Think about using an over-the-counter (OTC) antacid product for upset stomach or heartburn that does not contain aspirin.

The U.S. Food and Drug Administration (FDA) says that if you use an aspirin-containing product for acid indigestion, upset stomach, sour stomach or heartburn, you risk the potential for having stomach or intestinal bleeding.

To date, stomach bleed cases are rare but possible. Since 2009, the FDA has warned about the potential for stomach bleeding risk when consuming aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). However, there have been reports of antacid products causing that same effect since the 2009 caution, and some people have had to get a blood transfusion.

Most people don’t consider the potential of stomach products causing more stomach problems because they don’t read the label. Therefore, when considering a product for treating a stomach ailment, always check out the Drug Facts label to see if the product contains aspirin. If it does, you may want to find another product that is friendlier to your stomach.

It’s not that the FDA does not want people to use aspirin at all. The FDA just feels it’s important consumers are educated about the risk antacid products with aspirin can have.

So, when considering which OTC antacid to take for upset stomach, all you have to do is read the Drug Facts label to see if the product has aspirin and has a warning about stomach bleeding. If the medicine contains aspirin, you still have a lot of other options out there that don’t.

Who’s at Higher Risk of Bleeding

The FDA believes antacids with aspirin influence stomach bleed episodes because aspirin acts as a blood thinner. People with risk factors for stomach bleeding are more prone to have a bleeding episode than others when using these products.

People at a higher risk for bleeding when using aspirin-containing aspirin products are people who:

  • Are age 60 or older.
  • Have a history of stomach bleeding or ulcers.
  • Take anticoagulants or blood thinners that reduce the body’s ability to form blood clots.
  • Take steroids to treat inflammation (like prednisone)
  • Take other NSAIDs (like naproxen or ibuprofen).
  • Consume three or more alcoholic drinks daily.

Signs of stomach/intestinal bleeding are abdominal pain, bloody (or black) stools, vomiting blood or feeling faint. If you experience any of these signs, get medical attention as soon as possible.

How to Settle an Upset Stomach

There are alternative treatments for soothing stomach ailments. Look for product labels that say the product is an acid reducer or antacid.

A lot of products on the market for stomach ailments only have antacids like magnesium hydroxide, calcium carbonate or some other antacid. If you suffer from frequent heartburn, you can get acid reducers like H2 blockers (ranitidine, famotidine, cimetidine) or proton pump inhibitors (esomeprazole, omeprazole or lansoprazole).

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Scientific evidence shows that taking an aspirin daily can help prevent a heart attack or stroke in some people, but not in everyone. It also can cause unwanted side effects.

According to Robert Temple, M.D., deputy director for clinical science at the Food and Drug Administration (FDA), one thing is certain: You should use daily aspirin therapy only after first talking to your health care professional, who can weigh the benefits and risks.

Who Can Benefit?

“Since the 1990s, clinical data have shown that in people who have experienced a heart attack, stroke or who have a disease of the blood vessels in the heart, a daily low dose of aspirin can help prevent a reoccurrence,” Temple says. (A dose ranges from the 80 milligrams (mg) in a low-dose tablet to the 325 mg in a regular strength tablet.) This use is known as “secondary prevention.”

However, after carefully examining scientific data from major studies, FDA has concluded that the data do not support the use of aspirin as a preventive medication by people who have not had a heart attack, stroke or cardiovascular problems, a use that is called “primary prevention.” In such people, the benefit has not been established but risks—such as dangerous bleeding into the brain or stomach—are still present.

Caution Needed With Other Blood Thinners

When you have a heart attack, it’s because one of the coronary arteries (which provide blood to the heart), has developed a clot that obstructs the flow of blood and oxygen to the heart. Aspirin works by interfering with your blood’s clotting action.

Care is needed when using aspirin with other blood thinners, such as warfarin, dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixiban (Eliquis).

What about people who have not had heart problems or a stroke but who, due to family history or showing other evidence of arterial disease are at increased risk? Is an aspirin a day a safe and effective strategy for them?

Again, Temple emphasizes, the clinical data do not show a benefit in such people.

He adds, however, that there are a number of ongoing, large-scale clinical studies continuing to investigate the use of aspirin in primary prevention of heart attack or stroke. FDA is monitoring these studies and will continue to examine the evidence as it emerges.