A clash is about to begin. It's all about bellyaches.
Three giants are preparing to wage war over American stomachs. Pepcid, Tagamet and Zantac have been enormously successful as prescription ulcer medicines. Last year, combined sales exceeded $3 billion.
Now, the biggest switch in pharmaceutical history is under way. Pepcid AC (Acid Controller) is already available without prescription. Shortly Tagamet HB (Heartburn) and Zantac 75 will join it. Advertising budgets will total $300 million, and you may see, hear and read more commercials for indigestion than you can stomach.
Unlike antacids, these new over-the-counter (OTC) medicines actually suppress stomach acid rather than neutralize it. They work by blocking histamine receptors in the stomach that are responsible for acid secretion.
Unlike traditional antihistamines, which block histamine (H1) receptors in the nose, these stomach medicines only affect special histamine (H2) receptors in the digestive tract, hence the name H2 antagonists.
What has made these drugs so successful in the prescription marketplace is their convenience and effectiveness. Unlike chalky-tasting antacids, these pills are easy to take, relieve symptoms quite quickly and don't often cause side effects. Antacids can bring on constipation or diarrhea and have to be swigged many times a day.
The new over-the-counter acid suppressors will be marketed in lower doses than their prescription counterparts, but the ingredients will be identical. Although side effects such as headache, constipation or diarrhea should be rare at the lower dose, some gastroenterologists have expressed fears that people will take these drugs for granted once they go OTC. They worry that consumers might apply the "more is better" principle and take a handful to get rid of a bellyache.
This could lead to trouble, especially with Tagamet HB (cimetidine). Older people in particular may be susceptible to dizziness, joint pain, confusion and sexual difficulties. Cimetidine also can interact with a number of other medications, and this concern initially delayed approval for OTC status.
Another fear is that treating symptoms of heartburn and indigestion may lead people to overlook potentially serious underlying problems. Gastroenterologists believe that many cases of chronic gastritis or ulcers are caused by a bacterium that can be cured with antibiotic therapy. Left untreated, this microorganism might increase the risk of stomach cancer.
Despite such concerns, consumers will benefit from having these highly effective stomach drugs available without prescription. Used wisely, they can relieve a lot of discomfort. But gird yourself for the coming advertising war. The battle for your bellyache could be bruising.
Q: My husband consumes huge amounts of baking soda for his heartburn. He also has high blood pressure. I worry that the baking soda makes his blood pressure worse.
A: There is reason to be concerned. The sodium in baking soda could well make it harder to control elevated blood pressure. Your husband needs to consider a different approach. If his symptoms are persistent, he should see a physician.
Joe Graedon is a pharmacologist. Dr. Teresa Graedon is a medical anthropologist and nutrition expert.
