Rabeprazole

What is Rabeprazole

Rabeprazole is a gastric proton-pump inhibitor (PPI) indicated for the treatment of gastroesophageal reflux disease (GERD), peptic ulcer disease, and Zollinger-Ellison syndrome.

Rabeprazole is also indicated for short-term treatment of duodenal ulcers, and in combination with antibiotics in the eradication of Helicobacter pylori (H. pylori) infection to reduce the risk of duodenal ulcer recurrence.

Clinicians should test for H. pylori infection in patients presenting with non-ulcer dyspepsia; patients found to be H. pylori positive should be started on combination eradication therapy.

Eradication of H. pylori offers modest, but significant, symptom relief in non-ulcer dyspepsia and reduces the risk of developing peptic ulcer disease, atrophic gastritis, and gastric cancer.

For populations with a low prevalence of H. pylori infection (less than 10%), starting a 2 to 4 week empiric trial of a PPI is an alternate approach.

Rabeprazole is as effective as omeprazole in the treatment of duodenal ulcer, and gastric ulcer, and it is more effective than ranitidine in the treatment of GERD.

On the basis of available research, no clear advantage has been demonstrated for the use of one PPI over another in the treatment of GERD.

Instead, a key to optimizing effectiveness is tailoring dosage timing and considering twice daily dosing; traditional delayed release PPIs should be administered 30 to 60 minutes before a meal for maximal pH control.

A one-time switch to a different PPI in a refractory patient may be useful.

Rabeprazole uses a non-enzymatic pathway in addition to the CYP system for its metabolism, so drug interactions and the effects of CYP2C19 polymorphism on rabeprazole are minimal compared to other PPIs.

Brand Name

  • AcipHex
  • Aciphex Sprinkle

Indications

  1. duodenal ulcer
  2. dyspepsia
  3. eosinophilic esophagitis
  4. esophagitis
  5. gastric ulcer
  6. gastroesophageal reflux disease (GERD)
  7. Helicobacter pylori (H. pylori) eradication
  8. pyrosis (heartburn)
  9. Zollinger-Ellison syndrome

Side Effects

  1. abdominal pain
  2. agranulocytosis
  3. anaphylactoid reactions
  4. angioedema
  5. arthralgia
  6. blurred vision
  7. bone fractures
  8. bullous rash
  9. coma
  10. constipation
  11. delirium
  12. diarrhea
  13. dizziness
  14. elevated hepatic enzymes
  15. erythema multiforme
  16. flatulence
  17. gastric polyps
  18. headache
  19. hemolytic anemia
  20. hepatic encephalopathy
  21. hepatitis
  22. hyperammonemia
  23. hypomagnesemia
  24. infection
  25. interstitial nephritis
  26. jaundice
  27. leukopenia
  28. lupus-like symptoms
  29. myalgia
  30. nausea
  31. pancytopenia
  32. peripheral edema
  33. pernicious anemia
  34. pharyngitis
  35. pseudomembranous colitis
  36. rhabdomyolysis
  37. Stevens-Johnson syndrome
  38. thrombocytopenia
  39. toxic epidermal necrolysis
  40. vertigo
  41. vitamin B12 deficiency
  42. vomiting
  43. xerostomia

Monitoring Parameters

  • LFTs
  • serum magnesium

Contraindications

  • bone fractures
  • breast-feeding
  • diarrhea
  • gastric cancer
  • geriatric
  • hepatic disease
  • hypomagnesemia
  • infants
  • laboratory test interference
  • long QT syndrome
  • neonates
  • osteopenia
  • osteoporosis
  • pregnancy
  • proton pump inhibitors (PPIs) hypersensitivity
  • pseudomembranous colitis
  • rebound acid hypersecretion
  • systemic lupus erythematosus (SLE)
  • vitamin B12 deficiency

Interactions

  • Acalabrutinib
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Alendronate
  • Alendronate; Cholecalciferol
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Amiloride; Hydrochlorothiazide, HCTZ
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amobarbital
  • Amphetamine
  • Amphetamine; Dextroamphetamine
  • Amphetamine; Dextroamphetamine Salts
  • Ampicillin
  • Ampicillin; Sulbactam
  • Anticholinergics
  • Aprepitant, Fosaprepitant
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atenolol; Chlorthalidone
  • Atropine
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Edrophonium
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Azilsartan; Chlorthalidone
  • Barbiturates
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Belladonna; Opium
  • Benazepril; Hydrochlorothiazide, HCTZ
  • Bendroflumethiazide; Nadolol
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benztropine
  • Bisacodyl
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Boceprevir
  • Bortezomib
  • Bosutinib
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  • Budesonide; Formoterol
  • Bumetanide
  • Butabarbital
  • Calcium Carbonate; Risedronate
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  • Cannabidiol
  • Capecitabine
  • Captopril; Hydrochlorothiazide, HCTZ
  • Carbamazepine
  • Cefpodoxime
  • Ceftibuten
  • Cefuroxime
  • Chlordiazepoxide; Clidinium
  • Chlorothiazide
  • Chlorthalidone
  • Chlorthalidone; Clonidine
  • Citalopram
  • Clobazam
  • Cobicistat
  • Cyanocobalamin, Vitamin B12
  • Cyclosporine
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  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Eprosartan; Hydrochlorothiazide, HCTZ
  • Erlotinib
  • Escitalopram
  • Eslicarbazepine
  • Ethacrynic Acid
  • Fenofibric Acid
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  • Fosinopril; Hydrochlorothiazide, HCTZ
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  • Glycopyrrolate; Formoterol
  • Homatropine; Hydrocodone
  • Hydantoins
  • Hydralazine; Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ; Irbesartan
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Losartan
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Olmesartan
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrochlorothiazide, HCTZ; Valsartan
  • Hyoscyamine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Idelalisib
  • Indacaterol; Glycopyrrolate
  • Iron
  • Isavuconazonium
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
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  • Luliconazole
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  • Methohexital
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  • Neratinib
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  • Octreotide
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  • Omeprazole; Amoxicillin; Rifabutin
  • Oritavancin
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  • Pentobarbital
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  • Theophylline, Aminophylline
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  • Trihexyphenidyl
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  • Voriconazole
  • Warfarin
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