Many people with
heartburn
aren't taking their acid-reducing medicine at the right time, which
makes the drugs less effective and wastes money, according to new
research.
Only about one-third of those buying these medications -- such as Nexium,
Prevacid and
Prilosec
-- over-the-counter used them properly compared to just under half of
those who were prescribed the drugs by their primary care doctor. Those
who were given a prescription by a gastroenterologist were most likely
to use the drugs as they're supposed to be used, with seven out of 10
taking the drugs properly, according to the study.
These drugs are activated once in the body, said the
study's senior author, Dr. M. Michael Wolfe, a gastroenterologist and
chair of the department of medicine at MetroHealth System. "In order to
activate the medicine, you must eat. For that reason, you take it before
breakfast. If you don't take the drug correctly, you don't do as well,"
Wolfe said.
Despite labels advising users to take the drugs
before breakfast, people aren't following those directions, he said.
Those who aren't taking the medicines properly "are wasting money,
they're not feeling well and they aren't getting symptom relief," Wolfe
added.
The study was published in the June issue of The American Journal of Gastroenterology.
Heartburn is a painful, burning feeling just below
the breastbone, experienced at least once a month by about 44 percent of
U.S. adults. About 7 percent have heartburn daily. Frequent heartburn
may indicate a condition called gastroesophageal reflux disease, or
GERD. Food and acid from the stomach backs up, or refluxes, into the
esophagus. Reflux can damage the esophagus and cause serious issues over
time.
Direct costs related to GERD, including
acid-reducing medicines, top $10 billion each year in the United States,
according to background information in the study.
The medications looked at in this study are a class
of drugs known as proton pump inhibitors. They work by reducing the
amount of stomach acid produced, according to the U.S. National Library
of Medicine. Unlike antacids, such as Tums or Rolaids, proton pump
inhibitors don't provide immediate relief of
heartburn symptoms. It takes about 7 days of continuous use for the drugs to reach their maximum acid-suppressing potential, the study noted.
Wolfe and his colleagues surveyed 610 patients who used
heartburn medicine for their GERD. Of that group, 190 got a prescription
heartburn medicine from a gastroenterologist and 223 received a
prescription from their primary care doctor. The other 197 bought
over-the-counter heartburn medicines.
Those prescribed the medicines by their
gastroenterologist did best, Wolfe noted, with 71 percent taking the
medicines correctly. Only 47 percent of those who got prescriptions from
their primary care doctors took them correctly. And just 39 percent of
those who bought them over-the-counter used them right, the
investigators found.
In a previous study, only one-third of primary
care doctors told patients to take the medicines before meals, but
nearly all gastroenterologists did, according to the report.
In his study, Wolfe found, the severity and
frequency of symptoms were better in those who were prescribed the drug
by a gastroenterologist compared to a primary care doctor.
"If you have frequent heartburn, you have a
disease, GERD," Wolfe said. "And you really should see a physician and
not treat yourself," he explained.
Dr. John Lipham is director of the Digestive
Health Center at Keck Medicine of the University of Southern California.
Lipham reviewed the findings but was not involved in the study.
"It's something we have known since these
medications came out, that they work best if you take them 30 minutes or
so before a meal," said Lipham.
However, he pointed out that the new study puts some data behind what experts knew from experience.
Lipham said the new study is the first, to his
knowledge, to show a difference in taking the medicine correctly
depending on who prescribed it.
Wolfe and Lipham both find that patients often
think of the proton pump inhibitors in the same way as antacids, meant
to be taken when heartburn strikes.
"But these [proton pump inhibitor] medicines don't
work that way," Lipham said. "They need to be stimulated by acid and
need to build up in your system. You have to take them at the correct
time each day and you also need to take them every day to get the
maximum effectiveness of the medications."
As to why doctors aren't all telling their patients how
to use these drugs, Wolfe speculated that primary care doctors may be
too busy and don't have the time to read all of the drug literature.
The bottom line is "it boils down to education,"
said Wolfe. Physicians and consumers need to take the time to learn
about the drugs.
Ideally, Wolfe said, you should take the medicine
in the morning, then ''eat something that causes your stomach to make
acid, such as protein, an egg, a piece of cheese, yogurt." For those who
hate breakfast, he advises drinking a glass of milk or at least a cup
of coffee.