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The next time you reach for a nonprescription drug to treat your upset stomach or heartburn, consider whether you should use one of the many antacids that don’t have aspirin.

Why? Aspirin-containing medicines to treat heartburn, sour stomach, acid indigestion or upset stomach can cause stomach or intestinal bleeding, especially in some people, warns the U.S. Food & Drug Administration.

Aspirin is commonly used to reduce pain & fever. It is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of bleeding, including in the stomach & gastrointestinal tract (digestive tract).

“We’re focusing on bleeding risk specifically with antacid-aspirin products used to treat upset stomach or heartburn. We’re not telling people to stop taking aspirin altogether,” says Karen Murry, M.D., Deputy Director of the Office of Nonprescription Drugs at the FDA.

Cases of bleeding are rare. When the FDA reviewed its Adverse Event Reporting System database, it found new cases of serious bleeding caused by aspirin-containing antacid products despite an agency warning in 2009 about such a risk. Some of those patients required a blood transfusion.

“Take a close look at the Drug Facts label. If the product has aspirin, consider choosing something else for your stomach symptoms,” Murry says. “Unless people read the Drug Facts label when they’re looking for stomach symptom relief, they might not even think about the possibility that a stomach medicine could contain aspirin.”

How will you know what over-the-counter (OTC, or nonprescription) medicine to take to get relief from indigestion? The Drug Facts label will not only tell you if the medicine contains aspirin but also will list the risk factors for bleeding. If the medicine has aspirin, consider finding another product. There are plenty of stomach medicines that don’t contain aspirin.

Who’s at Higher Risk of Bleeding

Because aspirin thins the blood, the FDA believes the aspirin in these combination medicines is contributing to major bleeding events. People with one or more risk factors have a higher chance of serious bleeding with aspirin-containing antacid products.

You are at higher risk for bleeding with these products if you:

  • Are 60 or older.
  • Have a history of stomach ulcers or bleeding problems.
  • Take drugs that reduce the ability of your blood to clot (also known as anticoagulants or blood-thinning drugs).
  • Take steroid medicine, such as prednisone, to reduce inflammation.
  • Take other medicines containing NSAIDs, such as ibuprofen or naproxen.
  • Drink three or more alcoholic drinks every day.

Warning signs of stomach or intestinal bleeding include feeling faint, vomiting blood, passing black or bloody stools, or having abdominal pain. Those are signs that you should consult a health care professional right away.

What if you’ve been taking these products for a long time?

“Some people may have been taking aspirin-containing antacid products frequently for a long time. Apart from the bleeding risk, it’s not normal to have frequent or chronic upset stomach or heartburn. You should talk to a health care professional if that’s happening,” Murry says.

Take aspirin regularly? If your health care professional has advised you to take an aspirin a day to help prevent a heart attack or other condition, don’t stop without talking with them first. “Make sure you discuss what kind of medicine you can take in case you get an upset stomach,” Murry says.

How to Settle an Upset Stomach

People have many alternatives for treating heartburn, sour stomach, acid indigestion & upset stomach. Read the Drug Facts label & look for products that contain an “antacid” or “acid reducer.”

For example, there are numerous nonprescription medicines that contain only an antacid, such as calcium carbonate, magnesium hydroxide, or another antacid,” Murry says. These products can be used to treat heartburn, sour stomach, acid indigestion & upset stomach.

For frequent heartburn, there are acid reducers, such as proton pump inhibitors (esomeprazole, lansoprazole, omeprazole), or H2 blockers (cimetidine, famotidine).