Formulary
Rabeprazole sodium: Indications, Dosing, Side Effects and Interactions
For all proton pump inhibitors Proton pump inhibitors inhibit gastric acid secretion by blocking the hydrogen-potassium adenosine triphosphatase enzyme system...
MedNext Academy | 4 min read
Rabeprazole sodium: Indications, Dosing, Side Effects and Interactions
For all proton pump inhibitors Proton pump inhibitors inhibit gastric acid secretion by blocking the hydrogen-potassium adenosine triphosphatase enzyme system...
Drug action
For all proton pump inhibitors Proton pump inhibitors inhibit gastric acid secretion by blocking the hydrogen-potassium adenosine triphosphatase enzyme system (the 'proton pump') of the gastric parietal cell.
Indications and dose
**Benign gastric ulcer**
- **Adult** (By Mouth): 20 mg daily for 8 weeks, dose to be taken in the morning.
**Duodenal ulcer**
- **Adult** (By Mouth): 20 mg daily for 4 weeks, dose to be taken in the morning.
**NSAID-associated peptic ulcer disease**
- **Adult** (By Mouth): 20 mg once daily for 8 weeks.
**Gastro-oesophageal reflux disease**
- **Adult** (By Mouth): 20 mg once daily for 4-8 weeks; maintenance 10-20 mg daily.
**Gastro-oesophageal reflux disease (symptomatic treatment in the absence of oesophagitis)**
- **Adult** (By Mouth): 10 mg daily for up to 4 weeks, then 10 mg daily if required.
**Severe oesophagitis**
- **Adult** (By Mouth): 20 mg once daily for 8 weeks, continue as maintenance treatment if appropriate.
**Severe oesophagitis, refractory to initial treatment**
- **Adult** (By Mouth): 20 mg twice daily.
**Functional dyspepsia**
- **Adult** (By Mouth): 10 mg once daily for 4 weeks.
**Uninvestigated dyspepsia**
- **Adult** (By Mouth): 20 mg once daily for 4 weeks.
**Zollinger-Ellison syndrome**
- **Adult** (By Mouth): Initially 60 mg once daily, adjusted according to response, doses above 100 mg daily given in 2 divided doses; maximum 120 mg per day.
**Helicobacter pylorieradication [in combination with other drugs (seeHelicobacter pylori infection)]**
- **Adult** (By Mouth): Helicobacter pylori eradication [in combination with other drugs (see Helicobacter pylori infection )] 20 mg twice daily for 7 days for first- and second-line eradication therapy; 10 days for third-line eradication therapy.
Cautions
For all proton pump inhibitors Can increase the risk of fractures (particularly when used at high doses for over a year in the elderly); may increase the risk of gastro-intestinal infections (including Clostridioides difficile infection); may mask the symptoms of gastric cancer; may reduce absorption of vitamin B 12 with long-term treatment; patients at risk of osteoporosis Cautions, further information Risk of osteoporosis Patients at risk of osteoporosis should maintain an adequate intake of calcium and vitamin D, and if necessary, receive other preventative therapy. Gastric cancer Particular care is required in those presenting with 'alarm features', in such cases gastric malignancy should be ruled out before treatment. Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate for uncomplicated peptic ulcer disease or erosive peptic oesophagitis at full therapeutic dosage for longer than 8 weeks (dose reduction or earlier discontinuation indicated).
Side effects
For all proton pump inhibitors Common or very common Abdominal pain; constipation; diarrhoea; dizziness; dry mouth; gastrointestinal disorders; headache; insomnia; nausea; skin reactions; vomiting Uncommon Arthralgia; bone fractures; confusion; depression; drowsiness; leucopenia; malaise; myalgia; paraesthesia; peripheral oedema; thrombocytopenia; vertigo; vision disorders Rare or very rare Agranulocytosis; alopecia; gynaecomastia; hallucination; hepatic disorders; hyperhidrosis; hyponatraemia; nephritis tubulointerstitial; pancytopenia; photosensitivity reaction; severe cutaneous adverse reactions (SCARs); stomatitis; taste altered Frequency not known Gastrointestinal infection; hypomagnesaemia (more common after 1 year of treatment, but sometimes after 3 months of treatment); subacute cutaneous lupus erythematosus Side-effects For rabeprazole sodium Common or very common Asthenia; cough; increased risk of infection; influenza like illness; pain Uncommon Burping; dyspepsia; leg cramps; nervousness Rare or very rare Appetite decreased; hepatic encephalopathy; leucocytosis; neutropenia; weight increased Frequency not known Chest pain; chills; fever
Interactions
**Severe interactions:**
- Co-administration of rabeprazole sodium with ketoconazole or itraconazole may result in a significant decrease in antifungal plasma levels.
**Other interactions (6):**
- Therefore individual patients may need to be monitored to determine if a dosage adjustment is necessary when ketoconazole or itraconazole are taken concomitantly with PARIET.
- Co-administration of atazanavir 300 mg/ritonavir 100 mg with omeprazole (40 mg once daily) or atazanavir 400 mg with lansoprazole (60 mg once daily) to healthy volunteers resulted in a substantial...
- The absorption of atazanavir is pH dependent.
- Therefore PPIs, including rabeprazole, should not be co-administered with atazanavir (see section 4.4).
- Methotrexate Case reports, published population pharmacokinetic studies, and retrospective analyses suggest that concomitant administration of PPIs and methotrexate (primarily at high dose; see...
- However, no formal drug interaction studies of methotrexate with PPIs have been conducted.
Pregnancy
Manufacturer advises avoid-no information available.
Breast feeding
Specialist sources indicate use with caution-no human data available. Likely to be present in milk, but amount probably too small to be harmful.
Hepatic impairment
Manufacturer advises caution in severe impairment (no information available).
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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