1. Introduction
Rabeprazole is a proton pump inhibitor (PPI) that reduces stomach acid production. It is commonly used to treat gastro-oesophageal reflux disease (GERD), peptic ulcers, and conditions associated with excessive stomach acid, such as Zollinger-Ellison syndrome. Rabeprazole works by inhibiting the proton pump (H+/K+ ATPase) in the gastric parietal cells, thereby reducing acid secretion.
2. Indications
- Gastro-oesophageal reflux disease (GERD), including erosive or ulcerative GERD
- Peptic ulcer disease (gastric and duodenal ulcers)
- Zollinger-Ellison syndrome (hypersecretory conditions)
- Helicobacter pylori eradication (as part of combination therapy)
- Nonsteroidal anti-inflammatory drug (NSAID)-induced gastric ulcers
- Dyspepsia associated with excessive stomach acid
3. Dosage
Adults:
- GERD (erosive or ulcerative): 20 mg once daily for 4–8 weeks.
- Maintenance therapy for GERD: 20 mg once daily.
- Peptic ulcers: 20 mg once daily for 4–8 weeks.
- Helicobacter pylori eradication (in combination therapy): 20 mg twice daily with amoxicillin (1 g) and clarithromycin (500 mg) for 7–14 days.
- Zollinger-Ellison syndrome: Initial dose 60 mg once daily, adjusted based on response (maximum: 120 mg/day).
Children (≥12 years):
- GERD: 20 mg once daily for up to 8 weeks.
Elderly:
- No dose adjustment required.
4. Administration
- Take orally, with or without food.
- Swallow tablets whole; do not crush, chew, or split them.
- For Helicobacter pylori eradication, take rabeprazole as part of the prescribed combination therapy.
5. Forms Available
- Delayed-release tablets: 10 mg, 20 mg
6. Side Effects
6.1 Common Side Effects:
- Headache
- Diarrhoea
- Abdominal pain
- Flatulence
- Nausea
6.2 Less Common Side Effects:
- Dizziness
- Constipation
- Dry mouth
6.3 Rare but Serious Side Effects:
- Clostridioides difficile-associated diarrhoea
- Bone fractures (long-term use)
- Hypomagnesaemia (low magnesium levels)
- Severe allergic reactions (e.g., anaphylaxis)
- Interstitial nephritis
7. Warnings
- Bone Fractures: Long-term use (more than 1 year) may increase the risk of fractures, particularly in older adults.
- Hypomagnesaemia: Monitor magnesium levels during prolonged therapy, especially if combined with other drugs that lower magnesium.
- Clostridioides difficile Infection: Increased risk of diarrhoea associated with C. difficile infection.
- Gastric Cancer Masking: Symptomatic relief may delay the diagnosis of gastric malignancy.
8. Precautions
- Use cautiously in patients with severe hepatic impairment, as rabeprazole is metabolised in the liver.
- Avoid long-term use unless absolutely necessary due to risks of bone fractures, hypomagnesaemia, and vitamin B12 deficiency.
- Inform your doctor of persistent symptoms despite treatment.
9. Interactions
- Antifungals (e.g., ketoconazole): Reduced absorption of antifungals due to decreased gastric acidity.
- Clopidogrel: May reduce the antiplatelet effect of clopidogrel; use alternative PPIs if necessary.
- Digoxin: Increased absorption, leading to potential toxicity.
- Methotrexate: Increased serum levels of methotrexate; monitor closely.
- Warfarin: May alter INR; monitor coagulation parameters closely.
10. Monitoring Parameters
- Symptom relief and resolution of GERD or ulcer-related symptoms.
- Monitor magnesium, calcium, and vitamin B12 levels in long-term therapy.
- Observe for any gastrointestinal infections or persistent diarrhoea.
11. Use in Children
- Approved for use in children aged 12 years and older for GERD.
- Limited safety and efficacy data for children under 12 years.
12. Use in Pregnancy
- Category B: Animal studies have shown no risk to the foetus, but there are no adequate studies in pregnant women. Use only if clearly needed and under medical supervision.
13. Use in Elderly
- Generally safe, but monitor for long-term side effects such as fractures, hypomagnesaemia, or vitamin B12 deficiency.
14. Use in Kidney Disease
- No dose adjustment required in renal impairment.
15. Use in Liver Disease
- Use cautiously in patients with severe hepatic impairment due to increased plasma concentrations of rabeprazole.
16. Patient Counselling Points
- Take rabeprazole exactly as prescribed, at the same time each day.
- Do not crush or chew the tablets; swallow them whole.
- Inform your doctor if symptoms persist or worsen despite treatment.
- Avoid long-term use without medical supervision, as it may lead to side effects like bone fractures or vitamin deficiencies.
- Report any unusual symptoms, such as persistent diarrhoea or severe abdominal pain, immediately.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Aciphex | Eisai | 20 mg Tablet | $300 (30 tablets) |
Pariet | Janssen | 20 mg Tablet | $280 (30 tablets) |
Generic Rabeprazole | Various | 20 mg Tablet | $30 (30 tablets) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Rabeprazole used for?
Rabeprazole is used to treat GERD, peptic ulcers, and other acid-related disorders, and for Helicobacter pylori eradication.
2. How does Rabeprazole work?
It inhibits the proton pump in gastric parietal cells, reducing stomach acid production.
3. Can Rabeprazole cause diarrhoea?
Yes, diarrhoea is a common side effect and may indicate a Clostridioides difficile infection in rare cases.
4. How long does Rabeprazole take to work?
Symptom relief is usually noticed within a few days, but full healing may take 4–8 weeks.
5. Can Rabeprazole be used long-term?
Yes, but long-term use increases the risk of side effects like fractures, hypomagnesaemia, and vitamin B12 deficiency.
6. Is Rabeprazole safe during pregnancy?
Rabeprazole is considered safe (Category B) when used under medical supervision.
7. Can Rabeprazole be taken with antacids?
Yes, antacids can be taken alongside rabeprazole for additional symptom relief.
8. Does Rabeprazole interact with other medications?
Yes, it interacts with drugs like clopidogrel, digoxin, methotrexate, and antifungals.
9. Can Rabeprazole be taken on an empty stomach?
Yes, rabeprazole can be taken with or without food.
10. Can Rabeprazole cause vitamin deficiencies?
Yes, long-term use may reduce the absorption of vitamin B12 and magnesium.
11. Is Rabeprazole safe for children?
It is approved for children aged 12 years and older for GERD.
12. Can I stop Rabeprazole suddenly?
Stopping abruptly may cause rebound acid hypersecretion; consult your doctor for a tapering plan.
13. Can Rabeprazole cause headaches?
Yes, headaches are a common side effect.
14. How should Rabeprazole be stored?
Store at room temperature, away from moisture and heat.
15. Is Rabeprazole available over-the-counter?
In most countries, rabeprazole requires a prescription.