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Background and Aim: Since the first report of gastric adenocarcinoma of the fundic-gland type in 2010, the clinicopathological characteristics of gastric neoplasm of the fundic-gland type (GNFG) have become clearer; however, their risk factors remain unclear. This exploratory study aimed to identify the risk factors for GNFG., Methods: We conducted a single-center, retrospective, matched case-control study using medical information recorded at our health management center from January 2014 to July 2023. During this period, 39 240 people underwent upper gastrointestinal endoscopy. GNFG were extracted as cases and matched to controls, according to age and sex, in a 1:8 ratio, excluding those with a history of gastrointestinal surgery and those with a history or comorbidity of cancer. Univariate analysis was used to compare patient background and endoscopic findings. Multivariable analysis was performed, adjusting for factors with P values < 0.1 and antacid use., Results: A total of 20 GNFG cases and 160 matched healthy controls were included. In the univariate analysis, only reflux esophagitis was significantly more common in GNFG (40.0% vs 18.1%; P = 0.036). Factors antacids and duodenitis had P values < 0.1. Logistic regression analysis was performed, adjusting for antacids, reflux esophagitis, and duodenitis. Antacids and reflux esophagitis were the independent risk factors for GNFG (odds ratio = 3.68 [95% confidence interval: 1.04-11.91] and 3.25 [95% confidence interval: 1.11-9.35])., Conclusions: Although the sample of patients with GNFG was small, antacids and reflux esophagitis were identified as a risk factor. The pathogenesis of antacids and reflux esophagitis may be involved in the development of GNFG., (© 2024 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

The effect of food composition, tablet crushing, and antacid coadministration on maribavir pharmacokinetics was assessed in 2 Phase 1 studies in healthy adults. In the first, a single maribavir 400-mg dose was administered under fasting conditions, with a low-fat/low-calorie or a high-fat/high-calorie meal. In the second, a single maribavir 100-mg dose was administered under fasting conditions, as a crushed tablet, or as a whole tablet alone or with an antacid. The 90% confidence intervals of the geometric mean ratios were within 80%-125% for area under the concentration-time curve (AUC), but not for maximum plasma concentration (C max ) for low-fat/low-calorie and high-fat/high-calorie meals versus fasting or for whole tablet with antacid versus whole tablet alone. The 90% confidence intervals of the geometric mean ratios for AUC and C max were within 80%-125% for crushed versus whole tablet. Maribavir median time to C max value in plasma under fed conditions was delayed versus fasting conditions, but there was no statistical difference for crushed versus whole tablet or with versus without antacid. As the antiviral efficacy of maribavir is driven by AUC but not C max , findings suggest that maribavir can be administered with food or antacids or as a crushed tablet., (© 2024 Takeda Development Center Americas, Inc. Clinical Pharmacology in Drug Development published by Wiley Periodicals LLC on behalf of American College of Clinical Pharmacology.)

Commonly, most oral non-steroidal anti-inflammatory drugs (NSAIDs) have known gastric adverse reactions due to their long-term and high dose administration. In this study, a novel liquid sustained-release system based on multiple-unit in situ hydrogel beads was designed to address this issue. The system is composed of sodium alginate (SA), gellan gum (GG), zinc oxide (ZnO), and magnesium oxide (MgO). Furthermore, indobufen was loaded into the system to evaluate its gastric mucosal protection effect. This effect can be attributed to the topical antacid, pepsin inhibition, and sustained drug release properties of the system. It was proven that the stored solid gel system could undergo a "solid to liquid" transition after shaking. Once swallowed, the liquid gel could disperse well in the stomach as hydrogel beads. Then, the "liquid to solid" gelation occurred from the exterior to interior of each multiple-unit gel bead, triggered by the release of Zn 2+ and Mg 2+ from neutralization reactions. The formed gel demonstrated mild antacid effect that lasted for 3 hours and 66.3% pepsin inhibition in vivo. Moreover, the rats treated with the indobufen gel system showed a drug plasma concentration versus time curve with less fluctuation compared to the rats treated with the marketed preparation (YinDuo®) group. The gel system also exhibited an extended T max (6.50 hours) and reduced C max (52.87 μg/mL). Additionally, the gastric mucosal protection of the gel system was verified using three types of peptic gastric ulcer models. These findings suggested that this multiple-unit in situ gel could be a potential oral liquid sustained release delivery system for NSAIDs., Competing Interests: Declaration of Competing Interest The authors declared that they have no conflicts of interest to this work. We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted., (Copyright © 2023. Published by Elsevier Inc.)

Background: Calcium carbonate antacids are potent over-the-counter antacids, made more effective by adding magnesium carbonate (as in Rennie, Bayer). However, published studies on their onset of action are scarce. Therefore, we carried out an in vitro study comparing Rennie and placebo under simulated conditions of the human stomach (artificial stomach model) to reconfirm the onset of action of Rennie., Methods: The validated Simulator of the Human Intestinal Microbial Ecosystem apparatus (SHIME, ProDigest, Belgium) was used, comprising five reactors simulating different parts of the human gastrointestinal tract. Both Rennie and placebo were dosed at two tablets per incubation over six independent, 2-h stomach incubations each., Primary Objectives: to evaluate the time required to achieve pH 3.0, 3.5, 4.0 and 4.5, as well as the maximum pH reached., Secondary Objective: to evaluate pepsin activity over the entire 2-h gastric incubation., Results: After addition of Rennie, the gastric medium reached a pH of 3.0 within 40 s. The maximum pH of 5.24 was maintained for almost 10 min. In contrast, the maximum pH with placebo was 1.28 during the entire gastric simulation. Furthermore, Rennie strongly reduced the activity of mucosa-damaging pepsin during the period of increased pH. With placebo, the lower pH resulted in consistently high loads of digested peptides, reflecting the high cumulative and instantaneous pepsin activity., Conclusions: New data is a critical component in informed decision making. Our data confirm the high efficacy and fast onset of acid-neutralizing action of Rennie, which begins to work within seconds.

Background and Objective: Gastroesophageal reflux disease (GORD) is highly prevalent in idiopathic pulmonary fibrosis (IPF) and may play a role in its pathogenesis. Recent IPF treatment guidelines suggest that all patients with IPF be considered for antacid therapy. However, emerging evidence suggests that antacid therapy does not improve IPF patient outcomes and may increase the risk of pulmonary infection., Methods: Using prospectively collected data from the Australian IPF Registry including use of antacid therapy, GORD diagnosis and GORD symptoms, the relationship of these GORD variables to survival and disease progression was assessed. The severity of GORD symptoms using the frequency scale for symptoms of GORD (FSSG) and its relationships to outcomes was also assessed for the first time in an IPF cohort., Results: Five hundred eighty-seven (86%) of the 684 patients in the Australian IPF Registry were eligible for inclusion. Patients were mostly male (69%), aged 71.0 ± 8.5 years with moderate disease (FVC 81.7 ± 21.5%; DLco 48.5 ± 16.4%). Most patients were taking antacids (n = 384; 65%), though fewer had a diagnosis of GORD (n = 243, 41.4%) and typical GORD symptoms were even less common (n = 171, 29.1%). The mean FSSG score was 8.39 ± 7.45 with 43% (n = 251) having a score > 8. Overall, there was no difference in survival or disease progression, regardless of antacid treatment, GORD diagnosis or GORD symptoms., Conclusions: Neither the use of antacid therapy nor the presence of GORD symptoms affects longer term outcomes in IPF patients. This contributes to the increasing evidence that antacid therapy may not be beneficial in IPF patients and that GORD directed therapy should be considered on an individual basis to treat the symptoms of reflux.

Objective: To investigate the intragastric acid neutralization activity of a combined alginate-antacid formulation., Significance: Published studies have investigated the reflux-suppressing alginate component of Gaviscon Double Action (Gaviscon DA; RB, UK) but intragastric acid neutralization activity of the antacid component has not been evaluated in vivo., Methods: Intragastric pH monitoring, using a custom-made 10-electrode catheter, was evaluated in a two-part exploratory study in healthy subjects; Part I (n = 6) tested suitability of the catheter using antacid tablets (Rennie; Bayer, Germany); Part II (n = 12) evaluated gastric acid neutralization activity of Gaviscon DA liquid (20 ml) versus placebo in fasted subjects using a randomized, open-label, crossover design. The primary endpoint was the percentage of time that intragastric pH ≥4 was measured during 30 min post-treatment. A confirmatory study of identical design was subsequently conducted (n = 20)., Results: Monitoring pH using the multielectrode catheter was a viable approach, directly detecting changes in intragastric pH following a single dose of antacid tablets. In the exploratory study, the percentage of time that pH ≥4 during 30 minutes post-treatment was 46.8% with Gaviscon DA liquid versus 4.7% with placebo (p = 0.0004). These findings were supported by the confirmatory study, where pH ≥4 was recorded 50.8% of the time with Gaviscon DA versus 3.5% with placebo (p = 0.0051). In this study, Gaviscon DA was safe and well tolerated., Conclusions: These studies demonstrate the effective acid neutralizing capacity of Gaviscon DA versus placebo in healthy, fasted subjects. This adds to the evidence base for the combination of alginates and antacids.

Objective: Research to measure the chemical characterization of alginate rafts for good raft performance and ascertain how formulation can affect chemical parameters., Significance: A selection of alginate formulations was investigated all claiming to be proficient raft formers with significance between products established and ranked., Methods: Procedures were selected which demonstrated the chemical characterization allowing rafts to effectively impede the reflux into the esophagus or in severe cases to be refluxed preferentially into the esophagus and exert a demulcent effect, with focus of current research on methods which complement previous studies centered on physical properties. The alginate content was analyzed by a newly developed HPLC method. Methods were used to determine the neutralization profile and the acid neutralization within the raft determined along with how raft structure affects neutralization., Results: Alginate content of Gaviscon Double Action (GDA) within the raft was significantly superior (p < .0001) to all competitor products. The two products with the highest raft acid neutralization capacity were GDA and Rennie Duo, the latter product not being a raft former. Raft structure was key and GDA had the right level of porosity to allow for longer duration of neutralization., Conclusion: Alginate formulations require three chemical reactions to take place simultaneously: transformation to alginic acid, sodium carbonate reacting to form carbon dioxide, calcium releasing free calcium ions to bind with alginic acid providing strength to raft formation. GDA was significantly superior (p <.0001) to all other comparators.

Objective: This study was designed to investigate pharmacological interaction between magnesium laxative and antacid in patients receiving opioid analgesic., Methods: Data obtained from a total of 441 eligible patients receiving opioid analgesic for the first time were retrospectively analysed. The incidence of constipation, defined as stool-free interval of 3 days and more within the first week of opioid intake, was compared between patients who took laxative alone and those who received laxative in combination with antacid., Key Findings: Laxatives were prescribed in 74% of patients, among them 61% received antacids such as proton pump inhibitor and H2 receptor blocker. Magnesia was the most commonly used laxative (89%). Constipation occurred in 21% and 55% of patients with and without laxatives, respectively. Antacids reversed the laxative action of lower doses (<2000 mg/day) but not higher doses (>2000 mg/day) of magnesia without affecting the effects of other laxatives. Therefore, it is suggested that both acid-dependent and acid-independent mechanisms may operate in the laxative action of magnesia, in which the former may be involved in the action of lower doses of magnesia., Conclusion: Care should be taken to avoid the unfavourable pharmacological interaction between low doses of magnesia and antacid., (© 2016 The Authors. Journal of Pharmacy and Pharmacology published by John Wiley & Sons Ltd on behalf of Royal Pharmaceutical Society.)

A carbonated hydrocalumite was synthesized by the microwave method for being used as antacid. The gel was formed using Ca and Al nitrate solutions in a basic medium (NaOH+Na2CO3), then, this gel was aged and heated in a domestic microwave for 2.5 min (1250 W). The obtained white solid was washed with distilled water, dried in an oven at 100 °C for 18 h and characterized by different techniques such as: X-ray diffraction (XRD), Fourier transformed infrared spectroscopy (FT-IR), BET surface area measurements, scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX). Finally, the carbonated hydrocalumite was tested as antacid by using a synthetic gastric juice and its activity was compared with a commercial antacid formulated with hydrotalcite. Results showed that the carbonated hydrocalumite was more effective than that commercial antacid., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: Mouthrinsing with antacids, following erosive episodes, have been suggested as a preventative strategy to minimize tooth surface loss due to their neutralizing effect. The purpose of this in situ study was to evaluate the effect of an antacid suspension containing sodium alginate, sodium bicarbonate and calcium carbonate in controlling simulated erosion of enamel of intrinsic origin., Design: The experimental units were 48 slabs (3×3×2mm) of bovine enamel, randomly divided among 12 volunteers who wore palatal appliances with two enamel slabs. One of them was exposed extra-orally twice a day to 25mL of a hydrochloric acid (HCl) solution (0.01M, pH 2) for 2min. There were two independent phases, lasting 5 days each. In the first phase, according to a random scheme, half of the participants rinsed with 10mL of antacid suspension (Gaviscon(®), Reckitt Benckiser Healthcare Ltd.), while the remainder was rinsed with deionized water, for 1min. For the second phase, new slabs were inserted and participants switched to the treatment not received in the first stage. Therefore, the groups were as follows: (a) erosive challenge with HCl+antacid suspension; (b) erosive challenge with HCl+deionized water (DIW); (c) no erosive challenge+antacid suspension; (d) no erosive challenge+DIW. Specimens were assessed in terms of surface loss using optical profilometry and Knoop microhardness. The data were analyzed using repeated measures two-way analysis of variance and Tukey's tests., Results: Compared to DIW rinses, surface loss of enamel was significantly lower when using an antacid rinse following erosive challenges (p=0.015). The Knoop microhardness of the enamel was significantly higher when the antacid rinse was used (p=0.026)., Conclusions: The antacid suspension containing sodium alginate, sodium bicarbonate and calcium carbonate, rinsed after erosive challenges of intrinsic origin, reduced enamel surface loss., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: Both over-the-counter medicine, such as antacids or alginates, and proton pump inhibitors (PPI) are used for treating acid-related disorders. We sought to describe what characterizes users of these different medicines, including long-term PPI users within the general population., Method: A cross-sectional survey was conducted in an internet panel representative of the Danish adult population in 2012. Data queried included antacid/alginate and PPI use, reason for therapy, co-medication, and presence of upper gastrointestinal symptoms. Long-term PPI use was defined as using PPI ≥1/3 of the last year (∼120 days). Risk of long-term PPI use was estimated by logistic regression., Results: A total of 18,223 people received the questionnaire, of which 52% (9390) responded. Antacid/alginate use was reported by 23%; 16% reported use of only antacid/alginate. PPI use was reported by 13.6%; 6.2% were defined as long-term PPI users. Antacid/alginate users were younger, used less co-medication, had most often started on therapy because of reflux symptoms, and had less often ongoing symptoms. Risk of long-term PPI use appeared to be increased in male gender, by renewing PPI prescription by phone/e-mail, using co-medication, and having started on PPI for several reasons. Combination of antacid/alginate and PPI was reported by approximately 50% of those on therapy with weekly or daily symptoms., Conclusion: 23% of Danish adults were using antacids or alginates and 14% were using PPI, of which one-half were on long-term therapy. Prescription renewal by phone or e-mail and use of other prescription medication were associated with long-term PPI use, indicating a behavioral pattern, in which unnecessary PPI therapy may be maintained.

A accessible ultramodern life brings along with it a host of problems including acidity and Gastrointestinal issues. Poor eating habits, racy food and guzzling too numerous carbonated drinks Disrupts the pH balance and natural foliage of the stomach causing both bloating and acidity making Antacids the most common tone- specified specifics available over the counter. Common Dental Procedures and oral conditions requires dentists to define NSAIDs and antibiotics which alleviates Acidity. The antacids act by negativing the acid in the stomach and by inhibiting pepsin, which is a proteolytic enzyme. Each of These cationic mariners has a characteristic pharmacological property that determines its clinical use. In recent times, demands of identification and evaluation of new medicines conceivably of factory origin are gaining fashionability for the treatment of colorful gastrointestinal conditions. Hence, herbal drugs were considered a better cover for the treatment of acid influx/acidity with lower adverse side goods. The main ideal of the study was to elect sauces which were used as a home -- remedy having parcels for negativing the Acid of the stomach viz Cumin( Cuminum cyminum), Sprague (Trachyspermum ammi), and Peppermint (Mentha piperita) and incorporate in their excerpt forms in dividually into the new expression( Bouncy grains) developed by using wet granulation Method. Antacids are generally recommended for grown-ups and children at least 12 times old, and the FDA recommends antacids as the first-line treatment for heartburn in gestation. Herbal antacids are also one of the major classes of over the Counter drugs used by patient considering its safety. Hence, in present Study we attempted to prepare two formulations, one is aluminium Hydroxide suspension and second is combination of calcium carbonate and magnesium oxide suspension aswell as compares this by marketed Formulation through antacid activity using in vitro methods viz-acid-Neutralizing capacity and buffering capacity. [ABSTRACT FROM AUTHOR]

Magaldrate is an antacid have been widely used in the treatment of various gastric and duodenal disorders such as heartburn, reflux esophagitis, acid indigestion, gastritis, sour stomach, upset stomach, irritable stomach, gastric and duodenal ulcers. The conventional antacids dosage forms have a short duration of action which is about 2-3 hours due to gastric emptying process. A gastroretentive dosage form of antacid is needed since the healing of gastric ulcers occurs when gastric pH is kept above 3-4 during 24 hours. The present study was aimed at developing Gastro retentive bilayer drug delivery systems containing Magaldrate to minimize the side effect, improve the prolongation of action, to reduce the frequency of drug administration. A wet granulation technique was used to formulate 9 batches. Superdisintegrants like Polyplasdone XL-10, Ac-Di-Sol, and sodium starch glycolate was used for immediate release layer and HPMC K4 M, Ac-Di-Sol and lactose like polymers were used in floating layer. Preformulation studies were carried out to optimize the ratios required for various grades of polymers. The prepared floating tablets were evaluated for hardness, weight variation, thickness, friability, drug content uniformity, buoyancy lag time, total floating time, water uptake (swelling index), and in vitro dissolution studies. Successful formulation was developed having floating lag time as low as 30 sec and drug release was sustained up to 12 hrs. A biphasic drug release can be obtained by using bilayer tableting technology which involved compression of immediate and sustained release layer together. Bilayered floating tablets with release characteristics offer critical advantages such as, site specificity with improved absorption and efficacy. This technology can be inculcated to various medicaments which have stomach as the major site of absorption. [ABSTRACT FROM AUTHOR]

Summary: This population-based study demonstrates a strong link between Mg-containing antacid exposure and hip fracture risk in nondialysis CKD and dialysis patients. As an Mg-containing antacid, MgO is also commonly used as a stool softener, which can be effortlessly replaced by other laxatives in CKD patients to maintain bone health. Purpose: Bone fracture is a severe complication in chronic kidney disease (CKD) patients, leading to disability and reduced survival. In CKD patients, blood magnesium (Mg) concentrations are usually above the normal range due to reduced kidney excretion of Mg. The present study examines the association between Mg-containing antacid exposure and the risk of hip fracture of CKD patients. Methods: In this nationwide nested case–control study, we enrolled 44,062 CKD patients with hip fracture and 44,062 CKD matched controls, among which the mean age was 77.1 years old, and 87.9% was nondialysis CKD. Results: As compared to non-users, Mg-containing antacid users were significantly more likely to experience hip fracture (adjusted odds ratio (OR) 1.36, 95% CI, 1.32 to 1.41; p < 0.001). Subgroup analysis showed that such risk exists in both nondialysis CKD patients and long-term dialysis patients. In contrast, aluminum or calcium-containing-antacid use did not reveal such association. Next, we examined the influence of Mg-containing antacid dosage on hip fracture risk, the adjusted ORs in the first quartile (Q1), Q2, Q3, and Q4 were 1.20 (95% CI, 1.15 to 1.25; p < 0.001), 1.35 (95% CI, 1.30 to 1.41; p < 0.001), 1.49 (95% CI, 1.43 to 1.56; p < 0.001), and 1.54 (95% CI, 1.47 to 1.61; p < 0.001), respectively, showing that such risk exists regardless of the antacid dosage. A receiver operating characteristic curve analysis demonstrated that the best cutoff value of the exposed Mg dose to discriminate the hip fracture is 532 mEq during the follow-up period. Conclusion: This population-based study demonstrates a strong link between Mg-containing antacid exposure and the hip fracture risk in both nondialysis CKD and dialysis patients. [ABSTRACT FROM AUTHOR]

Antacids are usually alkaline substances that are used to neutralise excess acid in the stomach. Antacids were developed based on the hydroxides and carbonates of the group II and III metals, as well as the bicarbonates of the alkali metals. Antacids can be classified into two main classes being non-absorbable or absorbable antacids. Non-absorbable antacids have fewer side effects and further advantageous properties. Each antacid has a specific active ingredient which has a different effect on the gastric acid. Antacids act similar to when an acid reacts with a hydroxide; a salt and water are produced. Antacids are more effective in the form of suspension. The average therapeutic dose of an antacid is 10-15 ml of liquid or one to two tablets three to four times a day. These drugs have small volumes of distribution, undergo minimal hepatic metabolism and are excreted in faeces. Antacids that contain calcium, magnesium and aluminium ions are chelators. To avoid undesirable interactions, antacids are usually used two hours before or after taking any medication. Stress ulcerations are common in intensive care unit (ICU) patients. The pathophysiology of the ulceration probably results from an imbalance between mucosal protection and gastric acid hypersecretion. Whilst prophylaxis was provided to every patient previously, it is wise to individualise the decision and to only provide it to high risk patients. For critically ill patients who are able to receive enteral medications and in whom prophylaxis is indicated, an oral proton pump inhibitor (PPI) is preferred rather than an alternative prophylactic agent. For critically ill patients who cannot receive enteral medications, an intravenous (IV) histamine 2 (H2) receptor blocker or IV PPI can be administered. Where PPIs or H2 blockers cannot be administered, sucralfate is a suitable oral alternative. [ABSTRACT FROM AUTHOR]

Antacid tablets based on milk proteins were developed by a wet granulation method, with the aim of controlling the problem of hyperacidity in its early stages. Optimisation of the tablet formulation was carried out using milk protein ingredients, viz. rennet casein (RC) and whey protein concentrate (WPC), with mannitol used as a functional filler. An RC‐WPC ratio and a mannitol level of 1.96% and 10.75% w/w, respectively, were found to be optimum. The RC‐WPC ratio had a significant impact on buffering capacity (BC), tablet friability and density. The filler material, mannitol, also has an impact on BC and tablet density. [ABSTRACT FROM AUTHOR]

The article focuses on a study for comparison of antacid effect related with raw juice of Spinacia oleracea (spinach) along with natural antioxidant mixture of spinach's methanolic extract for an artificial stomach model. It states significance of stomach mucosa in maintenance of optimal functions along with usage of antacid in treatment of hyperacidity. It mentions disadvantage for neutralization of antacids leads to increment in secretion of gastric acid in the body.

Gastric acidity is a very common condition among the peoples of developing and developed countries. Increased gastric pH is associated with gastric ulceration, Bleeding ulcers, GERD, heartburn, discomfort, nausea and vomiting. The instant and quick relief from acidity can be obtained by oral administration of antacids. Current study was carried out to determine the acid neutralizing effect of household remedies like cold milk, Baking soda, Baking soda + citric acid in water verses marked preparations like Effervescent granules (ENO, Digene) and liquid antacid Gelusil (5ml and 10ml). Gastric simulation fluid of pH1.2 was prepared and pH was recorded before and after addition of marketed antacid/household remedies. Observations were recorded in multiple of three for 0 min to 60 min. percent acid neutralization were calculated for each marketed/household preparation. Results advocate that baking soda in water and Gelusil 10ml shows significant percent acid neutralization 444.35% and 428.57% respectively. The effect of acid neutralization of baking soda in water was instant and remained same whereas Gelusil 10ml showed progressive acid neutralization over a period of time. Effervescent granules ENO and Digene showed 322.58303.14% acid neutralization respectively. Milk 259.67% Gelusil188.28% and Baking soda + citric acidin Water421.25% showed acid neutralization. From results it can be concluded that household remedies are also significantly effective to control the acidity. [ABSTRACT FROM AUTHOR]

A hydrocalumite-type solid was synthesized by the homogeneous co-precipitation method by using Ca and Al nitrate solutions in a basic medium (NaOH). This solid was calcined at 700 and 900 °C, respectively. Then, solids were characterized by X-ray diffraction, FT-IR spectroscopy and BET surface area measurements. Finally, these solids were tested as antacids by using a synthetic gastric juice. Results showed that calcined samples were able to neutralize the synthetic gastric juice in more extension as an as-synthesized hydrocalumite; however, the last solid showed better conditions as a potential antacid. [ABSTRACT FROM AUTHOR]

What is known and objective Baking soda is a common household product promoted by the manufacturer as an antacid. It contains sodium bicarbonate and has the potential for significant toxicity when ingested in excessive amounts. Characterizing the patterns and outcomes from the misuse of baking soda as a home remedy can guide the clinical assessment and preventative counselling of patients at risk for use of this product. Methods We conducted a retrospective review of all symptomatic cases involving ingestion and misuse of a baking soda powder product that were reported to the California Poison Control System between the years 2000 and 2012. Results and discussion Of the 192 cases we identified, 55·8% were female, ages ranged 2 months to 79 years, and the most common reasons for misuse included antacid (60·4%), 'beat a urine drug test' (11·5%) and treat a UTI (4·7%). Most cases (55·2%) had significant symptoms warranting a medical evaluation, whereas 12 patients required hospital admission developed either electrolyte imbalances, metabolic alkalosis or respiratory depression. What is new and conclusion Misuse of baking soda can result in serious electrolyte and acid/base imbalances. Patients at highest risk of toxicity may include those who chronically use an antacid, those who use the method to 'beat' urine drug screens, pregnant women and young children. Self-treatment with baking soda as a home remedy may also mask or delay medical care thereby complicating or exacerbating an existing medical problem. We suggest that healthcare providers counsel high-risk patients about the potential complications of misuse of baking soda as a home remedy. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the effects of either famotidine or antacid on the pharmacokinetics of nilotinib in healthy subjects, with the specific focus to explore different dosing separation schemes leading to a minimized drug-drug interaction. Methods: Fifty-two subjects were randomized to receive the following treatments in a crossover manner: (A) single oral nilotinib 400 mg alone; (B) famotidine 20 mg twice a day for 3 days, followed by a single administration of nilotinib 400 mg and famotidine 20 mg on Day 4, where famotidine was given 2 h after nilotinib; (C) single oral nilotinib 400 mg and antacid suspension 20 mL, where antacid was given 2 h before nilotinib; (D) single oral nilotinib 400 mg and antacid suspension 20 mL, where antacid was given 2 h after nilotinib. Results: Comparing Treatment B to Treatment A, the geometric mean ratios of nilotinib C, AUC, and AUC were 0.966, 0.984, and 0.911, respectively (90 % confidence intervals (CIs), 0.875-1.066, 0.905-1.069, and 0.798-1.039, respectively). Nilotinib pharmacokinetic parameters following Treatment C or Treatment D were similar to those after Treatment A; the corresponding 90 % CIs of the geometric mean ratios of C, AUC and AUC all fell within the bioequivalence range of 0.8-1.25. Conclusions: Neither famotidine nor antacid significantly affected nilotinib pharmacokinetics. When concurrent use of an H2 blocker or an antacid is necessary, the H2 blocker may be administered 10 h before and 2 h after nilotinib dose, or the antacid may be administered 2 h before or 2 h after nilotinib dose. [ABSTRACT FROM AUTHOR]

Objective: To compare the palatability, acid consuming capacity and cost effectiveness of different brands of liquid antacids available in Karachi. Methodology: Fifty healthy volunteers between the age of 20 to 59 years were recruited in the study. A total of seven antacid brands available in market were physically and chemically tested. The trial design was that of randomized, double blind and cross over study type. All fifty volunteers were individually asked to taste different brands of respectively classified antacids. All antacids were given during a period of 2-hour. Scoring/rating was conducted on the basis of aroma, taste, consistency and after taste using a scheme similar to wine tasting point scale methodology. Acid consuming capacity of antacid were determined according to British Pharmacopeias 2007. Result: A total of 50 volunteers participated in the study after giving informed written consent. The taste rating scores deduced were independent of age and gender. Among all the antacids suspension B (Sodium Bicarbonate and Sodium Alginate) showed maximum palatability; however the overall palatability of the antacids was poor. Antacid containing sodium bicarbonate and sodium alginate was found least palatable. More over the extra strength antacid version showed highest acid consuming capacity entailing small dosage but shows reduced palatability. Conclusion: Antacid brand-B reveals lowest cost effectiveness and least palatability. While, based on the findings of this study G suspension can be one of the suitable antacid for the treatment of gastrointestinal disorders since it showed highest palatability scores and cost effectiveness. [ABSTRACT FROM AUTHOR]

AIM: To assess the antacid effects of the tonic Chinese herbal prescriptions, Si-Jun-Zi-Tang (SJZT) and Shen- Ling-Bai-Zhu-San (SLBZS). METHODS: Decoctions of the tonic Chinese herbal prescriptions, SJZT and SLBZS, were prepared according to Chinese original documents. The pH of the prescription decoctions and their neutralizing effects on artificial gastric acids were determined and compared with water and the active controls, sodium bicarbonate and colloidal aluminum phosphate. A modified model of Vatier's artificial stomach was used to determine the duration of consistent neutralization effect on artificial gastric acids. The neutralization capacity in vitro was determined with the titration method of Fordtran's model. RESULTS: The results showed that both SJZT and SLBZS have antacid effects in vitro . Compared with the water group, SJZT and SLBZS were found to possess significant gastric acid neutralizing effects. The duration for consistent neutralization of SLBZS was significantly longer than that of water. Also, SLBZS and SJZT exhibited significant antacid capacities compared to water. CONCLUSION: SJZT and SLBZS were consistently active in the artificial stomach model and are suggested to have antacid effects similar to the active control drugs. [ABSTRACT FROM AUTHOR]

Dasatinib is a tyrosine kinase inhibitor (including BCR-ABL and the SRC family) that is effective in patients with chronic myeloid leukemia. Dasatinib has pH-dependent solubility and is bioavailable as an oral formulation. The effect of gastric pH modifiers on dasatinib pharmacokinet-ics is evaluated in an open-label, randomized, 3-period, 3-treatment crossover study. Twenty-four healthy subjects receive treatment A (2 doses of dasatinib 50 mg separated by 12 hours), treatment B (famotidine 40 mg given 2 hours after dasatinib 50 mg and 10 hours before another dose of dasatinib 50 mg), and treatment C (30 mL of an antacid containing aluminum/magnesium hydroxides given 2 hours before dasatinib 50 mg and concomitantly with dasatinib 50 mg 12 hours after the previous dasatinib dose); a 7-day washout separates each treatment period. When famotidine is administered 2 hours after dasatinib, dasatinib exposure is similar to dasatinib administered alone. However, dasatinib exposure is reduced by ∼60% when famotidine is administered 10 hours before dasatinib dosing. In contrast, dasatinib exposure is unchanged when antacid (Maalox) is administered 2 hours before dasatinib; but when the antacid is coadministered with dasatinib, dasatinib exposure is reduced by ∼55% to 58%. This indicates that H2-receptor antagonists should not be coadministered with dasatinib. Dasatinib may be administered with acid-neutralizing antacids if the doses are temporally separated by at least 2 hours. [ABSTRACT FROM AUTHOR]

Matrix systems with a local antacid effect were produced in this study. Aluminium hydroxide and magnesium trisilicate in constant concentrations were used as active agents. Eudragit® E PO was applied as a matrix former and sodium bicarbonate as a disintegrant (third antacid component), in different ratios. Their effects on the properties of the tablets were studied. Such formulated systems must be insoluble if the pH of the stomach is less acidic, but a rapid disintegration must occur if necessary. It can be concluded that Eudragit® E PO in appropriate composition can ensure tablets with pH-dependent disintegration. Its binding effect allows tablet making from the elastic active component. The liberation of antacid materials from this system is controlled. If the pH reached 2.5, the erosion of the tablet was reduced. In contrast with expectations, the application of poorly compressible and effervescent sodium bicarbonate increased the time for disintegration of the tablets, because of its extended alkalizing effect around the tablet. This system with this acrylic component is appropriate to produce a controlled-release local antacid preparation. [ABSTRACT FROM AUTHOR]

Dasatinib is a tyrosine kinase inhibitor (including BCRABL and the SRC family) that is effective in patients with chronic myeloid leukemia. Dasatinib has pH-dependent solubility and is bioavailable as an oral formulation. The effect of gastric pH modifiers on dasatinib pharmacokinetics is evaluated in an open-label, randomized, 3-period, 3-treatment crossover study. Twenty-four healthy subjects receive treatment A (2 doses of dasatinib 50 mg separated by 12 hours), treatment B (famotidine 40 mg given 2 hours after dasatinib 50 mg and 10 hours before another dose of dasatinib 50 mg), and treatment C (30 mL of an antacid containing aluminum/magnesium hydroxides given 2 hours before dasatinib 50 mg and concomitantly with dasatinib 50 mg 12 hours after the previous dasatinib dose); a 7-day washout separates each treatment period. When famotidine is administered 2 hours after dasatinib, dasatinib exposure is similar to dasatinib administered alone. However, dasatinib exposure is reduced by ∼60% when famotidine is administered 10 hours before dasatinib dosing. In contrast, dasatinib exposure is unchanged when antacid (Maalox) is administered 2 hours before dasatinib; but when the antacid is coadministered with dasatinib, dasatinib exposure is reduced by ∼55% to 58%. This indicates that H2-receptor antagonists should not be coadministered with dasatinib. Dasatinib may be administered with acid-neutralizing antacids if the doses are temporally separated by at least 2 hours. [ABSTRACT FROM AUTHOR]

The effect of antacid (Antasida DOEN) 14 ml/ kg BW which containing polyvalent cation Mg (OH)2 and Al(OH)3 on the absorption of levofloxacin were examined in healthy rabbit. Twelve subjects were administered 23 mg/ml kg BW levofloxacin alone. On day 8 the six subjects were administered antacid and levofloxacin concomitant and the other were administered antacid two hours after levofloxacin. There were statistically significant different in pharmacokinetic parameter produced by administration with antacid concomitant but the other one were not significant different. There were Cmax and AUC decrease (p<0.05) but tmax increase was not significant different (p>0.05) for administration concomitant and but the other one were C max, AUC and tmax smaller than control but not significant different (p>0.05). The different had apparent effect on the plasma concentrations of levofloxacin and was determined with spectrofluorometric. Antacid may reduce the absorption of levofloxacin, the extent of this interaction appears to increase as time between administration of two drugs decreases. [ABSTRACT FROM AUTHOR]

What is already known about this subject • Febuxostat is a novel nonpurine selective inhibitor of xanthine oxidase. What this study adds • This is the first manuscript to address the effect of food and antacid on the pharmacokinetics and/or pharmacodynamics of febuxostat. • The study will determine whether the drug can be administered regardless of food or antacid. • It will therefore influence how the drug should be administered. Aims To evaluate the effects of food or antacid on the pharmacokinetics and/or pharmacodynamics of febuxostat. Methods Four Phase I, two-period, crossover studies were performed in healthy male and female subjects. Subjects either received single 40-mg ( n = 24), multiple 80-mg ( n = 24) and single 120-mg ( n = 20) doses of febuxostat in fasting and nonfasting conditions, or received single 80-mg ( n = 24) doses alone or with antacid. Results Food caused a decrease in Cmax (38–49%) and AUC (16–19%) of febuxostat at different dose levels following single or multiple oral dosing with febuxostat. However, a slightly greater percent decrease in serum uric acid concentrations (58% vs. 51%) after multiple dosing with 80 mg of febuxostat under nonfasting conditions was observed, which was statistically ( P < 0.05) but not clinically significant. Antacid caused a decrease in Cmax (32%), but had no effect on AUC of febuxostat. Febuxostat was safe and well tolerated in all studies. Conclusions Even though food caused a decrease in the rate and extent of absorption of febuxostat, this decrease was not associated with a clinically significant change in febuxostat pharmacodynamic effect. Despite a decrease in the absorption rate of febuxostat, antacid had no effect on the extent of febuxostat absorption. Therefore, febuxostat can be administered regardless of food or antacid intake. [ABSTRACT FROM AUTHOR]

In some multidrug therapy programs, ketoconazole (KTZ) may be administered with some antacids that could modify its dissolution rate and reduce its absorption, thus leading to therapeutic failures. The primary aim of this study was to evaluate the influence of Compritol HD5 ATO and Compritol 888 ATO on this interaction in comparison with commercial KTZ tablets. The second aim was to prepare lipid granules of KTZ that could be an alternative to the commercial formulation. Therefore, six KTZ sustained-release granules were prepared with different lipid concentrations, because they were found to be more suitable than tablets that are dissolved only in gastric medium. The results confirmed that the dissolution rate of KTZ granules was significantly reduced in the presence of antacids. The ideal formulation was selected as granules including 5% of Compritol lipids in relation to the suitability of the target profile. Therapeutic effects of orally administered, ideal KTZ granule formulations, and commercial tablets were evaluated in vivo by the experimental model of murine vulvo-vaginal candidiasis (VVC) with and without antacids. It was found that formulations were very effective on VVC, and the therapeutic effect decreased significantly in the presence of antacids. Histopathological studies were carried out for vagina, stomach, and liver tissues and hepatoxicity was also examined. The levels of reduced glutathione (GSH) were measured to assess the oxidative stress induced by KTZ and function of the liver. It was observed that orally administered formulations of KTZ were successful in treating candidiasis in mice without irritancy in stomach. However, liver tissues were damaged. The decreased GSH levels indicated toxicity in our study. This study suggested that in vitro release and in vivo microbiological-toxicological properties of KTZ were affected by antacids and drug-excipient interactions. Lipid granules of KTZ prepared with Compritol 888 ATO could be proposed as a new KTZ solid dosage form with optimum dissolution and therapeutic characteristics. [ABSTRACT FROM AUTHOR]

Abstract: A micellar electrokinetic chromatography method was developed for the determination and quantification of sodium alginate. The alginate peak migrated in the very short time of 1.33min and calibrated easily though the polydisperse properties of alginates. The minimum detection limit (LOD) of the method was calculated as 0.393mg/ml. This analysis method was successfully applied to the alginate quantification in an antacid pharmaceutical formulation. Precise and reproducible analysis results were obtained, with liquid formulations injected directly without any pre-separation process. [Copyright &y& Elsevier]

Abstract: A carbonated–nitrated cancrinite-type zeolite was synthesized using zeolite X as silicon and aluminum source under strongly alkaline conditions (NaOH and Na2CO3). Additionally, a hydrotalcite-like compound of 0.20 Al/(Al+Mg) ratio with nitrate and carbonate anions into its interlayer was also synthesized. Both solids were characterized by means of techniques such as XRD, FT-IR and BET surface area. These techniques confirmed the presence of pure cancrinite-type zeolite and hydrotalcite, without the presence of collateral phases. These solids had been previously tested as antacid agents and determined their interaction with acidic solution of aspirin. The results showed that these solids could be used as effective antacid without any possible interaction between both drugs. Following with our studies, we determined a possible interaction among tetracycline molecules and our synthesized antacids. These studies were carried out by UV–visible analysis of the supernatants and FT-IR of the interacted solids with tetracycline solutions. Variable quantities of zeolites and hydrotalcites were weighed and placed in contact with aliquots of tetracycline acid solutions at 37°C and under agitation for 1h to simulate stomach conditions. The FT-IR studies did not show interaction between the tetracycline molecule and these solids, however, in the studied supernatants, it was possible to confirm the formation of complexes among the cations from the dissolved solids and the tetracycline molecule. These interactions, determined by UV–visible spectrometry, were higher when pH increased. Also, these interactions were superior in the hydrotalcite than in cancrinite zeolite due to a large number of species in solution (Al3+ and Mg2+). In spite of our results, we believe that it is possible to administer cancrinite–zeolites as antacid 1h before administering drugs based on tetracycline. Additionally, these results could represent an important advance in the formulation of new broad range drugs for medical applications. [Copyright &y& Elsevier]

We studied the effect of proton pump inhibitors, histamine H2 receptor antagonists, and other types of antacid drugs on fracture risk. All cases were subjects with any fracture sustained during the year 2000 ( n = 124,655). For each case, three controls ( n = 373,962) matched on age and gender were randomly drawn from the background population. The primary exposure variables were use of proton pump inhibitors, histamine H2 antagonists, and other antacid drugs. Adjustments were made for several confounders, including diagnosis of an ulcer, nonsteroidal anti-inflammatory drug use, use of histamine H1 antagonists, stomach resection, previous fracture, and use of corticosteroids. The effect of dose was examined by stratifying for cumulated dose (defined daily dose). Use of proton pump inhibitors was associated with an increase in fracture risk for use within the last year [odds ratio (OR) = 1.18, 95% confidence interval (CI) 1.12–1.43 for overall fracture risk; OR = 1.45, 95% CI 1.28–1.65 for hip fractures; and OR = 1.60, 95% CI 1.25–2.04 for spine fractures). Histamine H2 antagonists were associated with a decreased fracture risk if they had been used within the last year (OR = 0.88, 95% CI 0.82–0.95 for any fracture, OR = 0.69, 95% CI 0.57–0.84 for hip fractures). Other antacids were not associated with overall fracture risk but were associated with hip and spine fractures. Proton pump inhibitors appeared to be associated with a limited increase in fracture risk, in contrast to histamine H 2 antagonists, which seemed to be associated with a small decrease in fracture risk. In all cases, the changes in risk estimates were small and the clinical significance was limited. [ABSTRACT FROM AUTHOR]

To investigate the effects of antacid suspension on oral absorption of itraconazole.A randomized, open-labelled, two-period, crossover study with a 1-week washout period was conducted in 12 healthy Thai male volunteers. The participants were allocated in either treatment A or B in the first period. In treatment A, the volunteers were orally administered with 200 mg of itraconazole alone. In treatment B, the volunteers were administered orally with 200 mg of itraconazole co-administered with antacid suspension. Serial serum samples were collected over the period of 24 h and subsequently analysed by using a validated high-pressure liquid chromatographic method with ultraviolet detection. Pharmacokinetic parameters were determined by non-compartmental analysis.Time to reach maximal concentration (Tmax), maximal concentration (Cmax) and area under the curve (AUC0--∞) were markedly decreased in antacid-treated group.Tmax for treatment A was 3·0 ± 0·4 and 5·1 ± 2·7 h for treatment B.Cmax and AUC0--∞ of treatments A and B were 146·3 ± 70·5 vs. 43·6 ± 16·9 (ng/mL) and 1928·5 ± 1114·6 vs. 654·8 ± 452·2 (ng·h/mL) respectively. 90% Confidence interval (90% CI) ofCmax and AUC0--∞ were 24·1–42·1 and 16·2–65·9 respectively.Rate and extent of itraconazole oral absorption were markedly decreased by concurrent use of antacid suspension. Hence, co-administration of itraconazole and antacid suspension should be avoided. [ABSTRACT FROM AUTHOR]

Aims To examine the effect of concomitant cimetidine or antacid administration on the pharmacokinetic profile of sildenafil citrate in healthy male volunteers in two open-label, randomized studies. Methods The first study was a parallel-group design in which 22 healthy male volunteers received sildenafil (50 mg) on days 1 and 5 and cimetidine (800 mg) or placebo on days 3, 4, 5, and 6. Blood samples were collected predose and at specified times up to 48 h postdose on days 1 and 5 to determine plasma levels of sildenafil and its metabolite, UK-103,320. The second study was a two-way crossover design in which 12 volunteers received sildenafil with or without a 30-ml dose of a magnesium hydroxide/aluminium hydroxide antacid. Blood samples were collected and analysed as in the first study. The two study periods were separated by at least 14 days. Results Coadministration of cimetidine had no statistically significant effect on the t max or kel of sildenafil but caused a statistically significant increase in sildenafil AUC t and C max of 56% and 54%, respectively (P <0.01). Differences between the two treatment groups were smaller for the metabolite than for sildenafil, although cimetidine treatment did significantly (P <0.05) increase the AUCt for UK-103,320 by 30%. Antacid coadministration had no statistically significant effect on any pharmacokinetic parameter of sildenafil or UK-103,320. Whether taken alone, with cimetidine, or with an antacid, sildenafil was well tolerated. Most adverse events were mild in nature, and no subject withdrew from either study for any reason related to the drug. Conclusions Cimetidine co-administration produced an increase in sildenafil plasma levels; however, this increase is not sufficient to warrant dosage adjustment of either drug. Antacid coadministration had no effect on the pharmacokinetic profile of sildenafil. [ABSTRACT FROM AUTHOR]

Objective: Although antacids were ineffective in preventing serious gastrointestinal complications caused by non-steroidal anti-inflammatory drugs (NSAIDs), many physicians in Taiwan still prescribe antacids concomitantly with NSAIDs. A survey of an outpatient prescription database was performed to measure the extent of such a combination and to explore its associated factors. Methods: One month of the outpatient prescription data in the polyclinic of a medical center in Taiwan served to estimate the frequency of concomitant antacid prescription with NSAIDs. The age of patients, duration of NSAID prescriptions, concomitant prescription of corticosteroid or ulcer-healing drugs, and inter-departmental variations were compared between the NSAID prescriptions with and without antacids. Results: Antacids were present in 87.3% of prescriptions with NSAIDs but only in 34.4% of prescriptions without NSAIDs (P<0.001). The prescription of antacids was significantly associated with the prescription of NSAIDs. The age of patients and duration of NSAID prescriptions did not influence the co-prescription of NSAIDs and antacids. Significant inter-departmental variations were noted in which the surgeons and orthopedic doctors tended to co-prescribe antacids with NSAIDs more often than the internists. Conclusion: The physicians in Taiwan tended to prescribe NSAIDs together with antacids. The rationality of this co-prescription deserves further investigation. [ABSTRACT FROM AUTHOR]

: Bone loss leading to osteoporosis is common after the menopause and in the elderly but uncommon in normal young adults without predisposing factors. The risk factors usually associated with osteoporosis include a family history of osteoporosis or fractures, aging, prior diseases, sedentary lifestyle, low calcium intake, hypogonadism, vitamin D deficiency, smoking, and excessive alcohol consumption. However, the issue of drugs has to be considered in “normal” individuals who present with osteoporosis or bone loss without predisposing genetic or other environmental factors. The list of drugs is extensive and includes, amongst others, glucocorticoids, thyroid hormone (excess), alcohol, medroxyprogesterone acetate, luteinizing hormone- releasing hormone agonists, anti-seizure medications, cyclosporine A, aluminium, lithium, and exchange resins. This paper reviews the pathophysiology and mechanisms of drug-induced bone loss, which includes osteoporosis and osteomalacia, and treatment concepts. Undoubtedly, physician awareness, appropriate investigation, careful prescribing, monitoring, and proper therapy for this eminently preventable side effect can preserve bone in the patients receiving bone-losing drugs. [ABSTRACT FROM AUTHOR]

Norfloxacin is a fluorquinolone that can interfere with antacids that contain aluminum and magnesium salts by complexation and modification of its solubility, which reduces its absorption and may lead to therapeutic failures. The purpose of this work was to evaluate the effect of the pharmaceutical design on this interaction and to develop a formulation of norfloxacin tablets in which this process could be avoided. Norfloxacin tablets were designed in 28 formulations. The interaction was studied in terms of in vitro dissolution behavior (USP 23, apparatus 2) in simulated gastric fluid with different doses of four commercially available antacid preparations. It was observed that dissolution rates were markedly reduced in the presence of all antacids studied. This phenomenon was practically avoided with some formulations of norfloxacin tablets in which a disintegrant (sodium starch glycolate or crospovidone) was included. These results indicated that the chelation among metal ions and norfloxacin could be affected by the delivering ability of the drug in the tablet. It was demonstrated that the pharmacotechnical design could modify an interaction process. Some formulations of tablets, in which the reduced dissolution rates in the presence of nonsystemic antacids in vitro was practically avoided, were developed by direct compression. [ABSTRACT FROM AUTHOR]