the level of acidity: the higher the acidity, the more active the effect of this drug. An increase in pH under the influence of the drug leads to a decrease in the proteolytic activity of pepsin. The drug does not cause alkalization of gastric juice, does not limit enzymatic processes and does not disrupt the physiological conditions of the digestion process. Long-term use The drug does not affect phosphorus metabolism. The actual effect of phosphalugel, which is in the form of hydrophilic colloidal micelles of the drug, is determined by colloidal aluminum phosphate, which has an antacid, enveloping and adsorbing effect. A small part of phosphalugel precipitates in the intestine in the form of oxides and insoluble carbonates, which enhances its protective, adsorbent and antacid effect. One gram of aluminum phosphate gel micelles, consisting of aluminum phosphate, agar gel and pectin, has a contact surface of about 1000 m², which ensures intensive communication with the walls of the digestive tract and adsorption of harmful substances. Gels of pectin and agar-agar, which are part of the drug, are involved in the formation of a mucoid, antipeptic protective layer in the gastrointestinal tract. Colloidal aluminum phosphate binds endogenous and exogenous toxins, bacteria, viruses, gases formed as a result of putrefaction and pathological fermentation throughout the gastrointestinal tract, normalizing their passage through the intestines and thereby facilitating their removal from the body of patients. Under the influence of the drug, they weaken and painful sensations. Adults and children over 6 years of age are usually prescribed 1-2 sachets 2-3 times a day immediately after meals and at night (for reflux esophagitis) or more often (for other diseases) - 1-2 hours after meals.

One of the antacid drugs, which has also recently attracted the attention of doctors, is hydrotalcite (rutacid, talcid), a drug with low content aluminum and magnesium. Among the features of the mechanism of action of this drug is the gradual release of aluminum and magnesium ions depending on the pH state of the gastric contents. Other advantages of hydrotalcite are the rapid and long-lasting neutralization of hydrochloric acid while maintaining a pH close to normal level, a protective effect on the gastric mucosa with a decrease in the proteolytic activity of pepsin, binding of bile acids, as well as the form of release of the drug - in the form of chewable tablets, which should be chewed thoroughly. When treating adult patients, hydrotalcite is usually prescribed 500-1000 mg (1-2 tablets) 3-4 times a day, 1 hour after meals and before bedtime; after errors in the diet, accompanied by the appearance of symptoms of discomfort, as well as in case of alcohol abuse - 1-2 tablets once. For children aged 6-12 years, the dosage is reduced by 2 times. The duration of treatment is determined general condition sick. It is not recommended to take this drug at the same time as drinking acidic drinks (juices, wine).

It is known that, along with dyspeptic disorders usually associated with various diseases esophagus and stomach, a significant part of patients are bothered by flatulence, which occurs due to various reasons, including in patients, according to our observations, long time taking proton pump inhibitors. The appearance on the Russian domestic market of a new antacid water-soluble drug Almagel Neo, containing in its composition the optimal amount of aluminum hydroxide and magnesium hydroxide (compared to the previously widely known Almagel suspension, the content of the latter is increased by 3.9 times) and simethicone (defoamer) introduced into its composition , allows patients with preserved and increased gastric secretion to obtain a positive effect in eliminating symptoms of discomfort, including flatulence, in short terms(on average on the fifth to seventh day); Only in cases of severe symptoms of flatulence, treatment of patients with Almagel Neo should begin with the use of 60 ml/day. The effectiveness of this drug is due to its high acid-neutralizing ability, the presence in its composition of simethicone (a surfactant that reduces the external tension of gas bubbles), which promotes the natural release of intestinal gases and their absorption, which to a certain extent prevents the occurrence of stool retention (constipation) and flatulence , reduces the likelihood of belching. The presence of neosorbitol in Almagel allows it to be used in the treatment of patients who, along with one of the acid-dependent diseases, also have diabetes. The usual dosages for prescribing this drug to patients are: orally for adults, 1 sachet or 2 dosage spoons 4 times a day, 1 hour after meals and at night; For children over 10 years of age, the dosage of the drug is determined by the attending physician (taking into account the body weight and condition of the child).

Known different variants prescribing antacid drugs to patients for various diseases, but most often antacid drugs are prescribed in the following cases: with so-called “on-demand” therapy to quickly eliminate (reduce the intensity) symptoms of dyspepsia, especially heartburn and pain (at any time of the day); during a course of treatment 30-40 minutes before or 30-60 minutes after a meal (if necessary and before bedtime) as monotherapy or in complex treatment, in combination, first of all, with prokinetics and/or with H2 histamine blockers receptors (the frequency and duration of taking antacid medications are determined by the general condition of the patients). The positive effect of antacid drugs in eliminating pain in the chest and/or epigastric region and/or heartburn (burning) in itself indicates the presence of an acid-dependent disease in the patient. Most often, as observations show, antacid drugs may be necessary in the treatment of patients suffering from peptic ulcer disease, chronic pancreatitis, GERD and/or NFD, which can be combined with chronic hyperacid or normacid gastritis, and is also possible in patients with NFD syndrome without morphological signs of gastritis.

As our observations have shown, it is most advisable to use antacid drugs in the following cases. At peptic ulcer, associated with Helicobacter pylori (HP), after eradication therapy when pain and/or dyspeptic disorders, especially heartburn, appear in patients. However, due to the adsorbing ability of antacid drugs, their use directly during eradication therapy is not justified Helicobacter pylori: during this period, patients take quite a lot of tablets or capsules - 6 times a day the basic drug (proton pump inhibitor, ranitidine or bismuth drug) in combination with 2 antibiotics (first-line therapy) or 13 times a day 4 drugs (second-line therapy) , since the likelihood of a decrease in the effectiveness of both antibiotics and the basic drug(s) increases. Taking into account the number of medications used by patients during the day and necessary to obtain the eradication effect, i.e., the destruction of Helicobacter pylori (HP), in the case of additional prescription of antacid drugs, the number of tablet forms of drugs will exceed the specified number of drug doses (taking into account dosages), more than 6 and 13 times a day in first- and second-line therapy, respectively.

For peptic ulcers not associated with HP, antacid drugs can be successfully used as independent therapy for newly diagnosed, uncomplicated duodenal ulcers (with small ulcers), as well as as additional therapy for gastric and duodenal ulcers to H 2-histamine receptor blockers, or in on-demand therapy for them or proton pump inhibitors. The success of treating patients largely depends on the depth of the ulcer.

When comparing the results of a 4-week treatment of 2 groups of patients suffering from uncomplicated duodenal ulcer (one of the groups was treated with various antacid drugs in “liquid” form or in tablet form, 4-6 times a day, which had different neutralizing abilities - from 120 to 595 mEq of H+ anions per day, another group of patients was treated in therapeutic doses with H 2 -histamine receptor blockers), no significant differences were noticed in the time of disappearance clinical symptoms and healing of ulcers. Another study compared the results of treatment of 42 patients treated with phosphalugel 11 g of aluminum phosphate gel 3 times a day (after meals) for 4 weeks, and treatment of 49 patients treated with ranitidine 150 mg 2 times a day also for 4 weeks , showed the following: healing of duodenal ulcers was noted in 60 and 55% of cases, respectively. According to another study, based on an analysis of the results of a 6-week treatment of 153 patients who received aluminum phosphate (1 sachet = 11 g of gel) 5 times a day, ulcer healing was established in 65% of cases.

Depending on the stage of treatment of GERD, antacid drugs can be effectively used in the following cases: as the main drug in some patients with endoscopic negative GERD and with GERD in the stage of mildly expressed reflux esophagitis (with minimal severe symptoms); in combination with H 2 -blockers of histamine receptors in the course treatment of patients with GERD in the stage of slightly or moderately severe reflux esophagitis, as well as during on-demand therapy; during a course of treatment of patients with GERD in the stage of erosive reflux esophagitis in combination with H 2 -histamine receptor blockers, in on-demand therapy in combination with constant treatment patients with proton pump inhibitors (during exacerbation of the disease); during a course of treatment of patients with GERD in the stage of peptic ulcer of the esophagus in combination with H 2 -histamine receptor blockers or in on-demand therapy (while treating patients with proton pump inhibitors).

To improve the condition of patients, it is advisable to use antacid drugs in the treatment of patients suffering from other diseases: in particular, when erosive and ulcerative lesions stomach and duodenum associated with non-steroidal anti-inflammatory drugs, with erosive and ulcerative lesions of the upper gastrointestinal tract, the occurrence of which is possible with decompensated cirrhosis of the liver, with peptic ulcer disease combined with gluten enteropathy, and with Zollinger-Ellison syndrome.

During the treatment of patients with the listed diseases, it is advisable to use antacid drugs during a course of therapy in combination with H 2 -histamine receptor blockers (in on-demand therapy and with proton pump inhibitors).

The use of antacid drugs is useful, as observations have shown, in the treatment of patients with acute gastritis (as an additional adsorbent agent for various types of acute gastritis); as an additional therapy (to H2-histamine receptor blockers or proton pump inhibitors) for Cushing's ulcers; in the treatment of patients with peptic ulcers of gastroenteroanastomosis and patients with chronic pancreatitis. Antacids are used in combination with H2-blockers or proton pump inhibitors as on-demand therapy.

It is advisable to use antacid drugs in the treatment of patients with functional diseases intestines to eliminate pain and/or discomfort. It was shown that one dose of aluminum phosphate gel with a volume of 100 to 300 ml, administered per os, just before taking a dose of radiostrontium 85Sr, reduced the absorption of the latter by 87.5%, while a dosage of 100 ml of aluminum phosphate gel was as effective as 300 ml, which indicates other possibilities for using antacid drugs.

It is known that aluminum phosphate gel, which is a combination of an antacid and substances that cover and protect the mucous membrane from the pathological effects of acid and bile acids, helps eliminate (reduce) their “irritating” (pathological) effect on the mucous membrane of the esophagus and stomach, which makes it possible to recommend short-term use of this drug in pregnant women or during lactation after childbirth. The same advantages of phosphalugel (cytoprotective effect of the drug) protect the mucous membrane from damage and from the effects of alcohol.

As a symptomatic (additional) remedy for eliminating (reducing the intensity) symptoms of dyspepsia, antacid drugs can also be used in the treatment of patients with organic dyspepsia of various etiologies(for example, before surgical treatment patients, if necessary, and after it), as well as to eliminate symptoms of discomfort in people who consider themselves healthy.

Features of prescribing antacids

When prescribing antacid drugs, it is necessary to take into account the mechanism(s) of their action and the symptoms of diseases observed in specific patients (constipation, diarrhea, etc.). In particular, in the presence of diarrhea (as additional means, if necessary), it is advisable to treat patients with antacid drugs containing aluminum (almagel, phosphalugel, rutacid, talcid); for constipation - antacid medications that contain magnesium (Gelusil Lac, Gastal, etc.).

It is known that antacid drugs (when entering the body of patients) have an adsorbing ability, due to which it is possible to reduce the activity and bioavailability of some medications taken by patients (for example, H 2 -blockers of histamine receptors, non-steroidal anti-inflammatory drugs, antibiotics, etc.) . Therefore, when prescribing antacid drugs in combination with other drugs, it is advisable to recommend that patients observe the time interval between taking antacid drugs and other drugs (before or after, about 2-2.5 hours), i.e., indicate the time patients take specific drugs during the day .

According to our observations, the effect of taking antacid drugs produced in the form of gels or suspensions (compared to tablet forms) occurs faster, although the tablet form seems somewhat more convenient for storage (especially when traveling).

When deciding on the use of antacid drugs, especially long-term (in high dosages), it is necessary to take into account the possibility of side effects. Side effects that are possible in some patients while taking antacid drugs largely depend on the individual characteristics of the patient, the dosage of antacid drugs and the duration of their use. Constipation or diarrhea (depending on the particular antacid drug used in the treatment of patients) are the most common side effects that occur in patients while taking antacid drugs. Significant increase in dosage of antacid drugs - main reason the appearance of constipation or diarrhea, and long-term, uncontrolled use - the appearance of metabolic disorders.

In particular, one of the features of the action of magnesium-containing antacid drugs is increased motor function intestines, which can lead to normal stool, but if taken in excess, it can lead to the development of diarrhea. An overdose of magnesium-containing antacid drugs (an increase in Mg+++ ions in the patient’s body) increases the magnesium content in the patient’s body, which can cause bradycardia and/or insufficiency of renal function.

Antacid drugs containing calcium, in case of overdose, cause an increase in Ca++ in the body of patients (the occurrence of hypercalcemia), which can lead to the so-called “alkaline” syndrome in patients suffering from urolithiasis, which, in turn, contributes to increased formation of stones. A decrease in the production of parathyroid hormone can lead to a delay in the excretion of phosphorus, an increase in the content of insoluble calcium phosphate and, consequently, to calcification of the body tissues of patients and the occurrence of nephrocalcinosis.

The level of aluminum absorption may be different for different drugs, which must be taken into account when determining the possible risk of side effects due to the fact that antacid drugs containing aluminum in some patients, especially with prolonged use, can cause hypophosphatemia, with renal failure- encephalopathy, osteomalacia (with an aluminum level of more than 3.7 µmol/l), clinical symptoms considered characteristic of poisoning (with an aluminum concentration of more than 7.4 µmol/l). It is also necessary to take into account the fact that the lower toxicity of aluminum phosphate A1PO4, compared to aluminum hydroxide A1(OH)3, is due to its greater resistance to dissolution and the formation of neutral complexes in the presence of acids usually contained in food, which indicates the lower toxicity of the phosphate aluminum

As a rule, the occurrence of side effects can be avoided if, when prescribing antacid drugs, the mechanism of their action, the condition of specific patients is taken into account, and, in addition, if detailed explanatory work is carried out with patients before prescribing antacid drugs.

For questions regarding literature, please contact the editor.

Yu. V. Vasiliev,doctor medical sciences, Professor

Central Research Institute of Gastroenterology, Moscow

Among medications that affect the digestive system, the group of antacids is used less frequently. The reason for this is the presence of other drugs that suppress acid production. However, antacids can also be used, although much less frequently. Due to the safety, especially characteristic of non-absorbable antacids, their use is also expanding to include pregnant women. Overall this is safe medicines, who have clinical deficiencies, but there are also objective advantages.

Due to the most important drawback, that is, the “rebound” phenomenon, antacid drugs are used noticeably less frequently in the treatment of esophageal, gastric and intestinal diseases. The essence of the “ricochet” comes down to a compensatory increase in the amount of acid secreted by parietal gastric cells in response to its neutralization by antacids. At first, the gastric pH level will increase, but then the acidity will increase (the pH will drop even more than before). This limits the possibilities of antacids for acid formation disorders.

Place of antacids in pharmacological classification

The group of drugs that affect the secretory abilities of the stomach includes many substances, including drugs of the antacid group. All gastrotropic drugs are divided into two types according to the purpose of use. The first is products that compensate for insufficient gastric secretion; they contain enzymes and artificial gastric juice, as well as substances used for excess secretion. The latter include non-absorbable and absorbable antacids.

Non-absorbable ones make up the bulk of antacids, as they do not have a systemic effect. They do not disturb blood pH and are safe for use by children and pregnant women. However, during lactation it is irrational to use them, since the absence of undesirable effects has not been proven. Although theoretically, since they do not enter the blood and cannot penetrate breast milk, one can justify their safety during lactation.

Classification of antacids

All antacids medications are divided into two different groups: absorbable and non-absorbable substances. Their mechanisms of action are therefore different. Absorbable ones include:

  • sodium bicarbonate is the simplest antacid with a quick effect, but tends to form foam in the stomach;
  • magnesium oxide is a safer substance, but tends to cause hypermagnesemia;
  • calcium carbonate (it is safer than magnesium oxide, although it tends to cause hypercalcemia);
  • basic (alkaline) calcium carbonate is less absorbed and therefore safer than the previous one;
  • basic (alkaline) magnesium carbonate is safer than magnesium oxide and is equally effective as alkaline calcium carbonate;
  • Bourget's mixture (composition of sodium bicarbonate, sulfate and phosphate);
  • mixtures of calcium and magnesium carbonates.

All of these antacid drugs are named after the substances they consist of. Only in the latter case does the mixture of antacid substances bear the trade name of the drug. These are Rennie's, Andrew's Antacid, and Tums. However, in terms of effectiveness, all absorbable ones are approximately the same, and they quickly provide the effect of reducing acidity. However, due to disturbances in the plasma electrolyte profile, they are less safe than their non-absorbable class counterparts.

Non-absorbable antacids

These include insoluble compounds of magnesium, calcium and aluminum, which, after chemical reaction with hydrochloric acid they do not form gas and are not absorbed into the blood. These are more advanced antacid drugs, the list of which is presented as follows (according to the ATC code):

  • A02AA - preparations based on magnesium;
  • A02AB - based on aluminum and its insoluble salts;
  • A02AC - calcium antacids;
  • A02AD - antacids of a combined composition containing salts and complex compounds of aluminum, magnesium, calcium and silicates.

The most common now are aluminum-magnesium or aluminum-magnesium-calcium antacids. This is explained by many positive effects from combining. Side effects are also mutually neutralized: for magnesium salts it is diarrhea, and for aluminum derivatives it is constipation. Modern antacids are combined with antispasmodics.

Therapeutic groups of non-absorbable antacid drugs

The composition of insoluble antacids determines their therapeutic properties. Depending on this, the type of medicine suitable for treating a particular disease is selected. The composition of antacids can be as follows:

  • aluminum phosphates (“Phosphalugel”);
  • alhydrate with magnesium hydroxide (“Almagel”, “Palmagel”, “Altacid”, “Gastratsid”, “Alumag”, “Maalukol”, “Maalox”);
  • sodium-calcium combinations, aluminum-magnesium-silicate antacid preparations with alginate (Gaviscon, Topalkan);
  • simethicone in combination with aluminum-magnesium preparations (Almagel Neo, Gestid, Relzer).

“Phosphalugel” does not alkalize the contents of the stomach and intestines and is most active at high acidity. The higher it is, the more important the therapeutic use of Phosphalugel. The second category of drugs is most often used in the treatment of ulcers and hyperacid gastritis. They are safe and effective, although at very low pH values ​​it is better to use aluminum phosphates.

The third category of drugs has important feature: alginates prevent the reflux of acidic contents into the esophagus. By eliminating gastroesophageal reflux, they effectively help in the treatment of GERD. On the one hand, these drugs neutralize acidity, and on the other, they protect the esophageal mucosa in its lower third from the aggressive effects of gastric contents. All antacid preparations (examples) containing alginates presented above are effective medications with GERD.

“Almagel Neo”, “Relzer” or “Gestid” differ slightly from their predecessors. They are more similar to the second group of antacids, that is, combinations of insoluble aluminum and magnesium salts. However, due to the presence of the carminative "Simethicone", they eliminate flatulence. This effect is important with clinical point vision because gases stretch the stomach and intestines, causing cells to produce acid. Absorbable antacids also have this drawback, in which it provokes the “ricochet” phenomenon.

Other effects of antacids

Analyzing the substances on the basis of which antacid drugs were developed, the list of their effects should be expanded. Their effect is not only to reduce acidity by binding chlorine, but also to protect the cells of the gastric mucosa. This effect is called gastrocytoprotection. It is most pronounced in aluminum-containing antacids. Aluminum phosphate potentiates the rate of prostaglandin synthesis, due to which the frequency of cell divisions in the stomach increases. This substance is also capable of binding bile acids if they enter the stomach.

In the intestine, the binding of bile acids is less important. In the stomach, the pathogenic effect on the epithelium is thus reduced, which helps prevent the development of chronic gastritis type "C". It is caused by the reflux of bile into the stomach. But in the intestines, the binding of bile acids leads to constipation. For this reason, aluminum-containing antacid preparations, the list of which is listed above, must be combined with magnesium-containing ones. As you can see, antacids can not only neutralize stomach acid, but also regulate intestinal motility and epithelial restoration.

Indications

If we analyze antacid drugs, the list of their therapeutic and side effects, as well as the features of the composition and pharmacological action, indications for their use can be determined. They depend on the specific type of antacid and the specific disease and associated conditions. Diseases requiring the use of antacids are the following:

  • GERD (gastroesophageal reflux disease);
  • any diseases that provoke GERD (achalasia cardia, hiatal hernia);
  • treatment of conditions after chemical or thermal burns esophagus;
  • stomach ulcer;
  • erosive gastropathy;
  • duodenogastric reflux disease;
  • duodenal ulcer.

All of the above antacid drugs (list) are unsuitable for monotherapy of any of the listed diseases. The most competent treatment is to combine them with agents that reduce the secretion of hydrochloric acid. They are the first line drugs. These are histamine H2 receptor blockers and proton pump inhibitors. However, if necessary, antacid and antisecretory drugs are effectively combined, accelerating the healing of ulcers and erosions.

Selection of antacids

Some antacid drugs, the names of which are indicated above, should be considered as the means of choice for certain pathologies. In particular, for GERD it is rational to use combinations of aluminum-magnesium-silicate antacids with alginate. These are “Almagel”, “Palmagel”, “Altacid”, “Gastratsid”, “Alumag”, “Maalukol”, “Maalox” and other analogues in composition.

In case of chronic hyperacid gastritis type “C”, as in any hyperacid conditions, it is reasonable to choose the drug “Phosphalugel”. It is also preferable for duodenogastric reflux. In other clinical situations, the choice depends on the person's underlying conditions. If he often experiences constipation, it is preferable to prescribe magnesium antacids. In children, it is better to use aluminum-magnesium preparations.

For stomach and (or) duodenal ulcers, any non-absorbable antacid drugs are used. Their list is wide due to the presence of many product names. Often, you should initially take one antacid with pain relief, and then use another substance without it. The anesthetic antacid is Almagel A, which contains anesthesin (benzocaine). It should be taken for 3-4 days if the ulcer or erosion is accompanied by severe pain, and then replace it with another antacid, without an anesthetic. Without medical supervision, you are allowed to take antacids for no more than 14 days.

Use of antacids during pregnancy

All non-absorbable antacids are safe during pregnancy because they cannot be absorbed into the blood. The inability of them to provide a resorptive effect provides this property. Therefore, during any period of pregnancy, antacid medications that are not absorbed into the blood cannot harm either the mother’s body or the fetus. The exception is the group of absorbable antacids, which theoretically can cause harm due to electrolyte and acid-base imbalances. Until the danger of using absorbable antacids during pregnancy has not been ruled out, their use should be avoided.

During lactation, the safety of antacids remains uncertain. No tests have been carried out with breastfeeding women, which means there is a possibility of an as yet unproven harmful effects. This risk is high with absorbable antacids and should theoretically be absent with non-absorbable ones. However, due to the lack of research information, as well as the lack of clinically significant experiments, prescribing any antacids to a woman during lactation is contraindicated.

Use in pediatrics

In accordance with the legislative norms of the Russian Federation, it is prohibited in the country to give proton pump inhibitors to children early age. In this regard, if diseases of the stomach or duodenum occur, it is necessary to use antacids or histamine H2 receptor blockers. The inability to absorb and provide a resorptive effect makes children's antacid drugs safe. They do not cause harm or damage the gastrointestinal tract, although they do have some side effects.

However, in pediatric practice, children's antacid medications cannot be used widely, because there are only a small number of diseases that require their use. In adult patients, on the contrary, there are significantly more indications. In children, stomach ulcers, erosions, and diseases of the duodenum are much less common. In addition, the use of aluminum-magnesium or exclusively aluminum non-absorbable antacids can lead to constipation.

It is noteworthy that there are no absorbable antacids for children. The reason for this is the risk of shifting the electrolyte and acid-base balance. In children normal concentrations change within smaller limits, which is why the risks of harm to a child from hypercalcemia, hypermagnesemia or alkalosis are significantly higher than in an adult. Effective drugs in in this case Non-absorbable antacids that do not have sodium bicarbonates should be considered: Almagel, Alumag, Maalox. Phospholugel is not recommended for use due to the possibility of constipation.

Limitations on the use of antacids

Antacid drugs, the classification of which indicates the presence of two types medicinal substances groups are somewhat limited in application. This is due to pharmacokinetic and pharmacodynamic characteristics, impaired absorption of food and other medications, as well as inadequate acid-suppressing effect. The short-term effect, requiring frequent use of the antacid, is also an important limitation of its use.

The duration of the acid-suppressing effect of non-absorbable antacids is 2-3 hours. Therefore, there is a need to use them 4-6 times a day, which is inconvenient in practical terms. Moreover, in the case of a stomach ulcer or hyperacid gastritis, antacids are able to maintain the pH at a level of 3-4. Without the use of drugs, the pH level is 1-1.5, which is characterized as a strong acidic environment.

A short-term decrease in acidity to 3-4 units does not have an important therapeutic effect. Moreover, after approximately 2 hours from the moment of application, the pH values ​​are restored. This means that the damaging factor that provoked the appearance of chronic inflammation, erosions or ulcers continues to act. This characterizes antacids as inferior and unsuccessful drugs for monotherapy of esophageal and gastric diseases.

Due to the pharmacological characteristics described above, antacids have given way to histamine receptor blockers in the treatment of gastrointestinal diseases. The latter are less effective than modern proton pump inhibitors. Therefore, most often in the treatment of hyperacid conditions, ulcers and erosions, preference is given to them. Examples of drugs are: Omeprazole, Esomeprazole, Pantoprazole, Lanzoprazole. They are well tolerated and have minimal clinically significant side effects.

Objective place of antacid drugs

Assessing the pharmacodynamic and pharmacokinetic characteristics of antacids, one can draw an obvious conclusion about possible areas use of antacid drugs. Obviously, their effects are not enough for monotherapy of ulcers, erosive gastropathy, and GERD. Therefore, only a few areas of clinical use remain for non-absorbable antacids:


All antacid drugs (names listed above) are used mainly on an empty stomach, that is, 1 hour before meals or 2 hours after last appointment food. They need to be taken 4-6 times a day due to their short-term acid-suppressing effect. Inhibitors of H+ pumps or histamine H2 receptors are used once a day. Provided that antacids interfere with the absorption of others, more active drugs, they should not be used before taking proton pump inhibitors.

Antacids also interfere with the absorption of antibiotics, can bind them and reduce them antibacterial activity in the treatment of Helicobacter pylori infection. In the case of the use of other drugs, it should be expected that while taking non-absorbable antacids, the resorption of other drugs will be impaired. Their therapeutic value decreases significantly. Therefore, many clinicians recommend against prescribing antacids if plasma concentrations of other drugs are of paramount importance.

IN this group includes agents that neutralize hydrochloric acid and reduce the acidity of gastric juice. These are anti-acid drugs. Usually this chemical compounds with the properties of weak bases, they neutralize hydrochloric acid in the lumen of the stomach. Reducing acidity is of great therapeutic importance, since the activity of pepsin and its digestive effect on the gastric mucosa depend on its quantity. The optimal pH value for pepsin activity ranges from 1.5 to 4.0. At pH = 5.0, pepsin is inactive.

Therefore, it is desirable that antacids raise the pH no higher than 4.0 (it is optimal that when taking antacids, the pH of the gastric juice is 3.0-3.5), which does not interfere with the digestion of food. Typically, the pH of gastric contents normally ranges from 1.5 to 2.0. Pain syndrome begins to subside when the pH becomes more than 2. In this sense, the role of antacids is twofold.

There are systemic and non-systemic antacids. Systemic antacids are drugs that can be absorbed, and therefore not only produce effects in the stomach, but can also lead to the development of alkalosis in the body as a whole. Non-systemic antacids are not absorbed, and therefore are able to neutralize acidity only in the stomach, without affecting the acid-base state of the body.

Antacids include SODIUM HYDROCARBONATE (baking soda), CALCIUM CARBONATE, ALUMINUM and MAGNESIUM HYDROXIDE, magnesium oxide. Typically, these substances are used in different dosage forms and in different combinations.

Systemic antacids include sodium bicarbonate and sodium citrate, while the rest of the above drugs are non-systemic.

Sodium bicarbonate (baking soda) is a compound that is highly soluble in water and reacts quickly in the stomach with hydrochloric acid. The reaction proceeds with the formation of sodium chloride, water and carbon dioxide. The drug acts almost instantly. Although sodium carbonate acts quickly, its effect is short-lived and weaker than that of other antacids. The carbon dioxide formed during the reaction stretches the stomach, causing bloating and belching. In addition, taking this drug may cause rebound syndrome. The last one is that rapid rise The pH in the stomach leads to the activation of parietal G cells in the central part of the stomach, which produce gastrin.

Gastrin stimulates the secretion of hydrochloric acid, which leads to the development of hyperacidity after the cessation of the action of the antacid. Typically, the “recoil” syndrome develops after 20-25 minutes.

Due to good absorption from the gastrointestinal tract, sodium bicarbonate can cause systemic alkalosis, which will be clinically manifested by decreased appetite, nausea, vomiting, weakness, abdominal pain, spasms and muscle cramps. It's pretty dangerous complication, requiring immediate discontinuation of the drug and assistance to the patient. Due to the severity of these side effects, sodium bicarbonate is used extremely rarely as an antacid.



Non-systemic antacids, as a rule, are insoluble, act in the stomach for a long time, are not absorbed, and are more effective. When using them, the body does not lose either cations (hydrogen) or anions (chlorine), and there are no changes in the acid-base state. The effect of non-systemic antacids develops more slowly, but is longer lasting.

First of all, it should be mentioned:

1) aluminum hydroxide;

2) magnesium oxide.

ALUMINUM HYDROXIDE (aluminum hydroxide; Aluminii hydroxydum) - a drug with moderate strength antacid action, acts quickly and effectively, showing a significant effect in about 60 minutes.

The drug binds pepsin, reduces its activity, suppresses the formation of pepsinogen and increases mucus secretion.

One gram of aluminum hydroxide neutralizes 250 ml of decinormal hydrochloric acid solution to pH = 4.0.

In addition, the drug has astringent, enveloping and adsorbing effects.

Side effects: not all patients tolerate the astringent effect of the drug well, which may result in nausea; Taking aluminum preparations is accompanied by constipation, so aluminum-containing preparations are combined with magnesium preparations. Aluminum hydroxide promotes the removal of phosphates from the body.

The drug is indicated for diseases with increased secretion of gastric juice (hydrochloric acid): ulcers, gastritis, gastroduodenitis, food poisoning, flatulence. Aluminum hydroxide is prescribed orally in the form of a 4% aqueous suspension, 1-2 teaspoons per dose (4-6 times a day).

Magnesium oxide (Magnesii oxydum; powder, gel, suspension) burnt magnesia is a strong antacid, more active than aluminum hydroxide, acts faster, lasts longer and has a laxative effect.

Each of the listed antacids has a certain range of advantages and disadvantages. In this regard, their combinations are used.

The combination of aluminum hydroxide in the form of a special balanced gel, magnesium oxide and D-sorbitol made it possible to obtain one of the most common and effective antacid drugs at present - ALMAGEL (Almagel; 170 ml; the drug was named from the words al-aluminum, ma-magnesium , gel-gel). The drug has an antacid, adsorbent and enveloping effect. Gel-like dosage form promotes uniform distribution of ingredients over the surface of the mucous membrane and prolongation of the effect. D-sorbitol promotes bile secretion and laxation.

Indications for use: stomach and duodenal ulcers, acute and chronic hyperacid gastritis, gastroduodenitis, esophagitis, reflux esophagitis, Zollinger-Ellison syndrome, pregnancy heartburn, colitis, flatulence, etc.

There is a drug called Almagel-A, in which, in addition to the composition of Almagel, anasthesin is added, which has both a local anesthetic effect and suppresses gastrin secretion.

Almagel is usually used 30-60 minutes before meals, and also within an hour after meals. The drug is prescribed individually depending on the localization of the process, the acidity of gastric juice, etc.

Preparations similar to Almagel:

Gastrogel (Czechoslovakia);

Phosphalugel (Yugoslavia) contains aluminum phosphate and colloidal gels of pectin and agar-agar, which bind and absorb toxins and gases, as well as bacteria, reduce the activity of pepsin;

Megalak (Germany);

Mylanta (USA) contains aluminum hydroxide, magnesium oxide and simethicone;

Gastal (Yugoslavia) - tablets, which contain: 450 mg of aluminum hydroxide - magnesium carbonate gel, 300 mg of magnesium hydroxide.

Currently, the most popular drug from the group of antacids in many countries around the world is the drug MAALOX (Maalox) from the French company Rhone-Poulenc Rorer. The composition of the drug includes aluminum hydroxide and magnesium oxide. Maalox is available in the form of a suspension and tablets; 5 ml of Maalox suspension contains 225 mg of aluminum hydroxide, 200 mg of magnesium oxide and neutralizes 13.5 mmol of hydrochloric acid; The tablets contain 400 mg of aluminum hydroxide and magnesium oxide, so they have higher acid-neutralizing activity (up to 18 mmol of hydrochloric acid). Maalox-70 is even more active (up to 35 mmol of hydrochloric acid).

The drug is indicated for gastritis, duodenitis, peptic ulcer of the stomach and duodenum, reflux esophagitis.

There are practically no side effects. MEGALAC - German drug, an analgesic antacid (hydrous aluminum-magnesium silicate). It contains 0.2 aluminum oxide, 0.3 magnesium oxide and 0.02 oxetaine.

TOPALCAN is a French antacid drug. It contains alginic acid, colloidal aluminum hydroxide, magnesium bicarbonate, hydrated silicon in a precipitated shapeless state. The drug has a foaming effect, forms a gel on the surface of the liquid contents of the stomach, and covers the mucous membrane; acts quickly (6-14 minutes) and for a long time (2-4 hours). Beneficial for esophagitis, reflux esophagitis.

DRUGS THAT PROTECT THE STOMACH MUCOSA FROM ACID-PEPTIC INFLUENCE AND IMPROVE REPAIR PROCESSES

1. Bismuth preparations (vikalin, vikair, de-nol).

2. Venter.

3. Prostaglandin preparations.

4. Dalargin.

Bismuth preparations are used as astringents and antiseptics in the treatment of patients with peptic ulcers. Most often these are combined tablets - VIKALIN (bismuth basic nitrate, sodium bicarbonate, calamus rhizome powder, buckthorn bark, rutin and kellin). Related drug VIKAIR (no rutin and kellin).

In recent years in medical practice included drugs that more powerfully protect the mucous membrane from acid-peptic effects. These are colloidal bismuth preparations of the second generation, one of which is DE-NOL (De-nol; 3-potassium dicitrate bismuthate; each tablet contains 120 mg of colloidal bismuth subcitrate). This drug envelops the mucous membrane, forming a protective colloidal protein layer on it. They do not have an antacid effect, but exhibit antipeptic activity by binding pepsin. The drug has antimicrobial effect, it is significantly more effective than bismuth-containing antacids and increases mucosal resistance. De-nol cannot be combined with antacids.

The drug is used for any location of the ulcer, it is highly effective for:

ü long-term non-scarring ulcers of the stomach and duodenum;

ü peptic ulcer in smokers;

ü prevention of relapses of peptic ulcer;

ü chronic gastritis.

Prescribe 1 tablet three times a day half an hour before meals and 1 tablet before bedtime. De-nol is contraindicated in severe renal failure.

VENTER (sukrat; in tablets of 0.5) is a basic aluminum salt of sucrose octasulfate. The antiulcer effect is based on binding to the proteins of dead tissue into complex complexes that form a strong barrier. Gastric juice is locally neutralized, the action of pepsin is slowed down, and the drug also absorbs bile acids. The drug is fixed at the site of the ulcer for six hours.

Venter and de-nol cause scarring of duodenal ulcers in three weeks.

Sukrat is used 1.0 four times a day before meals, and also before bed.

Side effect: constipation, dry mouth.

Preparations that improve trophism, regeneration and mucus formation.

There are many drugs among the “reparants” plant origin, There is biological drugs and artificially synthesized.

Most often used in gastroenterology practice the following drugs:

I generation:

Sodium oxyferriscarbon;

Gefornil;

Gastrofarm.

Sodium oxyferriscarbon contains di- and trivalent iron in combination with sodium salts various acids (gulonic and alloxonic).

The drug has a regenerating, anti-inflammatory and analgesic effect. Effective for stomach ulcers. For duodenal ulcers, the drug is ineffective.

Sodium oxyferriscarbon is prescribed intramuscularly at 30-60 mg for 10-20 days, the course is repeated 2-3 times.

SOLCOSERYL (Solcoseryl) - protein-free extract from the blood of large cattle. Protects tissues from hypoxia and necrosis. Used for trophic ulcers of any location.

Apply 2 ml 2-3 times a day, administered intravenously and intramuscularly, until the ulcer heals.

Prostaglandin preparations:

MISOPROSTOL (Cytotec), etc. Under the influence of these drugs, the acidity of gastric juice decreases, gastric and intestinal motility increases, and beneficial effects are noted on the ulcerative niche in the stomach.

The drugs also have a reparative, hypoacidic (by increasing mucus production), hypotensive effect.

MISOPROSTOL (Misoprostol; in tablets of 0.0002) is a prostaglandin E-2 preparation obtained from plant materials.

Synonym - CYTOTECH.

Prostaglandin preparations are indicated for acute and chronic ulcers of the stomach and duodenum.

Side effects: transient diarrhea, mild nausea, headache, abdominal pain.

Prescribe one tablet twice a day. A combination of misoprostol with an NSAID (Voltaren) – the drug ARTROTEK – is used.

DALARGIN (Dаlarginum; in amp. and bottles of 0.001) is a drug of peptide nature, promotes the healing of stomach and duodenal ulcers, reduces the acidity of gastric juice, and has a hypotensive effect.

The drug is indicated for exacerbation of gastric and duodenal ulcers.

Contraindications to the use of dalargin are hypotension and pregnancy.

DRUGS HAVING A SPECIFIC ANTIBACTERIAL EFFECT ON Helicobacter pylory

(De-nol, metronidazole, oxacillin, furazolidone) The drug metronidazole has a wide spectrum of action against protozoa (Trichomonas, amoebas, Giardia), acts on anaerobic microflora (for diseases of the organs chest, urinary tract), as well as Helicobacter pylory. The most effective antibacterial effect is observed with a combination of metronidazole and de-nol.

DRUGS AFFECTING INTESTINAL MOTORICS

Occasional heartburn, sour-tasting belching, stomach cramps, and pain require the use of antacids. Drugs included in the complex treatment of diseases of the gastrointestinal tract (gastrointestinal tract) associated with the effects of hydrochloric acid.

History of antacid use

Stomach diseases have been treated with antacids for more than a century. The most famous one can be found in any housewife - sodium bicarbonate (baking soda). Due to unwanted side effects, it is not recommended for treatment in its pure form.

The emerging antisecretory drugs initially replaced antacids. With their help, the production of the gastric enzyme, hydrochloric acid, decreased. But they were unable to completely solve the problems associated with the disease.

Therefore, antacid drugs have again taken a leading position in the treatment of gastrointestinal diseases.

How do antacids work?

Modern pharmacology has developed new drugs of combined action. In addition to neutralizing hydrochloric acid, they perform the following functions:

  • Adsorption.
  • Reducing the severity of tissue damage (cytoprotective effect).
  • Enveloping.
  • Increased synthesis of mucus glycoproteins.
  • Binding bile acid with lysolecithin.
  • Stimulation of the secretion of bicarbonates.
  • Protection of capillary epithelium from ulcerogenic (side) factors.
  • Preventing flatulence.


Types of Antacids

  1. Soluble (absorbable)– the substance itself or the products formed as a result of its interaction with stomach acid dissolves in the blood.

The carbon dioxide produced in this process contributes to the occurrence of negative side effects. A distended stomach causes acid secretion, and gastric contents undergo retrograde movement (gastroesophageal reflux).

  • Baking soda
  • Magnesium oxide (burnt magnesia, periclase)
  • Bourget's mixture (combination of Na bicarbonate + Na sulfate + Na phosphate)
  • Rennie
  • Andrews antacid

As a result of very rapid alkalization of the gastric environment, the symptom of “acid rebound” occurs. After the end of the drug's effect, a secondary increase in acid secretion occurs. Neutralized by food intake. Antacids containing Ca should not be taken before bedtime.

Fast, but short-lived effectiveness.

  1. Non-absorbable
  • Phosphalugel – neutralization of acid without alkalization, does not affect physiological process digestion.
  • Maalox, Almagel, is an adsorbent, enveloping suspension with an analgesic effect.
  • Gastracid - tablets with a mint flavor, relieve heartburn and painful attacks.
  • Maalukol, Alumag – combination drugs, produced in the form of chewable tablets, gel, suspension. They have an adsorbent, choleretic, carminative, and enveloping effect.
  • Altacid - available in the form of chewable tablets and suspension.

Note: when taking an antacid on an empty stomach, its therapeutic effect lasts about 30 minutes.

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