Antacids how to take. Modern antacid drugs in gastroenterological practice

Content

Heartburn, pain in the chest - the sensations familiar to many are not obstacle. The causes of the occurrence are different: from improper power to diseases of the gastrointestinal tract. Regardless of the cause, effective treatment is required to facilitate the state. Antacid drugs - a group of medicines intended for assistance in such states.

Action of antacid drugs

Antacids are medicines that are designed to help acid-dependent GTS diseases by neutralizing hydrochloric acid and bile of gastric juice. The name is formed from the ancient Greek words "against" and "acid". The feature of the use of antacid drugs - they do not treat the disease itself, the cause of pain, but only affect the symptoms. They are used to:

reduce the pain from the irritant acid action on the mucous membrane of the organs of the digestive system;
reduce pressure on the stomach;
prevent casting the contents of the duodenal in the gastric cavity.

Reception of these drugs accelerates food promotion. They envelop, protect the esophagus from aggressive factors, contribute to the oppression of the activity of bacteria that cause ulcers and gastritis - Helicobacter pylori. The antacid action begins to be felt 5-10 minutes after the reception, lasts 2-4 hours. Most of the drugs of this group are well tolerated, do not cause side effects.

Indications for the use of antacid drugs

failures in the work of the stomach from the reception of nonsteroidal anti-inflammatory funds;
diseases, inflammations of the pancreas, gallbladder, gallstone disease;
ulcery, GERB (gastroesophageal reflux disease);
acid-dependent diseases, including pregnant women;
one of the heartburn;
exacerbation of chronic diseases (pancreatitis, cholecystitis).

Types of antacid drugs

The classification of antacids is carried out in several criteria:

According to the type of assimilation, the drugs are suction and notes.
In composition - modern antacid drugs contain: hydroxide and aluminum phosphate, hydroxide or magnesium carbonate, carbonate calcium, sodium bicarbonate. Combined antacids are manufactured with several active substances.
By speed, short and long-term drugs are distinguished. The first more often includes absorbing drugs based on magnesium, calcium. They reduce the pain of short time, about 30 minutes. The effect of drugs with aluminum hydroxide, magnesium trisilicate longer - up to 4 hours.
The neutralizing ability is distinguished effective: with magnesium oxide, aluminum hydroxide, calcium carbonate and weaker: magnesium trisilicate, sodium bicarbonate.

Form release

Antacid remedies are available in the form of pills for resorption or suspension. There are already ready-to-eat mixes or powder for making medicine, packaged by sachets. The form of release directly affects the convenience of use and neutralizing ability:

Tablets are more convenient to take - they do not need to drink water, it is necessary to simply warm up.
Suspensions are more efficient, because their particles are smaller, and the area spread is greater. Their gel thick structure is better enveloped mucous membranes, anesthetic and protecting.

Suctional antacids

This group of funds (or products of their chemical interaction) is absorbed by the intestine and fall into the blood. They differ rapid, but short action from 30 minutes to 2 hours. The chemical reaction caused by them passes with the release of carbon dioxide. This causes belching, flatulence, which later time re-leads to heartburn. They are characterized by the "ricochet syndrome" - 1-2 hours after the reception increases the production of hydrochloric acid, which aggravates the disease.

Suctional antacid means contain calcium carbonate, magnesium, sodium bicarbonate. These include: Food soda, Renny, Vicalin, Vicair and others. They are spread throughout the body - it increases the risk of side effects. Main: changes in the composition of blood, malfunctions in the heart system, the effect on the work of the kidneys, swelling, an increase in blood pressure, the formation of kidney stones. Such signs appear more often with simultaneous reception with drugs of dairy products. It is recommended to apply them at all, and not long-term courses.

The main contraindications for taking suction antacids:

allergies or individual intolerance of the components;
renal failure of severe;
children's age up to 12 years;
hypercalcemia.

One of the widespread medicines of this type is Renny. These are chewable pills with mint, cooling or orange flavor, which neutralize excess hydrochloric acid and protect the mucous membrane of the food tract and stomach. The action is felt after 5 minutes, due to the excellent solubility and high calcium concentration:

Rennie actors: calcium carbonate and magnesium carbonate.
The form of the release of medication - tablets. Fasted on 6 or 12 pieces in blisters or packaging from heat-resistant aluminum. In a bundle from 1 to 8 blisters.
The cost of 24 tablets in the range of 290-320 rubles.
Accepted with an interval of 2 hours or more, the maximum daily dose of 11 tablets.

The cost of the drug is Vicair Tablets. They are prescribed to facilitate the symptoms of ulcerative disease, gastritis with a tendency to constipate. Dosage - 1-2 pieces 3 times a day. The effect of medication: antacid, binder, laxative, antispasmodic. Ingredients: magnesium carbonate, sodium bicarbonate, bismuth subnistrate, Koriya Aira, cortex cortex. Package price of 10 tablets 15-25 rubles.

Non-surging antacids

These are more modern drugs compared to absorbing drugs with gentle action. Exercise therapeutic effects on the gastrointestinal diseases are applicable to long-term reception. Their actors are not absorbed by the body, side effects are marked by patients much less often. Main components: Aluminum phosphate, aluminum and magnesium hydroxides, combined composition. Some drugs contain additional components: symmetics, alginic acid and its salts. Thanks to them, the risk of the appearance of side effects is reduced.

Insistent drugs envelop the mucous membrane, contribute to healing. Act 15-20 minutes after reception, the result is up to 4 hours. Carefully assign people with renal failure, due to the removal of active substances with urine. The main representatives of this group of medicines - Maaloks, Almaty, Gaviscon, Phosfaleugel, Palmagel A, Gastal, Alumag and others.

Possible side effects from application: intestinal disorders, nausea, vomiting, drowsiness, allergic skin rash. A long course of reception may cause a decrease in phosphorus and calcium in the blood, which will make the bones fragile. The risk of rock formation of kidneys, violations of their normal operation increases. Antacids of the non-commissioning group have common contraindications to use. Prohibited at:

renal failure;
alzheimer's diseases;
allergic reaction, individual intolerance to the components of drugs.

pregnancy, lactation;
heart failure;
injuries, brain diseases;
age over 65 years;
children under 18;
cirrhosis of the liver;
failure in the functioning of the kidneys.

Almagel is a popular agent with an active aluminum phosphate. Eliminates symptoms of duodenitis, gastritis, stomach ulcers, duodenal and other gastrointestinal diseases. Anesthetics, reduces heartburn. Available in the form of tablets Almagel T and suspension. The medicine is produced in 170 ml bottles or disposable bags of 10 ml. The cost of pharmacy networks is 195-300 rubles per vial. Packaging price Almagel T with 12 tablets - 60 rubles.

Suspension is made in several options:

Almagel is the standard composition of the gel with aluminum and magnesium hydroxide. Green box.
Almaty A - Gel Antacids with Anesthetics (Benzocaine). Yellow packaging.
Almagel neo - Simeticon in the composition eliminates gas formation. Red box design.

Phospalsugel - antacid group medication that protects the gastric mucosa, lowers the acidity of the gastric juice. It is used for gastritis, ulcerative diseases of the gastrointestinal tract, reflux-esophagite, digestive disorders and food poisoning. Sold in pharmacies without a doctor's prescription. Before taking the contents of the package to vail your fingers for mixing. It is consumed in pure form or is stirred with a small amount of water:

The main component is aluminum phosphate, additional - sorbitol, agar-agar, pectin, calcium sulfate dihydrate, purified water, flavoring.
Form of the release of phosphhalugel - white gel with a uniform structure. It is unpacked in packet of 16 or 20 grams for one reception.
In the package of 20 sachets weighing 20 grams or 26 sachets weighing 16 grams.
The price is 360-390 rubles.

Antacids for children

Children have diseases that require anticidal agents. These are gastroduodenites, erosion or ulcer mucosa, heartburn due to unbalanced nutrition. If necessary, choose a medicine for a child of younger (up to 10 years), it is worth considering that suction antacids are strictly prohibited. The reason is in the effect of the ricochet, penetration into the circulatory system, possible side effects.

You can choose a medicine to the child from non-playing antacids: This is Maalox, Gavisson, Alumag, Almagel, Phosfalugel and others. Phosfalugel does not disturb the phosphate balance and leans from bones of calcium. Allowed to children, with a dosage reduced 2-4 times (relatively with adults). The exact guidelines for the drug gives a doctor. Long use even allowed antacids to children is not recommended: it is necessary to treat the disease, and not facilitate its symptoms.

Medicinal interaction

Reception of antacid means worsens the absorption of nutrients and elements of food and drugs. Therefore, they should be used with an interval of 1-2 hours between them. A film that covers the mucous membrane of the gastrointestinal tract will reduce the absorption and action:

iron-containing drugs, iron sulfates;
fluorides;
phosphates;
fluoroquinolones;
benzodiazepines;
non-steroidal anti-inflammatory funds;
antibiotics: tetracycline, metronidazole;
anti-tuberculosis funds;
Phenitina, Digoxin, County, Warfinic.

Video

When anthacides are prescribed, the list of drugs of this group should give a doctor, depending on the individual characteristics of the patient. Since ancient times, people used drugs with pains and spasms in the stomach. These drugs were the first antacids. The function of such drugs, as well as the means of the antacid group, was interacting with gastric acid. After all, excess of hydrochloric acid leads to problems in the functioning of the digestive tract. Modern pharmaceuticals find more and more ways to get rid of an acid excess in the gastrointestinal tract.

For convenience, the entire list of antacid drugs was divided into 2 groups: absorbable and non-referred. A suction group is still used less due to side effects. The first group includes funds:

magnesium oxide (burned magnesia);
calcium carbonate;
sodium carbonate;
Renny;
bourge mixture;
Tamm.

But these funds rarely enjoy, as they contribute to the appearance of the abdomen and belching due to the resulting carbon dioxide. But at the same time they have a rapid effect. Second group of drugs:

magnesium hydroxide;
aluminum hydroxide;
Phosphhalugel;
Maaloks;
Topalkan.

These drugs act slowly, but the effect is delayed for longer (up to 1.5 hours), side effects are unlikely. Another important advantage of the unsuitable means is that it has the property of enveloping, thereby neutralizing and chloroic acid and bile acids.

Antacid drugs are also separated by the speed of action and by its duration. There are also a list of drugs divided by solubility in water: soluble and insoluble.

Means soluble in water. It is highly soluble in water in water: calcium carbonate, soda, sodium sulfate, sodium phosphate, sodium bicarbonate, calcium carbonate, magnesium carbonate. They quickly act, but as a result of this action, a gastric bag is stretched due to the formation of carbon dioxide, which contributes to the ricochet syndrome. Sodium bicarbonate due to solubility in aqueous solutions can be absorbed and systematically affected by the entire body.
Insoluble means. These drugs include all magnesium and aluminum compounds. In comparison with soluble means, these have a slow action, but more prolonged. Such a means partially sorbites toxins and is practically not absorbed into the liquid medium of the body. If the dose of aluminum salts exceeds the locking effect, and the magnesium salts are laxative.

The most common drugs of this group account for this list from the most common to medium fame and the applicability of the drug.

Medicines included in insoluble antacids

Phosfalugel, consisting of phosphate aluminum, is produced in the form of a gel. Enveloping adsorbing agent.
Maaloks - aluminum hydroxide and magnesium hydroxide. Release form: Tablets, suspension in the bottle and packaged.
Talcid consists of hydrotocitis. Chewing pills. Gastroprotective drug.
Gelusil-varnish - compounds of aluminum, magnesium, silicon (Simaldrat). Pills. Medication is often used as an adsorbent.
Renny, consisting of magnesium carbonate. Chewing pills.
Almaty - from magnesium hydroxide and aluminum hydroxide, suspension. It has good antacid, enveloping, adsorbing ability.
Almaty A. Additional substance - benzocaine, is produced as a bottle of suspension.
Almagel Neo. Additional substance - Siemeticone. Release form - suspension vial.
Alma-Gal - chewing tablets or suspension vial consisting of aluminum hydroxide and magnesium hydroxide having an additional sorbitol substance.
Alumag consists of magnesium hydroxide and algeldrat, produced in tablets, anti-sized, anticidal agent.
Sukralfat - aluminum hydroxide, is produced in tablets or granules.
Vicalin consists of magnesium carbonate, sodium hydrocarbonate, bismuth subtitrate and auxiliary substances - AIRA rhizomes, crawling crust.
Gastal is an enveloping drug in tablets, the composition includes aluminum, magnesium and carbonate hydroxides.
Gastric - chewing tablets consisting of calcium carbonate and hydroxide.
Gelevil - suspension for internal reception consisting of Simaldrat, in addition to the antacid action is a cytoprotective medicine.
Rutacid - chewing pills from hydrotcitis.
Tisacid consists of hydrocitis, produced in tablets.
Entignin - adsorbing tablets, as part of which lignin hydrolysis.

This is a small list of antacids, not suction in the blood. All of the above drugs are complex means, and therefore contain a complex of compounds affecting gastric acid.

The faster of all the drug Maaloks operates, further to increase the time go:

Phosphhalugel.
Remagel.
Megalak.
Almagel.

Antacid drugs are often used in therapy.

Phosfalugel medication treatment does not entail the occurrence of secondary hypersecretion of gastric acid.

Hydroatic acid (rutacid, talcid) quickly and for a long time binds hydrochloric acid with maintaining the normal level of stomach acidity, protects the mucous membrane from the action of pepsin enzyme.

Almagel and all preparations containing simethicone eliminate discomfort in the gastrointestinal tract, contribute to the natural release of gases and prevent the stool delay.

Sometimes they are accepted symptomatically, it is obvious to instantly eliminate pain, belching, heartburn.

In addition to the main disadvantage, the antacids (they do not eliminate the cause, but only reduce the symptoms of the disease), there are contraindications:

pregnancy.

The effect of suction and insoluble antacids is different. When and in what cases give preference to a particular group depends on therapeutic purposes.

Features of the use of suction antacids

Earlier, ordinary food soda was widely used to facilitate heartburn. Today it has been proven that such treatment has many drawbacks and inappropriate.

Systemic antacids act quickly and not long. The simplest tool that can be bought not only in the pharmacy, but also in the grocery store - soda. Many patients without thinking, with pain in his stomach, heartburn make themselves a solution and drink it. Immediately it seems to be relieved. The pain subsides, heartburn disappears. Such a tool, like other system antacids, effective, but it has side effects:

In the interaction of suction antacids with hydrochloric acid, carbon dioxide is formed. It causes a stomach stretching, annoying the mucous membrane and contributes to the development of the "ricochet" (activates re-gastric secretion). Provokes the development of gastroesophageal reflux.
Systemic antacids act shortly. They do not eliminate the cause of unpleasant symptoms.
During long-term use, alkalosis causes. They are absorbed into blood, violate its acid-base balance. Alcalosis is manifested by nausea, weakness ,.
The composition of most systemic antacids includes sodium. It is undesirable to take patients with heart or renal failure. He contributes to the appearance of eats.
Calcium antacides are taken by excluding dairy dishes from the diet. Otherwise, it will develop with milk-alkaline syndrome (hypercalcemia with alkalosis). Calcium contributes to education, reduces the excretion of the parathgamon.
Sodium bicarbonate in a complex with magnesium oxide is observed urine. As a result, phosphates fall into the sediment, and in the urinary tract, phosphate stones are formed in the kidneys.

Systemic antacids are preferably taken to make it possible when it is necessary to quickly learn pain symptom. For long-term use, in complex treatment and prevention of acid-dependent states, insoluble antacids are recommended.

Features of the use of non-surging antacids

They do not cause such side effects as soluble antacids, as they are not absorbed, they do not fall into the blood. In addition to the absence of risk of development of alkalosis, non-surging antacids have a number of advantages over the system:

reduce proteolytic activity of gastric juice;
lizelocitin binds, gorgeous acids, preventing mucous membranes from damage;
improve microcirculation;
protect the regeneration of the mucous membrane.

Invasive antacids eliminate the symptoms of acid-dependent states, contribute to the healing of ulcers, but they also have side effects. Prolonged use, especially uncontrolled, leads to various complications:

When receiving drugs containing aluminum, the absorption of phosphates in the intestine is reduced. Hypophosphamia occurs, leading to osteomalysis,. Most often, such an effect is observed in patients who do not distinguish between alcohol (even in small quantities), patients with renal failure.
Magnesium preparations lead to diarrhea, and aluminum medicines to. It is more expedient to take combined aluminum-magnesium antacids.

Insoluble antacids - prolonged action preparations. In pharmacies, they are sold in the form of tablets, suspensions, gel. Liquid drugs act faster, and in tablets it is more convenient for repeated use during the day.

Antacids- This is a group of pharmacological preparations, the impact of which leads to the elimination or neutralization of the increased acidity of the stomach. The basis of these drugs is calcium, magnesium and aluminum compounds. They are prescribed at various gastric diseases:

ulcers;
with disorders of the digestive tract during pregnancy;
meteorism;
reflux;
gastritis;

The classification of antacids subdivides them to absorbing and disadvantaged drugs.

Ansuit antacid drugs

These include drugs capable of penetrating and dissolve in the blood at high impact speed. The healing effect of these antacids are short-term, at regular reception does not eliminate the cause of the disease and can lead to the appearance of constipation, the formation of calcium stones in the kidneys, increase pressure and other unpleasant consequences. Also, for this type of antacid drugs, the effect is characterized, expressed in re-production of hydrochloric acid after the end of the therapeutic effect of the drug. In medical terminology, this effect is called an "acid ricochet".

The possibility of the fastest treatment effect is primarily in the elimination (reduction of intensity) heartburn and pain, after receiving the per os antacid drugs, doctors and researchers have long attracted. This quality of antacid drugs is advantageously distinguishes them from drugs of other classes, including H 2-blocks 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 the effect of their action comes somewhat later, and the financial value is significantly higher. .

The main point of the application of antacid drugs is the neutralization of hydrochloric acid isolated by parietal cells of the gastric mucosa. According to the observations of some researchers, when taking antacid drugs in conventional therapeutic dosages, the acidity level is not more than 5 (drugs are neutralized only by the excess acidity of the gastric juice), however, when the acidity level is reduced to 1.3-2.3, these drugs are neutralized with 90% gastric Juice, and with a value of 3.3 - 99% of the gastric juice.

Antacid drugs have long been used in the treatment of patients suffering from various gastroenterological diseases, primarily acid-dependent diseases. Currently, acid-dependent groups include a large group of diseases of the upper gastrointestinal tract, regardless of whether the factor of acid aggression is central or only additional, leading to the emergence and progression of these violations. Among the acid-dependent diseases, the ulcer disease of the stomach and duodenum is most often isolated, gastroesophageal reflux disease (GERB), a non-inflammable (functional, essential) dyspepsia (NFD), pancreatitis, ulcers associated with non-steroidal anti-inflammatory drugs (NSAIDs), Zolinger Ellison syndrome. Some researchers for acid-dependent diseases also include ulcers that may occur during hyperthyroidism. In our opinion, these violations can also be classified an idiopathic hypersecretory state, the peptic gastroenteroanastomosis peptic ulcers, arising from a part of patients after resection of the stomach, and, to some extent, Cushing ulcers, as well as ulcers appearing during gluten enteropathy.

In the treatment of patients suffering from acid-dependent diseases, various antacid drugs are used, which are more or less different from each other, primarily in composition, the rates of the onset of therapeutic effect, duration and efficiency of impact. These qualities of drugs are somewhat dependent on their form (tablet, gel, suspension). However, most modern antacid drugs have something in general - a decrease in the concentration of hydrogen ions in the stomach, resulting from the neutralization of hydrochloric acid; In addition, the neutralizing effect causes a decrease and peptic activity. In addition, in the stomach, antacid drugs are associated with biliary acids and lezoldincytin, providing an enveloping effect. Some of the antacid drugs (in particular containing aluminum hydroxide) have a cytoprotective action, which consists in strengthening the secretion of mucus and prostaglandin synthesis. It also turned out that antacid drugs are able to associate the epithelial growth factor and fix it in the field of ulcerative defect, stimulating cell proliferation, angiogenesis and tissue regeneration.

Taking into account the antagonistic action of the intravenously introduced in the magnesia's stomach on the calcium carbonate caused by the acid hypersecreation of the acids containing a mixture of calcium carbonate and magnesium hydrate hydrates. However, such antacid drugs do not eliminate the stimulating actions of calcium carbonate on the secretion of acid in the stomach. In addition, antacid drugs containing calcium carbonate, when interacting in the stomach with hydrochloric acid, cause the formation of a significant amount of carbon dioxide, which leads to the appearance or strengthening of the meteorism, and in the presence of cardia deficiency, including a diaphragm, combined with hernias. belching.

The stimulating effect of certain antacid drugs, rendered to the secretion of acid in the stomach, is partially associated with the octic of the anthral ventricle, in the release of gastrine and, possibly, other neurogor immunity factors, and in part with the immediate effect of these antacid drugs on parietal cells of the stomach mucosa.

Attempts have repeatedly been made to somehow classify antacid drugs (absorbing and non-seated, local and systemic, anionic and cationic, combined and monocomponent). Most often allocate suction and disadvantaged antacid drugs. The group of suction usually includes such drugs as sodium bicarbonate (soda), magnesium calcium carbonate main - MG (OH) 2, 4MGCO 3, H 2 O, Magnesium Oxide (Luggnezia), Calcium Main Carbonate - Caco 3, Bourge Mix (Na sulfate, Na phosphate and Na bicarbonate), Renny mixture (calcium carbonate and magnesium carbonate), a mixture of tamm (calcium carbonate and magnesium carbonate). For these antacid drugs, the relative speed of the onset of therapeutic effect is characterized (disadvantage - short-term neutralization of hydrochloric acid). These drugs, having a systematic action, increase the alkaline reserves of plasma, changing the acid-alkaline equilibrium, and neutralize (under local action) hydrochloric acid in the stomach, which in some cases can lead to an "acid ricochet" syndrome due to the persistent appearance of acid hypersecretion in the stomach After receiving such antacid drugs. In particular, the calcium carbonate includes the specified antacid drugs, which soon after the intake begins to stimulate the secretion of acid in the stomach - accelerated neutralization of hydrochloric acid in the stomach, activates the gain of its separation of the stomach mucosa with parietal cells. In this regard, calcium carbonate is currently very rarely used in the treatment of patients.

The group of non-drug antacid drugs most often include drugs such as phosphhalugel (aluminum salt of phosphoric acid), the so-called aluminum-magnesium antacid drugs (Maaloks, Almagel Neo, Talcid, Protab, Magalphyl, etc.) and aluminum-magnesium antacid drugs with adding Alginate (Topalkan). The overall feature of the primary action of this group of drugs (when admission to the stomach) is an adsorbing effect on hydrochloric acid, followed by its neutralization. In contrast to the absorbing antacid drugs, the unsussed antacid drugs have a longer antisectory (neutralizing) effect (up to 2-3 hours), do not cause changes in acid-alkaline equilibrium and do not lead to an increase in the pH of the gastric content above the neutral value, without causing the acid syndrome Rickest. "

Modern antacid drugs differ in each other and according to the composition of cations (magnesium, calcium, aluminum), which largely defines their basic properties (neutralizing, adsorbing, enveloping, binder and cytoprotective action).

In contrast to monocomponent antacid, combined antacid drugs consist of several components of their components and have different properties, depending on the composition. Sometimes aluminum-containing drugs (phosphhalugel, Maalox, Almatyel, Gelusyl Varnish, Talcide, etc.) are isolated (phosphhalugel, Talcid, etc.), one of the substantial advantages of which, along with the neutralization of hydrochloric acid in the lobes of the stomach, is to protect the mucous membrane of the esophagus and the stomach from the effects of the acid-peptic factor. Combined antacid drugs, especially containing aluminum, have different mechanisms of action, including a combination that ensures the neutralization of hydrochloric acid and increasing the protective properties of the mucous membrane, i.e., apparently possessing and cytoprotective action.

When evaluating the effectiveness of antacid drugs, their acid-meal 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 for assessing the therapeutic efficacy of antacid drugs used in the treatment of patients. It is known that antacid drugs, due to its ability to adsorb the stomach mucosa, cause a resistant acid-demitable effect, which allows them to show buffer properties at 2.4 pH.

Acid-neutralizing activity in different antacid drugs ranges from less than 20 mmol / 15 ml of an antacid preparation to 100 mmol / 15 ml. Under the acid-meterailizing ability (activity) of antacid drugs, the amount of a particular antacid drug in grams or mmol / l, necessary to achieve a level of pH 50 ml of 0.1N hydrochloric acid solution to 3.5, is usually understood.

The smallest duration of action among antacid drugs, the funds associated with the calcium carbonate group are somewhat larger than long - with a group of magnesium, even longer - with a group of phosphorus (up to 90 minutes). Other data on the duration of the action of antacid drugs are also known, in particular containing aluminum phosphate with an antacid effect due to their absorption on the gastric mucosa, which lengthens the duration of their buffer ability at a pH value \u003d 2.4 to 120 minutes.

According to a number of researchers, a combination of aluminum and magnesium hydroxides, as well as calcium and magnesium carbonates, only neutralizing activity also exhibit also accelerated passage through the stomach. The study of the properties of certain antacid drugs, according to the intragastric computer pH metry, using the 3-electrode rn-probe showed that the smallest time from the beginning of the introduction of an antacid drug to raising the pH (on average 8.9 min) was found at Maalox, the greatest time was identified. Almaty (on average 13.5 min) compared with Remagel, Phosfalygel, Megalak; The average duration of the octic effect (an alkaline time - from the beginning of the RN increases to return to the initial level) in the antacid drugs amounted to Almogel to 56 minutes at Maalox. At the same time, Remagel, Phosfalugel and Megalak occupied an intermediate position between Almaty and Maalox. An analysis of pH gram showed that the maximum figures of the pH after the reception of various antacid drugs differed slightly.

Antacid drug therapy

Antacid drugs can be successfully used in drug therapy of all acid-dependent diseases in the following cases: 1) as monotherapy in the initial stages of these diseases; 2) as additional funds (for example, in the treatment of patients with illuminated polyami, Histamine or Prokinetics-receptors); 3) as symptomatic means to eliminate (reduce the intensity) heartburn and pain behind the sternum and / or in the epigastric region, both during the treatment of patients, combining their reception with other drugs and during the remission (including as therapy " on demand"); 4) during the screening phase until the beginning of the alleged treatment, with the selection of patients to conduct randomized studies to study the effectiveness and safety of certain drugs or their applications (as a rule, the reception of antacid drugs is allowed in accordance with the protocols of these studies), as well as directly The time of such studies as emergency therapy in cases where the effectiveness and safety of prokinetics, H 2-blocks of histamine receptors, inhibitors of the proton pump or so-called cytoprotective preparations are studied.

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

One of the antacid drugs, periodically attracting the attention of researchers and doctors - phosphhalugel (colloidal aluminum phosphate in the form of a gel for intake, containing in one bag of 8.8 g). Phosfalugel is more common to the group of non-surging antacid drugs. Most of the aluminum phosphate gel is insoluble, however, at a pH of less than 2.5 phosphhalugel goes into a water-soluble ammonium chloride, some of which is capable of dissolving, after which the further dissolution of the aluminum phosphate is suspended. A gradual decrease in the level of acidity of gastric content to pH 3.0 does not lead to the emergence of an "acid ricochet": the use of phosphhalugel in the treatment of patients does not entail the emergence of the secondary hypersection of hydrochloric acid.

One of the advantages of phosphhalugel is its acid-meterailizing ability depends on the level of acidity: the higher the acidity, the more active effect of this drug. The increase in pH under the action of the drug leads to a decrease in the proteolytic activity of pepsin. The drug does not cause gastric juice, does not limit the enzymatic processes and does not violate the physiological conditions of the digestion process. Prolonged reception of the drug does not affect the metabolism of phosphorus. The actual effect of phosphhalugel, located in the form of hydrophilic colloidal micelles of the drug, is determined by the colloidal aluminum phosphate, which has an antacid, enveloping and adsorbing effect. The insignificant part of the phosphhalugel is precipitated in the intestine in the form of oxides and insoluble carbonates, which enhances its protective, adsorbing and antacid effect. One gram of micelles of aluminum phosphate gel, consisting of aluminum phosphate, agar and pectin gel, has a contact surface of about 1000 MI, which ensures intensive bond with the walls of the digestive tract and the adsorption of harmful substances. Pectin and agar-agar gels, which are part of the drug, are involved in the formation of a mucoid, antipeptic protective layer in the gastrointestinal tract. The colloidal aluminum phosphate binds endogenous and exogenous toxins, bacteria, viruses, gases formed due to rotting and pathological fermentation, throughout the entire gastrointestinal tract, normalizing their passage in the intestine and thereby contributing to the elimination of them from the organism of patients. The influence of the drug weakened and pain. Adults and children over 6 years old are usually prescribed 1-2 bags 2-3 times a day immediately after meals and at night (with reflux-esophagite) or more often (with other diseases) - 1-2 hours after meals.

One of the antacid drugs has recently also attracting the attention of doctors - hydrotalcite (rutacid, talcide), a low aluminum and magnesium preparation. Among the features of the mechanism of action of this drug - the gradual release of aluminum and magnesium ions, depending on the state of the pH of the gastric content. Other advantages of hydrotalcite are fast and long-term neutralization of hydrochloric acid with the maintenance of pH close to a normal level, protective effect on the gastric mucous membrane with a decrease in proteolytic activity of pepsin, binding of bile acids, as well as a form of release of the drug - in the form of chewable tablets that should be thoroughly chewed . In the treatment of adult patients, hydrotocytes are usually prescribed 500-1000 mg (1-2 tablets) 3-4 times a day after 1 hour after meals and before bedtime; After the errors in the diet, accompanied by the emergence of discomfort symptoms, as well as in 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 by the overall state of patients. It is not recommended to take this drug simultaneously with the use of acid-containing drinks (juices, wine).

It is known that along with dyspeptic disorders, usually associated with various diseases of the esophagus and stomach, a significant part of patients are worried about meteorism, which occurs due to various reasons, including patients, according to our observations, for a long time of host proton pump inhibitors. The emergence of a new antacid water-soluble drug Almagel Neo, containing an optimal amount of aluminum hydroxide and hydroxide hydroxide in its composition (compared with the last previously known Suspension of Almaty, the content of the latter increased by 3.9 times) and entered into its composition of Simeticon (defoamer) allows patients with preserved and increased secretion of the stomach to receive a positive effect in eliminating discomfort symptoms, including meteorism, in a short time (on average for the fifth seventh days); Only in cases of pronounced symptoms of meteorism, treatment of patients with Almaty Neo should begin with 60 ml / day. The effectiveness of the action of this drug is due to its high acid-meteitralizing ability, the presence in its composition of the Siemeton (surfactant that reduces the external voltage of gas bubbles), which contributes to the natural selection of intestinal gases and their suction, which to a certain extent prevents the appearance of a stool delay (constipation) and meteorism , reduces the likelihood of bumps. The presence of neo sorbitol as part of Almagel allows it to be used in the treatment of patients who, along with one of acid-dependent diseases, there are diabetes mellitus. Conventional dosages for the patient of this drug: inward for adults 1 bag or 2 dosage spoons 4 times / day after 1 hour after meals and night; Children over 10 years old dosage of the drug determines the attending physician (taking into account body weight and child condition).

Different options for prescribing with antacid drugs with different diseases are known, but most often antacid drugs are prescribed in the following cases: with the so-called "on demand" therapy to quickly eliminate (reduce the intensity) of dyspepsia symptoms, especially heartburn and pain (at any time) ; During a course treatment for 30-40 minutes before or 30-60 minutes after meals (if necessary and before bedtime) in the form of monotherapy or in complex treatment, in combination, first of all, with prokinetics and / or with H 2-blocks of histamine receptors (frequency and duration of reception of antacid drugs are determined by the overall state of patients). By itself, the positive effect of antacid drugs in the elimination of the pain behind the sternum and / or in the epigastric region and / or heartburn (burning) indicates the presence of an acid-dependent disease in a patient. Most often, observations show, antacid drugs may be necessary in the treatment of patients suffering from ulcerative disease, chronic pancreatitis, GERD and / or NFD, which can be combined with chronic hyperacid or normal gastritis, and possible in patients with NFD syndrome without morphological Signs of gastritis.

As our observations showed, it is most expedient to use antacid drugs in the following cases. With a peptic disease associated with nelicobacter pylori (HP), after carrying out eradication therapy when painting pain and / or dyspeptic disorders, especially heartburn. However, due to the adsorbing ability of the antacid drugs, their use is not justified directly during eradication therapy Helicobacter Pylori: during this period, patients take quite a lot of tablets or capsules - 6 times a day, the base drug (proton pump inhibitor, ranitidine or bismuth preparation) in combination With 2 antibiotics (first line therapy) or 13 times a day 4 of the drug (therapy of the second line), since the likelihood of reducing the effectiveness of the action of both antibiotics and basic (basic) drug (preparations) increases. Taking into account the number of drugs applied by patients during the day and necessary to obtain an eradication effect, that is, the destruction of Helicobacter pylori (HP), in case of additional purpose of antacid drugs, the number of tablet forms of drugs will exceed the specified number of drugs (taking into account dosages), More than 6 and 13 times a day in therapy of the first and second line, respectively.

With a peptic disease that is not associated with HP, antacid drugs can be successfully used in the form of independent therapy with the first revealed, uncomplicated ulcerative disease of the duodenum (with small in size of ulcers), as well as additional therapy of the ulcer of the stomach and duodenum to H 2-blocks of histamine receptors, or in therapy at the requirement or inhibitors of the proton pump. The success of the treatment of patients largely depends on the depth of ulcers.

When comparing the results of a 4-week treatment of 2 groups of patients suffering from uncomplicated ulcerative duel disease (in one of the groups, various antacid drugs were treated in a "liquid" form or in the form of tablets, 4-6 times a day, having a different neutralizing ability - From 120 to 595 MEQ anions N + per day, another group of patients treated in the therapeutic doses of H 2-blocks of histamine receptors), not observed significant differences in the timing of the disappearance of clinical symptoms and healing of ulcers. In another study, the comparison of the results of treatment of 42 patients treated with phosphhalugel in 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 within 4 weeks The following has shown: Healing of the duodenal ulcers is marked according to 60 and 55% of cases. According to another study, on the basis of an analysis of the results of a 6-week treatment of 153 patients who received aluminum phosphate (1 bag \u003d 11 g of gel) 5 times a day, the healing of ulcers in 65% of cases was established.

Depending on the flow stage in GERD therapy, antacid drugs can be effectively used in the following cases: as the main preparation in the part of patients with endoscopically negative GERD and at GERD in the stage of slightly pronounced reflux-esophagitis (with minimally pronounced symptoms); in combination with H 2-blocks of histamine receptors for coursewood treatment of HARB patients in the stage of slightly or moderately pronounced reflux-esophagitis, as well as during therapy on demand; under coursework patients with GERD in the stage of erosive reflux-esophagitis in combination with H 2-blocks of histamine receptors, in the treatment on demand in combination with constant treatment of patients with proton pump inhibitors (during the exacerbation of the disease); During the course treatment of HARB patients in the peptic ulcer of the esophagus in combination of H 2-blocks of histamine receptors or in therapy on demand (against the background of the treatment of patients with proton pump inhibitors).

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

During the treatment of patients with listed diseases, antacid drugs are advisable to use when conducting coursework therapy in combination with H 2-block histamine receptors (in therapy on demand and with proton pump inhibitors).

The use of antacid drugs is useful, as observations showed, and in the treatment of patients with sharp gastritis (as an additional adsorbing agent for various variants of acute gastritis); as additional therapy (to H 2-blocks of histamine receptors or to proton pump inhibitors) for Cushing ulcers; In the treatment of patients with peptic ulcers of gastroenteroanastomosis and patients with chronic pancreatitis. Antacid preparations are used in combination with H 2-blocks of histamine receptors or with proton pump inhibitors as therapy on demand.

Antacid drugs are advisable to use in the treatment of patients with intestinal functional diseases in order to eliminate pain and / or discomfort. It is shown that one dose of aluminum phosphate gel with a volume of 100 to 300 ml appointed by PER OS, in front of the reception of the dose, the radio line 85Sr, reduced the absorption of the latter by 87.5%, while the dosage of 100 ml of the aluminum phosphate gel was just as effective as 300 ml, which indicates other possibilities of using antacid drugs.

It is known that aluminum phosphate gel, which is a combination of antacid and substances covering and protecting the mucous membrane against the pathological effects of acid and bile acids, contributes to the elimination of the (decrease) of their "annoying" (pathological) action on the mucous membrane of the esophagus and the stomach, which allows us to recommend a short-term The use of this drug in pregnant women or during lactation after childbirth. The same advantages of phosphhalugel (cytoprotective effect of the drug) are protected from damage to the mucous membrane and from the effects of alcohol.

As a symptomatic (additional) means to eliminate (reduce 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 of patients, if necessary, after it), as well as to eliminate Symptoms of discomfort in people who consider themselves healthy.

Features of the appointment of antacid drugs

When appointing antacid drugs, it is necessary to take into account the mechanism (s) of their action and the symptoms of diseases marked in specific patients (constipation, diarrhea, etc.). In particular, in the presence of diarrhea (as additional funds, if there is a need for this), it is advisable to treat by antacid drugs containing aluminum (Almagel, Phosphaliagel, Rutacid, Talcid); With constipation - antacid drugs, which include magnesium (gelusyl varnish, gastal, etc.).

It is known that antacid drugs (when entering the patient's body) have an adsorbing ability, due to this, it is possible to reduce the activity and bioavailability of some drugs taken by patients (for example, H 2-blocks of histamine receptors, non-steroidal anti-inflammatory drugs, antibiotics, etc.) . Therefore, when appointing antacid drugs, in combination with other drugs, it is advisable to recommend patients to abide by the time interval between the reception of antacid drugs and other means (before or after, about 2-2.5 hours), i.e., indicate the time of receiving patients with specific drugs during the day .

According to our observations, the effect of receiving antacid drugs produced in the form of gels or suspensions (compared to tableted forms), it comes faster, although the tabletic form seems somewhat more convenient for storage (especially on trips).

When solving the question of the use of antacid drugs, especially prolonged (in high dosages), it is necessary to take into account the possibility of the appearance of side effects. Side effects that are possible in some patients against the background of adopting antacid drugs, largely depend on the individual characteristics of patients, the dosages of antacid drugs and the duration of their use. Constipation or diarrhea (depending on the patients used in the treatment of one or another antacid drug) are the most frequent side effects arising in patients against the background of receiving antacid drugs. A significant increase in the dosages of antacid drugs is the main reason for the appearance of constipation or diarrhea, and a long, uncontrolled application - the appearance of metabolic disorders.

In particular, one of the features of the action of the magnesium of antacid drugs is the strengthening of the intestinal motor function, which can lead to the normalization of the chair, but with excessive reception to the development of diarrhea. An overdose of magnesium antacid drugs (increasing in the body of patient ions Mg +++) contributes to an increase in magnesium content in the body of patients, which can cause bradycardia and / or deficiency of the kidney function.

Calcium antacid drugs cause an increase in CA ++ in the body of patients (the occurrence of hypercalcemia), which can lead to the emergence of the so-called "alkaline" syndrome in patients suffering from urolithiasis, which, in turn, contributes to strengthening the formation of concrections. The decrease in the products of the pararathgamon can lead to a delay in the excretion of phosphorus, an increase in the content of insoluble calcium phosphate and, consequently, to the calcification of the body tissues of patients and the occurrence of nephroalcinosis.

Aluminum absorption level may be different for different drugs, which must be taken into account when determining the possible risk of the appearance of side effects due to the fact that antacid drugs containing aluminum, in part of patients, especially during long-term reception, can cause the appearance of hypophosphatems, with renal failure - Encephalopathy, osteomalysis (at the level of aluminum is more than 3.7 μmol / l), clinical symptoms that are considered characteristic of poisoning (at aluminum concentration of more than 7.4 μmol / l). It is necessary to take into account the fact that the lower toxicity of aluminum phosphate A1RO4, compared with aluminum hydroxide A1 (OH) 3, is due to its greater resistance to the dissolution and formation of neutral complexes in the presence of acids, usually contained in food, which indicates a smaller phosphate toxicity Aluminum.

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

For literature, please contact the editor.

Yu. V. Vasilyev, Doctor of Medical Sciences, Professor

Central Research Institute Gastroenterology, Moscow