Acid neutralization capacity and cost effectiveness of antacids sold across various retail pharmacies in United Arab Emirates

Objective: To determine and verify the acid neutralization capacity (ANC) of antacid preparations sold across various retail pharmacies in UAE. Another important objective is to quantify the amount of sodium, calorific content, overall monthly consumption and cost of therapy with respect to its composition and manufacturer. Materials and Methods: In Vitro analysis was carried out on various antacid formulations as per USP30/NF25 methodology at 37±30C. Results and Conclusion: The tablet and liquid antacids fall into four statistically different ANC groups. The standard deviation for the lot to lot variation of tablet antacids was estimated to be 0.42. Three of them (H-1, H-2, H-3 and H-4) have ANCs that correlate with liquid antacid medications mentioned in high ANC class. Out of the five liquid antacids tested, only two found (LH-1 and LH-2) to have high ANC between four lots at 5% level of significance. The ANC of the maximum effective liquid antacid was proven to be twice strong, when compared to the lowest. This variation in capacity for neutralization is not observed, on the product description of antacid brands. The standard dose one to two teaspoonfuls will neutralize 20.22/40.44 mEq to 35.92/71.84mEq, depending on the antacid selected. The normal single dose needed to neutralize the maximum low/high dose regimen by liquid antacids and tablet antacids were estimated. It was apparent from quantification that high or an intermediate high ANC group contributes maximum ANC with minimum dosage volume/weight ratio. Consumption of these categories of antacids benefits in less sodium and calorie intake and minimum expenditure to pharmacist/community. Monthly cost of high dose therapy per day for high ANC tablet antacids is much cheaper than low ANC tablet antacids. In conclusion, if antacid doses to be used judiciously, it is imperative that acid neutralization capacity (mEq) should be enclosed on product label.