The Risk of Self-Medicating Your Heartburn

Q. Over-the-counter antacids tout benefits like extra calcium, etc., but is there any downside to taking a lot of antacids? Are there side effects to be concerned about?

A. While it’s true there are calcium-containing antacids (Tums, Rolaids), which may be of benefit in our battle against osteoporosis, it is important to remember that these are medications and should be discussed with your physician. I don’t mean to be harsh, but over the years I have met lots of people who "self-medicate" without any medical supervision. They figure over-the-counter medications are totally safe because they can get them without a prescription. But this is far from the truth. In general, any medication, whether over the counter or prescription, has the potential to cause unwanted side effects. Five of the most common reasons behind side effects include:

• Medication allergy
• Not taking the medication as directed
• Taking the medication for too long a time period without medical supervision
• Not adjusting the dosage if you have kidney or liver disease
• Interaction with one or more of your other medications.

That said, antacids are generally well tolerated. They are most often used to provide relief from a "sour stomach," excess gas, heartburn, gastroesophageal reflux disease (or GERD) and ulcers. However, it is important to know that there are distinct differences among antacids. For starters, some work by neutralizing gastric acid, while others act to protect the lining of the stomach and esophagus. How they work depends upon their active ingredients. These include aluminum hydroxide, calcium carbonate, magnesium hydroxide and sodium bicarbonate. Each antacid’s effectiveness, cost and potential side effects are determined by their particular active ingredients. But in general, the most common side effects include:

• Chalky taste in the mouth
• Stomach cramps
• Change in bowel-movement frequency and/or color.

However, I need to be more specific. If you are taking too much of your particular antacid, there may be some significant side effects associated with that type. Such as:

• Aluminum-containing antacids: constipation, bone pain, muscle weakness and swelling of wrists and ankles.
• Calcium-containing antacids: constipation, headache, muscle pain or twitching, unusual weakness or fatigue, difficult or painful urination, altered taste.
• Magnesium-containing antacids: diarrhea, dizziness, irregular heartbeat and loss of appetite, mood or mental changes.
• Sodium bicarbonate-containing products: frequent urge to urinate, swelling of the legs, ankles or feet, headache, restlessness, nausea or shortness of breath. Also, please know that antacids containing sodium bicarbonate are not recommended for people on a salt-restricted diet.

While generally safe and effective, taking "a lot" of antacids for heartburn or GERD may mask an even more serious disease—esophageal cancer. I don’t want to scare you, but whenever you need to take a lot of any medication for any symptom, your physician should investigate further. In the case of antacids, a general rule to follow is this: If you need to take an antacid on most days of the week for two weeks in a row, or if you find yourself having frequent "heartburn" or indigestion (more than two times per week), please speak with your health care professional.

Read More About Heartburn & GERD on MSN Health & Fitness:

• Heartburn and Drug Interaction
• The Long and Tortured History of Heartburn
• No Heartburn? You Could Still Have GERD
• Help for Heartburn
• MSN Health Centers: Heartburn & GERD

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)