|
|
Calcium Folic acid Phosphorus | |
|
Alginates | |
|
Citrate | |
| Side effect reduction/prevention |
None known |
| Reduced drug absorption/bioavailability |
None known |
An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.
Alginates
A thick gel derived from algae has been used together with aluminium antacids to treat
heartburn. Together, alginate gel and antacid were more effective at relieving
symptoms1 and improving healing.2 Alginate is believed to work by
physically blocking stomach acid from touching the oesophagus. According to these studies, two
tablets containing 200 mg alginic acid should be chewed before each meal and at bedtime.
Calcium
Aluminium hydroxide may increase urinary and stool loss of calcium.3 Also,
aluminium is a toxic mineral, and a limited amount of aluminium absorption from
aluminium-containing antacids does occur.4 As a result, most doctors do not
recommend routine use of aluminium-containing
antacids.5 Other types of antacids containing calcium or magnesium instead of aluminium are available.
Citrate
Several studies have shown that combination of citrate, either as calcium citrate supplements
or from orange and lemon juice, with aluminium-containing antacids increases aluminium levels
in the body.6 7 8 Calcium in forms other than calcium citrate
has been shown to not increase aluminium absorption.9 Drinking 7–10 ounces of
orange juice provides sufficient citrate to be problematic.10 11 Intake
of 950 mg calcium citrate greatly elevates aluminium absorption.12 People with
renal failure may be at particular risk of kidney damage due to elevated aluminium levels if
they combine aluminium hydroxide with citrate.13
Folic acid
Folic acid is needed by the body to utilise vitamin B12.
Antacids,14 including aluminium hydroxide, inhibit folic acid absorption. People
taking antacids are advised to supplement with folic acid.
Phosphorus
Depletion of phosphorus may occur as a result of taking aluminium hydroxide. For those with
kidney failure, reducing phosphorus absorption is the purpose of taking the drug, as excessive
phosphorus levels can result from kidney failure. However, when people with normal kidney
function take aluminium hydroxide for extended periods of time, it is possible to deplete
phosphorus to unnaturally low levels.
1. McHardy G. A multicentric, randomized clinical trial of Gaviscon in reflux esophagitis. South Med J 1978;71(suppl 1):16–21.
2. Graham DY, Lanza F, Dorsch ER. Symptomatic reflux esophagitis: A double-blind controlled comparison of antacids and alginate. Curr Ther Res 1977;22:653–8.
3. Spencer H, Kramer L. Antacid-induced calcium loss. Arch Intern Med 1983;143:657–8 [editorial].
4. Anonymous. Is aluminum harmless? Nutr Rev 1980;38:242–3 [review].
5. Gaby AR. Aluminum: The ubiquitous poison. Nutr Healing 1997;4:3,4,11.
6. Walker JA, Sherman RA, Cody RP. The effect of oral bases on enteral aluminum absorption. Arch Intern Med 1990;150:2037–9.
7. Weberg R, Berstad A. Gastrointestinal absorption of aluminum from single doses of aluminum containing antacids in man. Eur J Clin Invest 1986;16:428–32.
8. Fairweather-Tait S, Hickson K, McGaw B, Redi M. Orange juice enhances aluminum absorption from antacid preparation. Eur J Clin Nutr 1994;48:71–3.
9. Nolan CR, Califano JR, Butzin CA. Influence of calcium acetate or calcium citrate on intestinal aluminum absorption. Kidney Int 1990;38:937–41.
10. Anonymous. Preliminary findings suggest calcium citrate supplements may raise aluminum levels in blood, urine. Family Practice News 1992;22:74–5.
11. Fairweather-Tait S, Hickson K, McGaw B, Redi M. Orange juice enhances aluminum absorption from antacid preparation. Eur J Clin Nutr 1994;48:71–3.
12. Nolan CR, Califano JR, Butzin CA. Influence of calcium acetate or calcium citrate on intestinal aluminum absorption. Kidney Int 1990;38:937–41.
13. Walker JA, Sherman RA, Cody RP. The effect of oral bases on enteral aluminum absorption. Arch Intern Med 1990;150:2037–9.
14. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458–63.
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