Anaesthetic antacids: a review of its pharmacological properties and therapeutic efficacy

Abstract

Anaesthetic antacids, combination of antacids (Aluminium hydroxide, Magnesium hydroxide) with an anaesthetic (oxethazaine), is becoming a choice of physicians and is re-emerging across all types of GI disorders (esophagitis, peptic ulcer, duodenal ulcer, heartburn, gastritis, functional dyspepsia), despite the discovery of potent and efficacious acid suppressants like H2 receptor blockers and proton pump inhibitors (PPIs). The reason being that anaesthetic antacids increase the gastric pH and provide relief from pain for a longer period of duration at considerably a lower dosage. Furthermore, it significantly increases the duration between the time of medication and the peak pH as compared to antacid alone. Oxethazaine, an anaesthetic component, produces a reversible loss of sensation and provides a prompt and prolonged relief of pain, thereby broadening the therapeutic spectrum of antacids. Antacids vary widely in their in vitro acid neutralizing capacity (ANC), which measures the potency. Among marketed brands in India, Digecaine has shown the highest potency with maximum mean ANC value (28.84 mEq). The expert panel has recommended the inclusion of oxethazaine-antacid/alginate-antacid as complementary to the proton pump inhibitors in the management algorithm of gastroesophageal reflux disease. The present review summarizes the pharmacokinetic and pharmacodynamic of different components of anaesthetic antacids and its clinical use across different gastrointestinal indications, for generalists and specialists, based on existing evidences.