Rabeprazole

Rabeprazole

Pronunciation

Rabeprazole 20mg

Drug Class

Rabeprazole belongs to the class of medications known as proton pump inhibitors (PPIs). These drugs work by inhibiting gastric acid secretion.

Common Strengths

Rabeprazole is available in the following strengths:

• 10 mg delayed-release tablets
• 20 mg delayed-release tablets

Drug Trade Name

Rabeprazole is marketed under the trade name PARIET.

Drug Usage

Rabeprazole is primarily used for:

• Healing of erosive or ulcerative gastroesophageal reflux disease (GERD)
• Maintenance of healing of erosive or ulcerative GERD
• Treatment of symptomatic GERD
• Healing of duodenal ulcers
• Eradication of Helicobacter pylori to reduce the risk of duodenal ulcer recurrence
• Treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome

Mechanism of Action

Rabeprazole works by selectively and irreversibly inhibiting the H^+, K^+-ATPase enzyme system (the proton pump) at the secretory surface of gastric parietal cells. This inhibition reduces gastric acid secretion, thereby alleviating symptoms associated with excess stomach acid.

Route of Administration

Rabeprazole is administered orally, available as delayed-release tablets.

Dosages for Normal People

The typical dosage for adults is:

• GERD treatment: 20 mg once daily for up to 8 weeks; maintenance 10-20 mg daily.
• Benign gastric ulcer: 20 mg once daily for up to 8 weeks, dose to be taken in the morning.
• Duodenal ulcer: 20 mg once daily for 4 weeks, dose to be taken in the morning.
• Zollinger-Ellison syndrome: Initially 60 mg once daily, adjusted according to response, doses above 100 mg daily given in 2 divided doses; maximum 120 mg per day.
• H. pylori eradication: 20 mg twice daily.

For renal dosing based on eGFR:

• No specific renal dose adjustment is typically required, but caution is advised in patients with severe renal impairment.

Side-Effects: Common and Serious Side Effects

Common side-effects may include:

• Constipation
• Cough
• Influenza like syndrome

Serious side-effects may include:

• Increased Osteoporosis-related fractures, particularly in older adults
• Low blood magnesium levels
• Clostridium difficile infection in the colon
• Acute Tubulointerstitial Nephritis can manifest as decreased urine output or blood in the urine
• Vitamin B12 Deficiency: Symptoms include fatigue, sore tongue, and neurological issues

Pharmacokinetics

It undergoes hepatic metabolism and has a half-life of about 1 to 2 hours. The onset of action occurs within 1 hour, with a duration of action lasting up to 24 hours.

Drug Precautions

Pregnancy

The safety of rabeprazole during pregnancy is unclear; it should only be used if clearly needed.

Breastfeeding

It is unknown whether rabeprazole passes into breast milk; caution is advised.

Children and Elderly

Rabeprazole can be used in children aged 12 years and older for GERD treatment. Use in elderly patients may require careful monitoring due to potential increased sensitivity to side effects.

Monitoring Items

Patients on rabeprazole should be monitored for:

• Signs of gastrointestinal bleeding
• Electrolyte levels, particularly magnesium

Drug Interactions

Rabeprazole may interact with other medications, including:

• HIV Medications: Atazanavir, nelfinavir, and rilpivirine by reducing the absorption and effectiveness of these antiretroviral drugs, which may lead to treatment failure and resistance development.
• Clopidogrel: Rabeprazole may reduce the effectiveness of clopidogrel, a blood thinner, potentially increasing the risk of cardiovascular events.
• Itraconazole and ketoconazole: The absorption of these antifungal agents may be decreased when taken with rabeprazole due to altered gastric pH.
• Methotrexate: Concurrent use can lead to increased levels of methotrexate in the body, raising the risk of serious side effects such as kidney damage and anemia.
• Digoxin: Rabeprazole can increase the serum levels of digoxin, which is used to treat heart conditions, necessitating careful monitoring.
• St. John's Wort: This herbal supplement can reduce the effectiveness of rabeprazole by inducing hepatic enzymes that metabolize the drug.

FAQ

How should I take the tablet?

Take rabeprazole orally, usually once daily before a meal. Swallow the tablet whole without crushing or chewing.

What should I avoid while taking?

Avoid concomitant use with certain medications like iron supplements and St. John's wort.

What happens if I miss a dose?

If you miss a dose, take it as soon as you remember. If it's almost time for your next dose, skip the missed dose and resume your regular schedule. Do not double the dose.