WHAT IS CAUSING HEARTBURN?

Although we are often reluctant to admit it, down deep we probably realize that our hectic lifestyle can impact drug consumption, both legend and OTC. Do you remember those relaxing meals with the family around the dinner table when we were growing up? Perhaps this scenario did not take place in all families, but it was true in mine. Now fast-food meals eaten on the run seem to be the more common practice. Has heartburn become the scourge of the fast meals? The amount of advertising attention that heartburn treatments are receiving suggests that the problem is real and that patients can be influenced to choose specific products.

I even remember thinking that direct-to-consumer advertising of prescription drugs would probably never grow too big because the choice of drugs was the physician?s decision, with only minimal patient input?at least for some classes of drugs. I was really wrong. The current activity related to proton pump inhibitors (PPIs) may be only a mirror of what is to come. It is obvious that these promotional practices must affect the patient?s choice of drugs, or the advertising investment would not be so large.

Nexium (esomeprazole), the replacement branded PPI for Prilosec (omeprazole), was the leading drug in terms of directto- consumer advertising in 2002, with $211 million spent, or a 166% increase over expenditures in 2001 (Chain Pharmacy Industry Profile. 2003:47). We know that the real motivation was to create a perceived need for Nexium because patent protection on Prilosec ended. At the same time, to benefit from the Prilosec name recognition, an OTC dosage form is being heavily promoted.

The makers of Pepcid (famotidine), an OTC H2 [histamine2] blocker, have challenged this promotional campaign in court. Health plans and insurers have gotten into the game to promote OTC Prilosec use (most third-party plans do not cover OTCs) by increasing copays on prescription PPIs to encourage patients to purchase OTC Prilosec. The generic manufacturer of omeprazole is heavily promoting a rebate on omeprazole prescriptions. All of this activity suggests that the profit potential from these products must be huge.

Indeed, all of this activity is to treat a problem that for many people may be the result of a lifestyle choice. Is what we are experiencing with these various promotional practices setting the stage for the future?

All of these promotional messages may end up confusing rather than informing the patient. The resulting information overload may provide pharmacists with an opportunity to help patients make the best use of their heartburn drugs. Are you prepared to take advantage of this opportunity?