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

Transcripts: 510-4 and 510-5

Week: 510.4 Guest: Robert Mathieson, M.D. Topic: Over the Counter Antacids - Part One Host: Richard Roeder Producer: Ed Graham

NEMA: This is the first half of a conversation on the use and safety of over the counter antacid drugs. My guest is Dr. Robert Mathieson, Chief of Gastroenterology at Union Memorial Hospital in Baltimore, Maryland.

NEMA: Dr. Mathieson, anyone who watches television in this country has seen lots of ads in the last few months, Tagamet seems to be the medication that receives the most attention but Pepcid is certainly right up there. I understand that Zantac, another drug, has gone over the counter. Before we discuss that element, would you just briefly describe what these medications are, what that class of medication is.

MATHIESON: The medications you're describing have a name. They're called H2 antagonists and basically they work at a special receptor site in the stomach that is thought to be one of the mechanisms by which acid secretion occurs in the stomach. So if you block that receptor, than you decrease the acid secretion and by doing so you help in the treatment of very common conditions such as reflux and ulcer disease.

NEMA: The drugs that have gone over the counter as opposed to their previous prescription status, are they of similar potency and are they really the same chemical composition as the prescription drugs are?

MATHIESON: They are the same chemical composition but they are not of the same strength that you would receive if you received the prescription drug. For example, if we take Tagamet, the amount of milligrams of Tagamet and the over the counter medication is half of what you would receive if you received a prescription item. That's also true of Pepcid AC which is the other medication that is now out over the counter and it is half the strength of the regular prescription item.

NEMA: Now the real question I wanted to ask you about these - obviously if a person can now purchase these over the counter, they're basically self-diagnosing. How do you feel about this and what are the chances that a person is self-diagnosing a condition as being an acid problem and in fact it may be masking a far more serious underlying condition?

MATHIESON: That's a very good question and it's probably - let me try to give you a clear answer on this. I think that, number one, the use of Maalox and Mylanta, the old standard drugs that people can still get over the counter to treat ulcer symptoms, really have little effect on patients who have reflux or have ulcer disease. It gives them very temporary relief and you have to take large quantities of this medication to really get any sustained acid suppression. When a patient comes into the office to see a doctor and he's complaining about reflux symptoms, heartburn, indigestion, or if he's complaining about stomach growling and gnawing kinds of symptoms that people have with peptic ulcer disease, the first thing that's usually done in the doctor's office is to give them an H2 antagonist without really invoking any other tests per se unless the patient has certain warning signs.

NEMA: Join me for the second half of my conversation on over the counter antacids with Dr. Robert Mathieson.

Transcripts:

Week: 510.5 Guest: Robert Mathieson, M.D. Topic: Over the Counter Antacids - Part Two Host: Richard Roeder Producer: Ed Graham

NEMA: This is the second half of a conversation on the use and safety of over the counter antacid drugs. My guest is Dr. Robert Mathieson, Chief of Gastroenterology at Union Memorial Hospital in Baltimore, Maryland. I asked Dr. Mathieson about symptoms that indicate a serious condition requiring medical attention rather than over the counter medications.

MATHIESON: Difficulty in swallowing, feeling bloated and losing weight or having bleeding or evidence of black tarry stools in the bowel. These particular sorts of complications would warrant immediate investigation as to what the problem is and to treat the problem aggressively but for the average person who just has some indigestion, heartburn, and comes in to a doctor's office, the first thing they would do would be to get a prescription of Zantac or Pepcid and treat their condition and see if they respond. Is it all right for patients to then go to the pharmacy and try these medications? These medications basically are meant to treat acid reflux. They're not really meant to treat ulcer disease per se. Is it all right for them to take this medication? It's all right I think and I think it's also very safe for them to do because these medications have stood the test of time. They have been out and tested over and over and over again for the last 15, 20, 25 years so they are exceedingly safe. You are taking half the standard dose that people would normally be taking with these medications which would even increase the margin of safety but I think what the message is that needs to be taken home to people who purchase these medicines is if this medication does not help you or if you're having any of these warning signs and symptoms, then you ought to see your physician and get appropriate further treatment.

NEMA: Okay. One of my favorite ads for one of these medications, and I really don't remember which one it is, but basically the husband is standing there saying to his wife "I can't eat those explosive meatballs tonight. It'll kill me." And she says "Oh don't worry honey. Make a pig out of yourself because here's what you can take first. No problem." That seems like a rather peculiar message since even if his abdomen doesn't explode on him, that's probably not great for his heart and who knows what else. How do you feel about the way this is being approached?

MATHIESON: Unfortunately, I think many patients end up taking the medications exactly under those circumstances and I'm not trying to say that's right or correct because if you're going to take a medication, you should take it appropriately but many patients anticipate that they're going to be going out, they're going to be drinking, they're going to be going to a rich meal and having a good time and they don't want to worry about having a lot of reflux so they pop a Zantac or whatever they've got at hand to kind of help them out. The medication really isn't designed for that type of use. It's really meant to treat long term acid problems and not to be taken as a rapid remedy type thing. I don't know if there have actually been studies that have compared these little half-strength pills to antacids in terms of how do they rapidly improve symptoms of indigestion but the goal stated has always been that if you take some Maalox or Mylanta and swig that down, it will give you very rapid relief of any kind of indigestion that you might have.