Heartburn Relief, From Aciphex to Zantac

NY Times ^ | February 22, 2005 | MARY DUENWALD

[neverdem]

THE CONSUMER

Five popular heartburn drugs work in essentially the same way, but only one of them, Prilosec, is sold without a prescription. Does that mean it is not as effective as the others? No, doctors say, Prilosec works just as well as the prescription drugs for most people - but only if they can get their hands on it.

The pills are in such short supply that many drugstores are asking customers to wait two weeks or more for fresh stocks. Some patients have tracked down the medicine by calling around to other stores or shopping on eBay. Others have switched to prescription brands like Prevacid, Nexium, Aciphex and Protonix, which cost five to six times as much.

The drugs belong to a class known as proton pump inhibitors, or P.P.I.'s.

But another alternative is to switch to less powerful and less expensive over-the-counter acid blockers like Zantac or Tagamet, or even old-fashioned antacids like Rolaids and Pepto-Bismol, which doctors say offer relief to many people with mild to moderate heartburn.

One side effect of the shortage, in other words, may be to demonstrate that P.P.I.'s are often not the most economical choice.

"Saying they are the right treatment for heartburn is a little like saying that driving a Rolls-Royce to the supermarket is the best way to get there," said Dr. Jerry Avorn, an internist at Brigham and Women's Hospital, in Boston, who wrote "Powerful Medicines: The Benefits, Risks and Costs of Prescription Drugs." "At current prices, it is wasteful and irrational for them to be the first thing that a patient or a doctor thinks of whenever they see a bellyache."

Americans spent $13.5 billion on prescription P.P.I.'s in 2003, making them the second biggest-selling class of drugs, after cholesterol-lowering medicines, according to NDCHealth, a healthcare information company. The drugs are used to treat GERD (gastroesophageal reflux disease), whose chief symptom is recurring heartburn, and to heal the esophageal sores it can cause.

More than 60 million Americans suffer from GERD at least monthly, according to the National Institute of Diabetes and Digestive and Kidney Diseases. "These conditions are so common and the drugs are so safe that patients go through them like water," said Dr. Nicholas Shaheen, director of the Center for Esophageal Diseases and Swallowing at the University of North Carolina.

Demand for proton pump inhibitors has been fueled by a barrage of advertisements. AstraZeneca, which makes Nexium, spent more than $110 million on television commercials for the "purple pill" last year, according The AARP Watchdog Report.

AstraZeneca also makes Prilosec, the best-selling prescription drug before it went over the counter less than two years ago. Chemically, the two drugs are distinct, but they keep stomach cells from producing acid in a similar manner. And doctors say they work equally well for a great majority of patients. "Unless your condition is very bad, you're going to do pretty well on either drug," Dr. Shaheen said.

Prevacid, Aciphex and Protonix, the other prescription P.P.I.'s, also work in basically the same way. "There are certainly chemical differences between them, but no significant clinical differences, provided the doses are the same," said Dr. Steven F. Moss, a gastroenterologist at Brown Medical School.

Prilosec is approved by the Food and Drug Administration for self-treatment of frequent heartburn, which, if it occurs at least twice a week, falls under the definition of GERD. Prilosec use should be limited to one 14-day course every four months.

The over-the-counter medicine does not pose any special danger with longer use. But people whose heartburn persists longer than two weeks should see a doctor to check for more severe problems, like scarring in the throat or Barrett's esophagus, a precancerous disorder.

Doctors often prescribe or recommend P.P.I.'s without conducting any diagnostic test for GERD, like an endoscopy, figuring that success with the medicine will demonstrate that the patient's problem was excess acid. Patients then often continue taking the drugs for months or years.

But half of the people who have GERD can get relief instead from H2 blockers, the class of acid-reducing drugs that includes Zantac and Tagamet. The H2 blockers work faster, while P.P.I.'s need a day or two to take effect.

Prescription P.P.I.'s cost about $4 a pill. A Prilosec is 65 to 80 cents. Zantac, Tagamet and similar medicines are available over the counter for 20 to 35 cents each.

Cheaper still are Rolaids, Alka-Seltzer, Maalox and Pepto-Bismol, antacids that can quickly calm occasional cases of heartburn. And even cheaper are changes in behavior, like cutting back on caffeine, nicotine, alcohol and spicy foods, avoiding eating within a few hours of bedtime and losing weight.

But such changes may not help people with severe GERD. "Of course, you want people to stop smoking and lose weight, but the idea that that's going to stop their reflux may be a pipe dream," said Dr. Stuart Jon Spechler, chief of gastroenterology at the Veterans Affairs Medical Center in Dallas.

Only 2 to 3 percent of P.P.I. users suffer side effects, mainly headaches and diarrhea, so the issue of safety usually does not prompt doctors to turn to less potent drugs. Insurers have begun pushing physicians to consider the cost. Georgia Medicaid, for example, requires that doctors try treating patients with H2 blockers before resorting to P.P.I.'s. In 2002, this rule saved the state $20.6 million, said Dr. Tom Delate, who reviewed Georgia's drug costs for Express Scripts, a pharmacy benefits manager.

Procter & Gamble, which markets Prilosec, has been working with AstraZeneca to ease the shortage. A P&G spokesman said shelves should be stocked in two to three months.

[Youngman442002]

I have a bottle of Zantac...and Prilosac....Prilosac wins big time..instant relief...and I have taken..tums-prescriptions...the big P for me..I am selling my bottle of Zantac on e-bay

[Graybeard58]

Ping

[Museum Twenty]

bump for later

[Magnolia]

Fennel tea, or chewing fennel seeds after the meal.

Thanks. I knew it was great for a colicky baby, but never thought about it for adults! I'm going to recommend it to my mother.

[neverdem]

Calcium (carbonate) is the major ingredient in most OTC antacids.

It's the carbonate anion that does the trick, just like in baking soda, aka sodium bicarbonate. It's the carbonate anion in the ionic salt, Calcium carbonate, that reacts with the excess stomach acid to make water and carbon dioxide. Something tells me you never took chemistry. Scroll down the page of that link about three quarters of the way until you find "The Chemistry of Carbonates: CO₃^2- and HCO₃^-"

The formulas on that page are called chemical equilibrium reactions. Atoms of elements combine in specific ratios to form molecules, depending on their natural tendency to gain or lose electrons, becoming negatively or positively charged, respectively. Other symbols on that link are:

(g) meaning gas
(l) meaning liquid
(s) meaning solid
(aq) meaning aqueous, i.e. a solution with water

We're dealing with the chemistry of ionic molecules when they are dissolved in water. In water they can become ions with either negative(-) or positive(+) charges, the sum of which must always equal zero, and which are denoted as superscripts. The number of of atoms of the same element in a molecule or ion are denoted by subscripts. A positively charged ion is called a cation. A negatively charged ion is called an anion.

The chemical symbol for the element and an atom of hydrogen is "H".
The chemical symbol for the element and an atom of oxygen is "O".

Water is a molecule composed of 2 atoms of hydrogen and one atom of oxygen. The molecule of water can disassociate into a hydrogen ion, H⁺,i.e. a proton , with a positive charge and hydroxide ion, OH^-, with a negative charge. The chemical symbol for a molecule of water is H₂O.

The chemical symbol for the element and an atom of carbon is "C".
The chemical symbol for a molecule of carbon dioxide is CO₂.
The chemical symbol for the element and an atom of calcium is "Ca". An ion of calcium is Ca²⁺. It's a cation.
The chemical symbol for the element and an atom of sodium is "Na". An ion of sodium is Na⁺. It's a cation.
The chemical symbol for the carbonate ion is "CO₃^2-". It's an anion.
The chemical symbol for the bicarbonate ion is "HCO₃^-". It's an anion.

[TomGuy]

Something tells me you never took chemistry.

Well, apparently, you did. and you want to show off.

But, from what I can discern from your lengthy dissertation, my statement still stands: Calcium is the major ingredient in most OTC antacids.

[neverdem]

Well, apparently, you did. and you want to show off.

But, from what I can discern from your lengthy dissertation, my statement still stands: Calcium is the major ingredient in most OTC antacids.

Try to find some plain calcium. No, I wasn't trying to show off. I was hoping to teach some chemistry. The gov't does all sorts of things, such as regulating the environment, that it would help if the people understood some science.

If you took calcium chloride, it wouldn't do anything for heartburn. I wasted my time, and I can't type. I regret sending you the comment. Hopefully, someone else might profit, but it's unlikely many will read it now. The thread is rather stale. Adios

[lainde]

bttt