Class: Proton Pump Inhibitor
Dosage Forms. Tablet, Delayed Release: 20 mg
Common FDA Label Indication, Dosing, and Titration.
1. Duodenal ulcer disease: 20 mg po daily × up to 4 wk
2. Helicobacter pylori GI infection: 20 mg po bid × 10-14 d in combination with amoxicillin 1000 mg and clarithromycin 500 mg po bid
3. Gastric hypersecretion: 60 mg po daily, may titrate to 60 mg po bid
4. Gastroesophageal reflux disease, erosive or ulcerative, for symptom control, initial treatment, or maintenance: Adults and Children >12 y, 20 mg po daily
1. Drug-induced gastrointestinal disturbance, indigestion: 20 mg po daily
2. Gastric ulcer disease: 20-40 mg po daily
MOA. Rabeprazole is a proton pump inhibitor (PPI) that, when protonated in the secretory canaliculi of the parietal cells, covalently binds to H+/K+-ATPase (proton pump), which is the final pathway for acid secretion. Rabeprazole produces a profound and prolonged antisecretory effect and inhibits basal, nocturnal, and pentagastrin- and food-stimulated gastric acid secretion.
Drug Characteristics: Rabeprazole
Medication Safety Issues: Rabeprazole
Drug Interactions: Rabeprazole
Adverse Reactions: Rabeprazole
Efficacy Monitoring Parameters. Resolution of GI discomfort, resolution of ulcers shown on endoscopy; for treatment of H pylori, negative urea breath test.
Toxicity Monitoring Parameters. Severe headache or blistering skin rash.
Key Patient Counseling Points. Should be taken 1 h before meals.
Clinical Pearls. Multiple H pylori regimens exist that include different combinations of PPIs and antibiotics; patients should complete full regimen if prescribed for H pylori management. Many PPI and H2 antagonists available OTC; warn patients not to take multiple products concurrently to avoid additive risk of adverse effects. Possible risk of osteoporosis. Use for shortest period of time and avoid use in those at risk for osteoporosis if possible. Aciphex sprinkle formulation approved in March 2013.