Alka Seltzer

[SteveGrenard]

Has anyone ever stopped to look at the ingredients and their amounts on regular and extra stremgth Alka Seltzer tablets?

I suggest anyone with hypertension, kidney problems, diabetes, or heart disease at risk of CHF, etc. do so. The only warning on this drug is about Reyes Syndrome. Should there be others?

[Rob Lister]

I kept going while I looked.

[Soapy Sam]

As a kid, I used to pinch one from my mother's med. box and just suck it. This made me look like I had rabies, which is pretty cool when you're six.

[SteveGrenard]

When you're six Alka Seltzer is not a problem....at least I would hope so. But:

Since nobody has gotten it yet, I'll reveal what I am referring to. Each regular strength Alka Seltzer tablet contains not only 325 mgs (adult dose) of aspirin but 1,916 mgs of
sodium as NaHCO3. Two tablets containing 3,832 mgs of Sodium constitutes the average
dose although there are folks who dissolve three. Two tablets equals about 2 X the maximum daily allowable dose of Sodium plus they are ingested in a few swallows.
Anyone with chronic heart failure can develop CHF and pulmonary edema.
Anyone with hypertension can spike their blood pressure on this dose and anyone with
kidney problems can permanently impair their kidneys if they take this drug on a regular basis. What's more aspirin can impede the effect of loop diuretics such as Lasix and
by themselves can cause sodium retention.

The only warning on this product is for Reyes Syndrome because of the aspirin. I am wondering if anyone here feels that heart, hypertension and kidney patients should be warned as well?

[Soapy Sam]

Don't know enough biochem. to answer that. I'd have thought in a drug that has been around as long this must have come up before?

[Goshawk]

I would assume that the FDA doesn't feel a need to put disclaimers and cautions for all those on the label because those people who have chronic heart disease, kidney disease, and severe hypertension problems are already aware--have already been made aware by their doctors--of the dangers of using Alka-Seltzer and other OTC medications that might affect their condition.

The warning about Reyes is there because Reyes strikes unexpectedly, and it targets people who are otherwise healthy (other than having the flu), thus delivering a nasty surprise. So the FDA is doing its bit to get the word out about Reyes by putting it on the label.

You're also not supposed to take aspirin if you have a bleeding disorder, like hemophilia, or a recent history of stomach or intestinal bleeding, or liver disease, or gout, but again, the FDA assumes that if you have those particular health problems, you will already have been informed by your doctor not to take medications with aspirin in them.

Really, there's a limit as to how much the Feds can be expected to protect us from ourselves.

[Soapy Sam]

I wonder how many people read the inserts anyway?

[Zep]

NEW! ALKA SELTZER for UPSET STOMACH! PLOP PLOP FIZZ FIZZ!

WARNING: Not to be taken by anyone for anything. This stuff is poison. Just put the bottle back on the supermarket shelf where you found it and walk away, OK? Off you go now. Drop it...just drop it. Good, now walk away. Excellent! Keep going...don't even look back...

[fuelair]

Just a quick chem note : 1916 mg of NaHCO3 is not 1,916 mg of sodium. Only app. 445mg of that is sodium (moles, masses, %composition)so even 3 tablets is about half the
ca. 2300mg max recommended intake of Na. I personally wouldn't use AS however - tastes terrible - and adding lemon just makes it worse.

[CapelDodger]

As a kid, I used to pinch one from my mother's med. box and just suck it. This made me look like I had rabies, which is pretty cool when you're six.

It can get you out of all sorts of trouble when you're sixty.

[CapelDodger]

I would assume that the FDA doesn't feel a need to put disclaimers and cautions for all those on the label because those people who have chronic heart disease, kidney disease, and severe hypertension problems are already aware--have already been made aware by their doctors--of the dangers of using Alka-Seltzer and other OTC medications that might affect their condition.

Who takes Alka Seltzer when they haven't very recently f***ed themselves up on alcohol anyway? Doctors tend to prioritise alcohol when it comes to advice. Spoil-sports.

[Soapy Sam]

It can get you out of all sorts of trouble when you're sixty.

That is worth remembering.
53 this year. When does the time go?

[CFLarsen]

..daily allowable dose...

Not the daily allowable, but the daily recommended dose.

of Sodium plus they are ingested in a few swallows.

So are all pills. What does that have to do with anything?

Anyone with chronic heart failure can develop CHF and pulmonary edema.
Anyone with hypertension can spike their blood pressure on this dose and anyone with
kidney problems can permanently impair their kidneys if they take this drug on a regular basis. What's more aspirin can impede the effect of loop diuretics such as Lasix and
by themselves can cause sodium retention.

The only warning on this product is for Reyes Syndrome because of the aspirin. I am wondering if anyone here feels that heart, hypertension and kidney patients should be warned as well?

Since the amount is well below the recommended dose, will you retract your unneccesary alarmist warning?

[fls]

From the information here:

http://www.alka-seltzer.com/as/as_original.htm

Alka Seltzer contains 567 mg of Sodium per tab (there is also sodium with the ASA). Under "warnings" is "Ask a doctor before use if you have...a sodium-restricted diet".

I see this all the time - someone with an exacerbation of CHF due to excess sodium ingestion. Rarely (if ever) does it happen in spite of due diligence.

Linda

[SteveGrenard]

Since the amount is well below the recommended dose, will you retract your unneccesary alarmist warning?

Actually no. The daily recommended or whatever you want to call it dose is over the course of the day. This very high dose of sodium for regular strength alka seltzer or
extra strength alka seltzer is swallowed in a few gulps over a few minutes. Hence the sodium load for people with certain prexisting conditions including chronic heart failure and hypertension is much larger than one would assume when looking at the global numbers and sodium content foods eaten over the course of the day. If you look at the sodium content of many foods on the shelf you will see they are often in the double digits, below 100 mgs per designated portion. And these are not considered low sodium foods. There are also traditionally highly salty foods with humongous numbers. The situation for healthy people is not the same for the aforementioned pre-existing conditions. Healthy people can tolerate and handle high sodium loads people with CHF, HTN and kidney problems cannot.

My original concern is based on an actual case history. When you consider how many people have been taking AS for headaches and upset stomachs for decades, with good and quick results and without looking at the sodium content, then one wonders how many of these folks (with the common pre-existing conditions) get themselves into serious trouble after they take this product. Add to that the fact that aspirin, which is also found in this drug, is known both to tend to retain sodium as well as impair the effect of the loop diuretic Lasix (which many CHF and HTN patients are on), then
perhaps a warning should be considered. A report has been made to FDA's Medwatch.

I appreciate everyone's feedback on this and would appreciate more opinions on this subject.

"Ask a doctor before use if you have...a sodium-restricted diet".

Thanks for finding this statement on their website. It is not on the box or the packets
and perhaps by itself is evidence that it should be.

[Zep]

So what's your actual point, Steve? Get to the point, please.

[Ivor the Engineer]

If you are on a sodium-restricted diet, why would you need to ask your doctor if you should take ~50% of the recommended daily maximum sodium intake for a healthy adult in a few gulps?

[SteveGrenard]

Extra strength Alka Seltzer has 588 mgs of sodium per tablet. The std dose is two tablets, = to 1076 mgs of sodium. A lot of people take 3 or 1,664 mgs of sodium per half a glass of water (used to dissolve the tablets). There is also more aspirin in extra strength, 500 mgs I believe. Two tablets = 1000 mgs of aspirin, 3 tablets obviously = 1500. That's also a lot of aspirin for a single dose if you are a HTN, heart or kidney patient at risk for sodium retention and/or if you're on Lasix which these patients frequently are.

My point is this is a lot of sodium to take over a few minutes and I was recently made aware of a case where a HTN/CHF patient with an upset stomach swallowed some AS then nearly died as a result. And it was not an allergic reaction. It was flash pulmonary edema, CHF, BP=over 200/100. My point is that Speedy Alka Seltzer has been around for a very long time and a lot of people might think it is completely safe and harmless. If they go to their website they will see the warnings but the package continues to perpetuate the myth. Bayer is also saying they are going to bring back Sir Speedy, their happy Alka Seltzer cartoon character to market this product. I was surprised also when speaking with a few doctors that they admitted they had not realized just how much sodium was in these things.

My point also was to get feedback from members here.

How many knew about the sodium and aspirin problems in AS and how many did not?

How many people who have used and continue to use a common OTC med like Alka Seltzer would even bother to look it up on the internet if they could?

I would be interested in getting a feel for this as well.

Anyway those are my points. Once again thanks to those who have responded with positive information and queries.

[SteveGrenard]

If you are on a sodium-restricted diet, why would you need to ask your doctor if you should take ~50% of the recommended daily maximum sodium intake for a healthy adult in a few gulps?

As an engineer I am sure you can appreciate the difference between something coming at you over time versus all at once. The load would be much larger, the body's ability to handle it much less. But a good question.

[CFLarsen]

So what's your actual point, Steve? Get to the point, please.

This:

My original concern is based on an actual case history.
...
A report has been made to FDA's Medwatch.

Steve wants to create a modern medical myth. To become another Andrew Wakefield, or Paul Brodeur. You know: Scare people.

My point is this is a lot of sodium to take over a few minutes and I was recently made aware of a case where a HTN/CHF patient with an upset stomach swallowed some AS then nearly died as a result. And it was not an allergic reaction. It was flash pulmonary edema, CHF, BP=over 200/100.

Note that Steve doesn't provide any sources of this one-time case.

How many knew about the sodium and aspirin problems in AS and how many did not?

Note that Steve has gone from asking leading questions about the possible danger of Alka Selzer to establishing that there are problems with not just sodium, but also aspirin.

Anyway those are my points. Once again thanks to those who have responded with positive information and queries.

Note that Steve is not interested in negative information that proves him wrong.

This will be a classic example of a pseudoscience scare. One more for the article.

[SteveGrenard]

This:



Steve wants to create a modern medical myth. To become another Andrew Wakefield, or Paul Brodeur. You know: Scare people.


Go hereto Bayer's Alka Selzter websites, this one and links to the side:

http://alkaseltzer.com/as/as_extra_strength.htm

Now consider the fact that there are people, maybe millions of them, have no way of knowing, without web access. Is there anything on these website(s) that the manufacturer of Alka Serltzer admits to with respect to precautions and advisories that should be included with the package for PC and web derived users?



Note that Steve doesn't provide any sources of this one-time case.


It may be a one time case, unpublished, that I am referring to but as another poister
has pointed out and as the general literature on CHF, pulmonary edema and hypertension
underscores, it is not the only case. The evidence for the need for precautions is self-evident ... and is self-admitted by Alka Seltzer's maker.


Note that Steve has gone from asking leading questions about the possible danger of Alka Selzer to establishing that there are problems with not just sodium, but also aspirin.

There is a book on pharmacology by Goodman and Gilman. Why don't you study the aspirin
parts and get back to me.


Note that Steve is not interested in negative information that proves him wrong.

I am very interested in information that says it is not necessary to use a warning label on the package or a package insert to warn buyers/users with feet on the ground who are not
availaling themselves of information on the internet or don't have access to same. Or are too
old or too sick or too uninformed to do so.


This will be a classic example of a pseudoscience scare. One more for the article.

This would be hysterical if it were not for the fact that every pharmacology std text and Bayer Healthcare itself admits to the issues brought up in this thread. But it is typical of some to yell pseudoscience when there is any effort to inform the populace and
hurt big pharma sales of potentially harmful products, whether Rx or OTC. Thanks for letting us know where you stand. But do yourself a favor and take some time to study the
matter before your accusation of pseudoscience turns out to be the most pseudononymous thing that has come out of this discussion.

So before you proceed further with your threats do your due diligence.

[CFLarsen]

Go hereto Bayer's Alka Selzter websites, this one and links to the side:

http://alkaseltzer.com/as/as_extra_strength.htm

Now consider the fact that there are people, maybe millions of them, have no way of knowing, without web access. Is there anything on these website(s) that the manufacturer of Alka Serltzer admits to with respect to precautions and advisories that should be included with the package for PC and web derived users?

Note how Steve continues to spread fear, doubt and uncertainty, still without providing any evidence whatsoever.

It may be a one time case, unpublished, that I am referring to but as another poister
has pointed out and as the general literature on CHF, pulmonary edema and hypertension
underscores, it is not the only case. The evidence for the need for precautions is self-evident ... and is self-admitted by Alka Seltzer's maker.

Note how Steve now has given up on providing any sources of this one-time case. Now, it has now become "self-evident". We are now expected to accept the validity of his claim without evidence.

There is a book on pharmacology by Goodman and Gilman. Why don't you study the aspirin
parts and get back to me.

Note how Steve drags up some book which he - possibly, but knowing Steve, far from certain - has read. The book itself is implied to be the final word on the scare that Steve is creating.

I am very interested in information that says it is not necessary to use a warning label on the package or a package insert to warn buyers/users with feet on the ground who are not
availaling themselves of information on the internet or don't have access to same. Or are too
old or too sick or too uninformed to do so.

Note how Steve now has shifted the onus on the manufacturers: Now, it is their responsibility to warn the public about Steve's scare: Not only has it been established that Steve is right, it is now the fault of the manufacturers if anything goes wrong.

This would be hysterical if it were not for the fact that every pharmacology std text and Bayer Healthcare itself admits to the issues brought up in this thread. But it is typical of some to yell pseudoscience when there is any effort to inform the populace and
hurt big pharma sales of potentially harmful products, whether Rx or OTC. Thanks for letting us know where you stand. But do yourself a favor and take some time to study the
matter before your accusation of pseudoscience turns out to be the most pseudononymous thing that has come out of this discussion.

Note how Steve now claims that his scare is not pseudoscience. He plays the role of the Persecuted Whistleblower, and starts pointing fingers at those who disagree with him, placing the blame on them.

[Rob Lister]

"Ask a doctor before use if you have...a sodium-restricted diet".



Thanks for finding this statement on their website. It is not on the box or the packets
and perhaps by itself is evidence that it should be.

I'm sitting here reading that exact warning on a box of AS.

Oddly, my box of koshering salt has no such warning.

[SteveGrenard]

duplicate

[SteveGrenard]

"Ask a doctor before use if you have...a sodium-restricted diet".




I'm sitting here reading that exact warning on a box of AS.

Oddly, my box of koshering salt has no such warning.

Did you check the Kosher salt website? Maybe they have a religious exemption.
My box of Alka Seltzer only has Reyes Syndrome warning. Nothing abut
sodium restriction diets.

[Rob Lister]

My box of Alka Seltzer only has Reyes Syndrome warning. Nothing abut
sodium restriction diets.

Well, that's easy enough for you to prove. Scan the box and post it. The box I'm looking at contains all of the warnings posted on the web site.

[JPK]

How big would the box need to be, or how fine would the print have to be, to include all of the things that the makers of AS, need to warn us about? How far down on that list never insert them into your ears?
JPK

[fls]

I think you're busted, SG. I was just in the grocery store, so I checked out the Alka-Seltzer and it included the warning about sodium restricted diets and the amount of sodium per pill on the drug information label on the outside of the box.

Linda

[SteveGrenard]

I gave my box to my doctor for submission to the FDA. However, I will be in my store
tomorrow and will look at and buy another box.

[CFLarsen]

I gave my box to my doctor for submission to the FDA. .

How convenient.

You don't really think anyone is buying that, do you?

[Rob Lister]

I gave my box to my doctor for submission to the FDA. However, I will be in my store
tomorrow and will look at and buy another box.

That's pretty lame.

[CFLarsen]

That's pretty lame.

I'm sure they already reacted to Steve's scare tactics and changed the text.

[Smackety]

I am sure his doctor put in the circular file.
Salt is not like inorganic arsensic, which is dangerous at any level. It is dangerous if you have high blood pressure, and eating too much can cause high blood pressure. It is not dangerous in normal doses.
Sodium Intake (http://www.nhlbi.nih.gov/new/press/17-1998.htm)
Anyway, isn't aspirin a blood thinner? Does it (more than) offset the sodium?

[SteveGrenard]

I am now back in possession of a new box of Alka Seltzer Regular Strength. Thanks to those who are interested in my concerns for their patience. Those in possession of the same packaging I have,purchased in the U.S. can now follow along with their own boxes. My box was purchased today,March 29, 2008 in New York City, State of New York, U.S.A.

Try as I might I cannot find any reference warning the following disease/disorder categories:

High Blood Pressure or Hypertension
Chronic heart disease, heart failure, CHF
Chronic or acute Kidney Disease

This is and was my major concern, the absence of any warning to these very
common categories of sufferers.

On the other hand there are warnings for the following diseases and disorders:

Asthma
Ulcers
Bleeding Problems
Frequent stomach problems (heartburn, upset stomach or pain)

Reyes Syndrome (children) given aspirin if they have chicken pox or flu symptoms; correct me if I am wrong but other infectious viral diseases might be a concern here as well. But okay it mainly chicken pox and flu symptoms covers a lot of stuff.

Allergy to Aspirin

If you are a frequent alcohol drinker (also aspirin related)

Curiously under indications headache due to overindulgence in food and drink is one of them. I guess if you do this frequently you can’t use Alka Seltzer since it is indicated and contraindicated for this at the same time.

I concede there is a single line as a continuation from the side panel to the back panel which just says “sodium restricted diet.” Ambiguous. It does not indicate which diseases would be involved even though “the box” has no problem listing other diseases and disorders save those above (e.g.:HTN, CHF, Renal, etc). This is clearly not enough. The sodium restricted diet is a continuation of the advice “Ask a doctor.” The reality of this happening easily whenever someone feels the need to cure their painful upset stomach with Alka Seltzer is mostly slim to none. I guess what I am saying is that this is not a strong enough warning, especially given all the other named (disease/disorder) warnings that they do give.


And don’t forget this. First, thanks to the poster who ferreted out the US Govt’s maximum daily allowance for sodium as 2,400 mgs. Remember each tablet of Alka Seltzer regular strength contains 567 mgs of sodium. Under the Maximum Daily dose for Adults and Children over 12 which is in a table on the back panel it says “do not exceed 8 tablets in 24 hours.” Thus healthy and normal individuals who are 12 and over or 60 or less according Bayer can take, according to the box, 567 X 8 or 4,536 mgs of Alka Seltzer in 24 hours. If you are over 60 then that recommended maximum daily dose is halved, to 4 tablets. I am not sure what changes in people between the ages of 59 and 60.x but would be interested in knowing.


And for those who defend the dosing in AS don’t forget that the sodium in Alka Seltzer’s maximum allowance or otherwise (e.g. twice the normal recommended amount if you’re under 60 or over 12) is likely to be in addition to any dietary sources of sodium you may ingest before or after you take the drug..

And don’t forget, also, contrary to a misconception voice by another above, aspirin tends to retain sodium and impair effectiveness of a loop diuretic such as Lasix. Eight regular strength Alka Seltzer tablets also delivers 325 X 8 mgs = 2,600 mgs of aspirin in 24 hours. Ref: any std pharmacology textbook including Goodman and Gilman.

While I was shopping I checked other antacids. No other brand uses a sodium salt antacid (NaHCO3), only AS. I wonder why that is?

Everybody’s feedback including negatives and misperceptions and misconceptions is appreciated since it helps to prepare for any argument against an additional set of warnings for this drug.

[CFLarsen]

I am now back in possession of a new box of Alka Seltzer Regular Strength. Thanks to those who are interested in my concerns for their patience. Those in possession of the same packaging I have,purchased in the U.S. can now follow along with their own boxes. My box was purchased today,March 29, 2008 in New York City, State of New York, U.S.A.

Try as I might I cannot find any reference warning the following disease/disorder categories:

High Blood Pressure or Hypertension
Chronic heart disease, heart failure, CHF
Chronic or acute Kidney Disease

This is and was my major concern, the absence of any warning to these very
common categories of sufferers.

Did it contain a warning about sodium restricted diets and the amount of sodium per pill?

On the other hand there are warnings for the following diseases and disorders:

Asthma
Ulcers
Bleeding Problems
Frequent stomach problems (heartburn, upset stomach or pain)

Reyes Syndrome (children) given aspirin if they have chicken pox or flu symptoms; correct me if I am wrong but other infectious viral diseases might be a concern here as well. But okay it mainly chicken pox and flu symptoms covers a lot of stuff.

Allergy to Aspirin

If you are a frequent alcohol drinker (also aspirin related)

Curiously under indications headache due to overindulgence in food and drink is one of them. I guess if you do this frequently you can’t use Alka Seltzer since it is indicated and contraindicated for this at the same time.

I concede there is a single line as a continuation from the side panel to the back panel which just says “sodium restricted diet.” Ambiguous. It does not indicate which diseases would be involved even though “the box” has no problem listing other diseases and disorders save those above (e.g.:HTN, CHF, Renal, etc). This is clearly not enough. The sodium restricted diet is a continuation of the advice “Ask a doctor.” The reality of this happening easily whenever someone feels the need to cure their painful upset stomach with Alka Seltzer is mostly slim to none. I guess what I am saying is that this is not a strong enough warning, especially given all the other named (disease/disorder) warnings that they do give.


And don’t forget this. First, thanks to the poster who ferreted out the US Govt’s maximum daily allowance for sodium as 2,400 mgs. Remember each tablet of Alka Seltzer regular strength contains 567 mgs of sodium. Under the Maximum Daily dose for Adults and Children over 12 which is in a table on the back panel it says “do not exceed 8 tablets in 24 hours.” Thus healthy and normal individuals who are 12 and over or 60 or less according Bayer can take, according to the box, 567 X 8 or 4,536 mgs of Alka Seltzer in 24 hours. If you are over 60 then that recommended maximum daily dose is halved, to 4 tablets. I am not sure what changes in people between the ages of 59 and 60.x but would be interested in knowing.


And for those who defend the dosing in AS don’t forget that the sodium in Alka Seltzer’s maximum allowance or otherwise (e.g. twice the normal recommended amount if you’re under 60 or over 12) is likely to be in addition to any dietary sources of sodium you may ingest before or after you take the drug..

And don’t forget, also, contrary to a misconception voice by another above, aspirin tends to retain sodium and impair effectiveness of a loop diuretic such as Lasix. Eight regular strength Alka Seltzer tablets also delivers 325 X 8 mgs = 2,600 mgs of aspirin in 24 hours. Ref: any std pharmacology textbook including Goodman and Gilman.

While I was shopping I checked other antacids. No other brand uses a sodium salt antacid (NaHCO3), only AS. I wonder why that is?

Everybody’s feedback including negatives and misperceptions and misconceptions is appreciated since it helps to prepare for any argument against an additional set of warnings for this drug.

More scare tactics.

[George]

I use earplugs to drownout the roar of the little buggers. :faint:

[Gord_in_Toronto]

Some years ago ISTR Consumer Reports suggested that Alka Seltzer should only be used in the extremely unusual case that you had a headache and a stomachache at the same time.

Advice I have followed ever since and never had to worry about its contents once.