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Clinician’s Corner: Stomach Acid

Back when I started practicing pharmacy the histamine-2 receptor antagonists (H2RA) were just in their infancy. Physicians and patients rejoiced when we had drugs to suppress stomach acid.  General surgeons whose bread and butter were gastrectomy procedures due to stomach ulcers were maybe not quite so excited.

Tagamet was initially approved in 1977 as four times a day dosing, then changed to 400mg twice daily dosing to compete with Zantac.  The battle was on, and Zantac wrestled a good bit of this lucrative business away from Tagamet. It became apparent that Tagamet after being used by millions of patients, indeed had side effects and drug interactions.

This very lucrative market joined by Pepcid (famotidine) and Axid (nizatadine) came to a screeching halt in the 1990’s. Omeprazole was first marketed in the United States in 1989, under the brand name Losec. In 1990, at the request of the FDA, the brand name Losec was changed to Prilosec to avoid confusion with the Lasix 20mg (furosemide). As when the FDA intervenes, things often go amiss, and the new name led to confusion between omeprazole (Prilosec) and fluoxetine (Prozac)!!

I remember discussing this new class of stomach acid suppressants with the Tagamet salesman, who said “no doubt this Losec shuts down stomach acid production better than Tagamet, but the question becomes… how much is too much” He said certainly stomach acid does more than causes stomach ulcers, and aids digestion; but what about its protective effect.  Possibly could stomach cancers become more common with this drug.   No one seemed concerned about this excess acid suppression as Prilosec buried the competition.

In 2002 the generics were approved by the FDA, and prices dropped like a rock.  Insurance companies no longer required prior authorizations, because they were so cheap.   Some patients get prescribed these drugs and are left on them indefinitely. Much to my amazement this powerhouse acid blocker went over the counter in 2003, and was welcomed by all consumers as a cheaper alternative to the prescription variety. Other proton pump inhibitors like Zegerid and Prevacid followed suit., and had their own OTC formulations. Patients didn’t even need to consult a physician or a pharmacist.  Sure, the FDA required a 14 day limit on the box, and a warning of no more than 3 cycles of 14 tablets per year; as the companies sold these drugs in “warehouse packs”!

Today the focus is “deprescribing” proton pump inhibitors.  How do we even begin, when the patients can buy these potentially harmful drugs without a prescription? Your physician and Thompson Pharmacist are a great resource when it comes to discussion of these potent acid blockers.  Go ahead and ASK…at Thompson Pharmacy, it’s all for you.