Al/Mg hydroxide-containing antacids and sodium bicarbonate

Active substances and pharmaceuticals concernedMechanism of interactionConsequences and possible symptoms of the interactionRecommended SupplementationSpecial instructions for useReferences

Active substances and pharmaceuticals concerned

Name of active substance	Trade name	Affected micronutrients
Al-/Mg-Hydroxide-containing antacids	Maalox®, Riopan®, Talcid®	Iron, Zinc, Calcium
Sodium hydrogen carbonate		Folic acid/ Vitamin B₁₂

Mechanism of interaction

Mechanism of interaction
Iron Zinc Calcium	Frequent and regular use of antacids containing Al/Mg hydroxide impairs the zinc, iron and calcium balance. Food phosphates are bound by aluminum. In addition, simultaneous ingestion of micronutrients in the form of citrates (especially calcium citrate) leads to increased aluminum absorption.
Folic acid/ Vitamin B₁₂	Increasing the pH value reduces absorption and bioavailability.

Consequences and possible symptoms of the interaction

Negative consequences of the interaction		Possible symptoms
Iron Zinc Calcium	Disorder of bone metabolism	Osteomalacia
Folic acid/ Vitamin B₁₂	Waste of folic acid / vitamin B₁₂-level	Increase in homocysteine level

Recommended Supplementation

Medical substance	Recommended supplementation	Dosage
Al/Mg hydroxide-containing antacids	If antacids containing Al/Mg hydroxide are taken regularly, a multivitamin-mineral combination with folic acid, vitamin B6, B12, D, iron and zinc* is recommended to prevent nutrient loss.
Sodium hydrogen carbonate	Folic acid	0.6 -1mg/d p.o.
Sodium hydrogen carbonate	Vitamin B₁₂	100 -1000µg/d p.o.

Special instructions for use

Name of active substance		Instructions for use
Al/Mg hydroxide-containing antacids		Appropriate mineral combinations should be taken with a wait time of two hours from taking antacids.
Sodium bicarbonate		There should be a two-hour interval between taking antacids and folic acid/vitamin B12 intake.

References

Coburn JW, Mischel MG, Goodman WG, Salusky IB: Calcium citrate markedly enhances aluminum absorption from aluminum hydroxide. Am J Kidney Dis. 1991 Jun; 17(6): 708–11.
Ekenved G, Halvorsen L, Sölvell L: Influence of a liquid antacid on the absorption of different iron salts. Scand J Haematol Suppl. 1976; 28: 65–77.
Gröber, Uwe: Mikronährstoffe: Metabolic Tuning – Prävention – Therapie. 3., völlig überarb. u. erw. Aufl. Stuttgart: WVG, 2011.
Gröber, Uwe: Arzneimittel und Mikronährstoffe: Medikationsorientierte Supplementierung. 3., akt. und erw. Aufl. Stuttgart: WVG, 2014.
King CE, Leibach J, Toskes PP: Clinically significant vitamin B12 deficiency secondary to malabsorption of protein-bound vitamin B12. Dig Dis Sci. 1979 May; 24(5): 397–402.
Russell RM, Golner BB, Krasinski SD, Sadowski JA, Suter PM, Braun CL: Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med. 1988 Oct; 112(4): 458–63.
Spencer H, Lender M. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology. 1979 Mar; 76(3): 603–6.
Stargrove, Mitchell Bebel, Jonathan Treasure, and Dwight L. McKee: Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies. St. Louis, Mo: Mosby/Elsevier, 2008.