COVID Shortages From Bottom to Top; Now It's Rolaids?

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Toilet paper always flies off the shelves when there's a crisis, whether it's real or perceived. But after nine months of COVID, there's a new "panic item": antacids. Here's why.

The indignities that COVID has heaped upon us in the form of shortages now range from one end of the gastrointestinal?expressway to the other.?

The toilet paper shortage is hardly news. Nor is it surprising. If the National Weather Service predicts one-quarter of an inch of rain people mob stores in a desperate quest for bread, milk, and, especially, toilet paper. But COVID has hit us hard and relentlessly for about nine?months and it's taking a toll on the physical and mental health of many of us. Even this past summer, well before the current wave had slammed into the US prescriptions for medications to treat depression, insomnia, and anxiety had?risen?by 15-34 percent. Likewise, binge drinking of alcohol has risen by 20 percent.?

Since there is a well-known connection between the stomach and brain it is not surprising that COVID anxiety has given rise to stomach issues. Back in October, when I interviewed Dr. Michael Glick, a New York gastroenterologist, he explained how gastric reflux ("heartburn") is exacerbated by stress and anxiety:

Acid reflux clearly worsens when someone is under significant stress.?Think about when you’re anxious—you can feel the tightening of the muscles you can control in your arms and legs, called skeletal muscles.??In contrast, the body’s sphincters consist of smooth muscle, and these go lax when we’re stressed.?That’s why someone might feel the need to run to the bathroom before giving a presentation at work.?The lower esophageal sphincter also consists of smooth muscle and will loosen when someone is anxious.??This leads to more acid reflux, which can cause more stress and the cycle self-perpetuates.

So, it cannot be surprising that people are wolfing down antacids like candy, which has lead to sporadic shortages, according to a New York Times article?– simple antacids, like Tums, Rolaids, and Maalox, as well as over-the-counter acid reducers like Pepcid?and Prilosec?(1,2).?

Even the most prepared survivalists are unlikely to have shelves of Rolaids in the bunker. This run on antacid?medications is unprecedented. But the shortage depends on the drug. Even though the sales of simple calcium,?magnesium, or aluminum-based antacids (3) like Tums and Maalox have increased due to COVID-related stress, you can still buy them – most of the time (4).?But there is another reason why they are being used more frequently: stockpiling?of Pepcid (famotidine).

In the Times article, a Johnson & Johnson spokesperson said (regarding Pepcid) “we understand supply may still be temporarily out of stock in some stores and online...?We are taking all possible measures to ensure product availability in a timely and quality-based manner.”

While an increase in Pepcid?(famotidine) sales makes sense (it effectively treats heartburn), there is more going on here. As early as last winter there were suggestions that famotidine might be helpful in treating COVID. Whether it does or not is anyone's guess. There are multiple studies that conclude that the drug improves outcomes in hospitalized patients (5) and others that conclude that it does not (6).

Keep in mind that these studies are all retrospective cohort studies, which are less reliable than a randomized control trial, one of which is now in progress.

Panic and hoarding go hand in hand. Whatever is next on the "list" is anyone's guess.

NOTES:

(1) This list would have certainly contained?Zantac (ranitidine) but it was recalled this past April due to the presence of a carcinogenic impurity called N-nitrosodimethylamine?(NMDA).?

(2) Both of these as well as Zantac began life as prescription drugs. They are now sold over the counter.?

(3) Tums, Rolaids, etc.?contain carbonate or hydroxide, are simply weak bases that neutralize some of the acid in the stomach. Their effect is short-lived compared to the histamine blockers (Pepcid) and proton pump inhibitors (Prilosec), which affect a biological process to limit stomach acid.

(4) According to the Times article, Tums may not be so easy to buy either. According to a Glaxo spokesperson,?“We are aware that there may be pockets of supply constraints [of Tums].”?

(5) Examples: Studies?A, B

(6) Examples: Studies C, D

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