Old-fashioned Italian antacids ease reflux

Before there were antacid drugs, there were antacids. For decades, people have relied on products like Alka-Seltzer, Bromo-Seltzer, Anfojel, Di-Gel, Maalox, mylanta, Rolaids AND Tums, to name just a few. Then came H2 antagonists like Tagamet (cimetidine) e Pepcid (famotidine). Later proton pump inhibitors (PPIs) such as Prilosec (omeprazole), Prevacid (lansoprazole) e Nexio (esomeprazole) have made their appearance. Here’s a recent question that brought us back down memory lane. He reminded us that antacids relieve reflux surprisingly well.

What’s in Riopan?

Q. While visiting Italy, I had a terrible bout of acid reflux. A doctor prescribed an oral medication called Riopan, which I took before bed. It worked very well. I was told you can take it indefinitely without worrying about side effects.

Is this drug available in the United States by prescription or over the counter? It’s the best drug I’ve taken for this problem.

Antacids ease reflux very well:

A. Riopan is an old-fashioned antacid first developed in Germany. Chemists use its generic name magaldrate because it contains a combination of aluminum and magnesium hydroxides. Magaldrate received a patent in 1960.

Although magaldrate is no longer available in the United States, you can get the same basic ingredients in such familiar over-the-counter antacids as Digel, Gelusil, Maalox AND mylanta.

Milk of magnesia:

Magnesium hydroxide dates back much earlier than magalhydrate. You’ve probably heard of them Phillips Milk of Magnesia. It was invented by a British pharmacist named Charles H. Phillips. He had immigrated to Elizabeth, NJ in the mid-19th century.

His product, Phillips Milk of Magnesia, was patented in 1873 for the treatment of digestive problems such as heartburn. It was also an effective laxative. The key ingredient was magnesia hydrate (also known as magnesium hydroxide). It was a gigantic best seller. The familiar blue Milk of Magnesia bottle is iconic:

Fifty years later, a major pharmaceutical manufacturer, Sterling Products Corp., acquired his company. Phillips Milk of Magnesia is still available today with the Bayer logo.

Antacids ease reflux without diarrhea orR Constipation:

Magnesium hydroxide can neutralize stomach acid (hence the name antacid or antacid). But, as mentioned, it can loosen your bowels. Namely it has anti-constipation (laxative) activity. Too much, though, and you end up with diarrhea.

Drug makers found that if they added another antacid, aluminum hydroxide, to the mix, the two ingredients could balance each other out. This is because aluminum hydroxide is a bit constipating.

So if you put aluminum hydroxide together with magnesium hydroxide, you may get an antacid effect and the two may cancel each other out unwanted gastric consequences. Think of it a bit like 1+1=0. You don’t suffer from constipation or diarrhea, but antacids relieve your reflux.

For decades, brands like Maalox and Mylanta have been staple foods for indigestion relief. Doctors have even prescribed these products to help heal ulcers.

The aluminum controversy:

Questions about a connection between aluminum exposure and dementia have been circulating for decades. If you were to enter aluminum and Alzheimer’s into a search of the PubMed (National Medical Library) website you would uncover over 1,200 articles.

Many articles, including a recent piece in New York Times (June 9, 2023) titled Are Natural Deodorants Really Better for You?, downplays the danger of aluminum. Many writers assume that we absorb very little aluminum through the skin.

We have been researching the toxicity of aluminum for many years. There is a surprising lack of data on dermal absorption (Journal of Applied Toxicology, November 2021). This is especially true for women who shave their underarms and then apply an aluminum-containing antacid.

How is aluminum absorbed?

An article in International journal of molecular sciences (April 2023) points out that people absorb aluminum from food, water, personal care products and antacids:

As a result of the widespread use of over-the-counter antacids, Al [aluminum] ingestion could exceed that of food and drink by more than 100 times, although absorption is usually in the range of 0.011%. It has been estimated that orange juice could increase Al absorption from antacid drugs 8-fold, and that citric acid increases intake up to 50-fold.

The authors go on to conclude:

The literature clearly suggests that AD [Alzheimers disease]EUR [alcohol use disorder]SM [multiple sclerosis]Pd [Parkinsons disease]and it’s [dialysis encephalopathy] patients experience excessive accumulation of Al in the central nervous system [central nervous system]. Epidemiological links have been observed between higher exposure to Al and their higher incidence in AD, PD and DE. In AD and PD, the potential use of Al as a disease marker has been noted. Furthermore, favorable results of the use of Al chelators [removers] they were observed in AD, AUD, MS and DE. Furthermore, cleaning the dialysis fluid from Al prevents the development of DE.

You can read much more about aluminum and neurotoxicity at this link.

Magnesium and aluminum antacids ease reflux:

We don’t think that occasional use of an aluminum-magnesium antacid contributes to Alzheimer’s disease. However, we limit our exposure to aluminum.

If we need something for the occasional heartburn, we turn to calcium carbonate (tums, For example). We also like a product like Full Pepcid. Contains the H2 antagonist, famotidine. In addition, the antacids calcium carbonate and magnesium hydroxide provide rapid acid neutralizing action.

Learn more:

To learn more about managing heartburn and other gastrointestinal issues, we recommend checking out our e-guide to overcoming digestive upsets. This online resource is available under the Health eGuides tab.

Share your experience with heartburn in the comments section below. Have you found that antacids ease reflux?