BMA Concise Guide to Medicine & Drugs

Rabeprazole

Brand name Pariet

Used in the following combined preparations None

QUICK REFERENCE

Drug group Anti-ulcer drug

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Rabeprazole belongs to a class of anti-ulcer drugs known as proton pump inhibitors. Because the drug inhibits the secretion of gastric acid, it is used to treat gastro-oesophageal reflux disease (GORD), also called heartburn, and to help prevent it from recurring. It may also be used in the treatment of Zollinger-Ellison syndrome (a condition in which the stomach produces extremely large amounts of acid).

Rabeprazole may also be used to treat active duodenal and peptic ulcers by protecting them from the action of stomach acid, allowing them to heal. The drug is also used in combination with antibiotics to eradicate the Helicobacter pylori bacterium in patients with peptic ulcer disease. Rabeprazole is also occasionally prescribed to people who experience the gastrointestinal adverse effects associated with non-steroidal anti-inflammatory drugs (NSAIDs) but need to continue NSAID treatment.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets.

Frequency and timing of doses Once daily, generally in the morning, before food. Swallow whole; do not crush or chew.

Adult dosage range 10–20mg. Zollinger-Ellison syndrome 60–120mg.

Onset of effect 2–3 hours. Pain should improve in 2–3 days.

Duration of action Up to 48 hours.

Diet advice None, although spicy foods and alcohol may exacerbate the condition being treated.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember, then return to your normal dosing schedule. Do not take an extra dose to make up.

Stopping the drug The drug can be safely stopped as soon as you no longer need it.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. However, if you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Most common adverse effects of rabeprazole are mild and usually clear up without the need to discontinue treatment. They include headache, diarrhoea, abdominal pain, flatulence, and insomnia. Discuss with your doctor if they are severe or if you develop a cough, bronchitis, or sinusitis. Long-term use of rabeprazole increases the risk of intestinal infections and, in women, hip fractures (see Prolonged use).

INTERACTIONS

Itraconazole and ketoconazole Rabeprazole reduces the effects of these drugs.

Digoxin Rabeprazole may increase the effects of digoxin.

Clopidogrel The antiplatelet effect of clopidogrel is reduced by rabeprazole.

Warfarin Rabeprazole increases the anticoagulant effect of warfarin.

Atazanavir Rabeprazole can reduce the blood levels of atazanavir, and the two drugs should not be used together.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You are allergic to other proton pump inhibitors.

· You think you might be pregnant or are breast-feeding.

· You have a history of liver disease.

· You are taking other medicines.

Pregnancy Not prescribed. Safety not established.

Breast-feeding Not recommended. It is not known whether the drug passes into the breast milk. Discuss with your doctor.

Infants and children Not recommended.

Over 60 No special problems.

Driving and hazardous work Do not undertake such activities until you have learned how rabeprazole affects you because the drug can cause drowsiness.

Alcohol Avoid. Alcohol irritates the stomach, which can lead to ulceration and acid reflux.

PROLONGED USE

Long-term use of rabeprazole may increase the risk of certain intestinal infections (such as Salmonella and Clostridium difficile infections) because of the loss of the natural protection against such infections provided by stomach acid. Prolonged use also increases the risk of hip fractures in women.