Is Taking Too Many Over-the-Counter Antacids Dangerous?

Antacids can be good for providing short-term relief, but long-term use can cover up more serious medical conditions.

If you’ve ever experienced heartburn, you’ve likely taken an over-the-counter antacid for quick relief. While these medications are FDA-approved for general-population use once daily for a maximum of six weeks, there can be danger in taking too many antacids or using antacids long-term.  

What is a normal dose of antacids?  

“I don’t think there is a ‘normal’ amount,” says John Lipham, MD, a gastrointestinal surgeon and leader of the USC Esophageal and Foregut Disorders Center, part of the USC Digestive Health Institute and Keck Medicine of USC. “If you’re taking these medications periodically only when needed — such as once or twice a week after experiencing a little bit of acid reflux from eating a really spicy meal or having alcohol or caffeine with your meal — that’s probably normal. But if you find yourself taking antacids daily for an extended period, that’s probably not normal.” 

If you find yourself using antacids frequently, you should be checked out by a medical provider, he explains, because your discomfort could be a sign of a more serious medical issue such as gastroesophageal reflux disease (GERD) or Barrett’s esophagus, a precancerous change in the esophagus caused by acid reflux that can lead to esophageal cancer.  

How are antacids dangerous? 

Antacids such as Tums or Pepcid or Prilosec all work to decrease the acid in your stomach fluid, Dr. Lipham says. Because acid produces a lot of the symptoms associated with reflux — mainly heartburn — lowering acid in the stomach fluid can cause heartburn symptoms to improve. 

“But what’s important for a patient to realize is that none of these antacids actually stop reflux itself; they only stop the symptoms of reflux,” Dr. Lipham says. Even after taking antacids, stomach fluid will continue to back up into the esophagus. Because there is less acid present, patients don’t feel the burning as badly. But the reflux still contains other materials that can damage the esophagus, such as bile, pancreatic enzymes and other digestive enzymes. In this way, antacids can hide the root problem. 

“First and foremost, the biggest danger is that antacids make you feel better,” he says. “And if you feel better, then you think your problem has been eliminated when in fact the damage is still ongoing. These medications are just masking the problem and giving you a false sense of security.” 

In addition to delaying detection of a bigger problem, ongoing use of some antacids and proton pump inhibitors, which are also used for acid reflux, have been associated with long-term problems such as kidney damage, osteoporosis, some infections of the bowel and even cardiac and stroke risk, Dr. Lipham says. He does point out that research has yet to prove a direct causal link between antacid use and these conditions.  

What are the safest antacids to take?  

Tums (calcium carbonate) are generally considered the safest to take because they are the weakest, Dr. Lipham says.  

“Generally, patients will start out taking Tums, and then they escalate their therapy to H2 blockers (Pepcid and Zantac),” he says. “These seem to be a little bit safer than the proton pump inhibitors, but they are not quite as effective at suppressing the acid.” 

Long-term effects have mostly been studied in the next class of acid reflux medications: proton pump inhibitors like omeprazole (Prilosec) and esomeprazole (Nexium), which are very powerful at suppressing acid.  

In 2023, an even stronger class of medication called PCAB inhibitors was FDA approved, but more research will be needed to identify any long-term effects with these medications since they are relatively new, Dr. Lipham says.  

How long is too long to be on antacids?  

“If you find yourself not being able to get off these medications after a six-week period, many of the gastrointestinal societies would recommend that at that point you need to be evaluated by a physician to see if you need to undergo endoscopy or further testing,” Dr. Lipham says. 

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