THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 486.1 Guest: Angelo Voxakis, P.D. Topic: Antacids Host: Richard Roeder Producer: Ed Graham

NEMA: This is a conversation about over-the-counter antacids and when to use them with pharmacist Dr. Angelo Voxakis from the Hereford Pharmacy in Parkton, Maryland.

NEMA: Dr. Voxakis, if I walk into a pharmacy in 1995 and go to the antacid shelf, I will probably see dozens of different brands from which to choose but by what mechanism do these preparations work and are there great differences in the chemistry of one over the other?

Voxakis: A year ago, we'd tell you how they work is by neutralizing the acid. But now there will be a "whole new series of antacids" coming out with the introduction of Pepcid which is going over the counter and this basically works by cutting down, turning off the switch that secretes stomach acid so it lowers the stomach acidity by causing less acid to be excreted. Soon you'll be seeing Tagamet going over the counter so this is a whole new era now of medications being used for antacids. Maalox, those kinds of things, the Mylantas - Mylanta now has an added ingredient which will be simethicone which is anti-flatulent - where Maalox began as strictly an antacid but you also have Maalox Plus which has simethicone in it for deflatulent. The same means to an end and it goes back to our previous conversation. Try it. If it works, stick with it.

NEMA: Where do you draw the line between occasional indigestion and appropriate use of an OTC antacid and a serious problem that should be investigated by a physician?

Voxakis: If it's chronic indigestion - don't forget, if I remember my statistics correctly, half of the population has the hiatal hernia which can cause the reflux into the esophagus which causes the heartburn so usually what we tell customers is to try these. If they get relief, then fine. If it continues and if they only get relief upon taking this medication or after they're eating, then usually I stress to them to go see a physician to get it checked out. If nothing else, let the physician check it out and say no, it's not an ulcer, all it is is indigestion. I'd be more comfortable by doing this. This is my fear as far as the new antacids coming out like the Pepcids and Tagament. People will use them instead of seeking medical help.

NEMA: Have you had occasion to have a customer come into your pharmacy and ask you for an antacid and upon speaking to them, you've said "you need to not be here buying an over-the-counter antacid, you need to go see a doctor."

Voxakis: It's happened to me, not all the time but you have to play each patient as an individual. You have to weigh it. Are they going to go see a physician or should you try to steer them towards a physician and give them some relief? Let them try something because again, you're going to find that patients are reluctant to pay the doctor's fees. They'd rather try and self-medicate first so you try and steer them the proper way but at the same time explain to them that if they don't find relief, then they should see a physician.