RABEprazole

General

**BEERS Drug**

Genetic Implications: Genetic Implications

Pronunciation:
ra-bep-ra-zole


Trade Name(s)

  • Aciphex
  • Aciphex Sprinkle
  • Pariet Canadian Tradename

Ther. Class.
antiulcer agents

Pharm. Class.
proton pump inhibitors

Indications

  • Gastroesophageal reflux disease (GERD).
  • Duodenal ulcers (including combination therapy with clarithromycin and amoxicillin to eradicate Helicobacter pylori and prevent recurrence).
  • Pathological hypersecretory conditions, including Zollinger-Ellison syndrome.

Action

Binds to an enzyme in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen.

Therapeutic Effect(s):

  • Diminished accumulation of acid in the gastric lumen, with lessened acid reflux.
  • Healing of duodenal ulcers and esophagitis.
  • Decreased acid secretion in hypersecretory conditions.

Pharmacokinetics

Absorption: Delayed-release tablet is designed to allow rabeprazole, which is not stable in gastric acid, to pass through the stomach intact. Subsequently 52% is absorbed after oral administration.

Distribution: Unknown.

Protein Binding: 96.3%.

Metabolism and Excretion: Mostly metabolized by the CYP3A4 and CYP2C19 isoenzymes in the liver; Genetic implication (the CYP2C19 enzyme system exhibits genetic polymorphism; 15–20% of Asian patients and 3–5% of Caucasian and Black patients may be poor metabolizers and may have significantly ↑ rabeprazole concentrations and an ↑ risk of adverse effects); 10% excreted in feces; remainder excreted in urine as inactive metabolites.

Half-life: 1–2 hr.

TIME/ACTION PROFILE (acid suppression)

ROUTEONSETPEAKDURATION
POwithin 1 hrunknown24 hr†
†Suppression continues to increase over the first wk of therapy.

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity to rabeprazole or related drugs (benzimidazoles);
  • Concurrent use of rilpivirine.

Use Cautiously in:

  • Severe hepatic impairment (dose reduction may be necessary);
  • Patients using high-doses for >1 yr (↑ risk of hip, wrist, or spine fractures and fundic gland polyps);
  • Patients using therapy for >3 yr (↑ risk of vitamin B12  deficiency;
  • OB:  Safety not established in pregnancy;
  • Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant
  • Pedi:  Children <12 yr (safety and effectiveness not established).

Adverse Reactions/Side Effects

Derm: cutaneous lupus erythematosus, photosensitivity, rash

F and E: hypomagnesemia (especially if treatment duration ≥3 mo)

GI: CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), abdominal pain, constipation, diarrhea, fundic gland polyps, nausea

GU: acute tubulointerstitial nephritis

Hemat: vitamin B12  deficiency

MS: bone fracture, neck pain

Neuro: dizziness, headache, malaise

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS, ANGIOEDEMA, OR TUBULOINTERSTITIAL NEPHRITIS), chills, fever, systemic lupus erythematosus

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

Route/Dosage

Gastroesophageal Reflux Disease

PO (Adults): Healing of erosive or ulcerative GERD– 20 mg once daily for 4–8 wk;  Maintenance of healing of erosive or ulcerative GERD– 20 mg once daily;  Symptomatic GERD– 20 mg once daily for 4 wk (additional 4 wk may be considered for nonresponders).

PO (Children ≥12 yr): Short-term treatment of symptomatic GERD– 20 mg once daily for up to 8 wk.

PO (Children 1–11 yr): ≥15 kg– 10 mg once daily for up to 12 wk (given as sprinkle);  <15 kg– 5 mg once daily for up to 12 wk (given as sprinkle); may ↑ up to 10 mg once daily if inadequate response.

Duodenal Ulcers

PO (Adults): Healing of duodenal ulcers– 20 mg once daily for up to 4 wk.

H. pylori Eradication to Reduce the Risk of Duodenal Ulcer Recurrence (Triple Therapy)

PO (Adults): 20 mg twice daily for 7 days, with amoxicillin 1000 mg twice daily for 7 days and clarithromycin 500 mg twice daily for 7 days.

Pathological Hypersecretory Conditions Including Zollinger-Ellison Syndrome

PO (Adults): 60 mg once daily initially, may be adjusted as needed and continued as necessary; doses up to 100 mg daily or 60 mg twice daily have been used.

Availability (generic available)

Delayed-release capsules (sprinkle): 10 mg

Delayed-release tablets: 10 mg Canadian Tradename, 20 mg

Assessment

  • Assess routinely for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of Clostridioides difficile-associated diarrhea (CDAD). May begin up to several wk following cessation of therapy.

Lab Test Considerations:

Monitor CBC with differential periodically during therapy.

  • May cause hypomagnesemia. Monitor serum magnesium prior to and periodically during therapy.

Implementation

  • High Alert: Do not confuse rabeprazole with aripiprazole. Do not confuse Aciphex with Accupril or Aricept.
  • PO 

    Administer doses before meals, preferably in the morning. Tablets should be swallowed whole; do not break, crush, or chew.

    • Capsules may be opened and sprinkled on a small amount of soft food (apple sauce, fruit, or vegetable-based baby food, yogurt) or empty contents into small amount of liquid (infant formula, apple juice, pediatric electrolyte solution). Food or liquid should be at or below room temperature. Whole dose should be taken within 15 min of being sprinkled. Granules should not be chewed or crushed. Dose should be taken 30 min before a meal. Do not store mixture for future use.

Patient/Family Teaching

  • Instruct patient to take medication as directed for the full course of therapy, even if feeling better. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses.
  • May cause occasional drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation.
  • Caution patients to wear sunscreen and protective clothing to prevent photosensitivity reactions.
  • Advise patient to report onset of black, tarry stools; diarrhea; abdominal pain; or persistent headache to health care professional promptly.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
  • Instruct patient to notify health care professional of onset of black, tarry stools; diarrhea; abdominal pain; or persistent headache or if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
  • Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

  • Decrease in abdominal pain or prevention of gastric irritation and bleeding. Healing of duodenal ulcers can be seen on x-ray examination or endoscopy.
  • Decrease in symptoms of GERD. Therapy is continued for 4–8 wk after initial episode.
RABEprazole is a sample topic from the Davis's Drug Guide.

To view other topics, please or .

Davis’s Drug Guide for Nurses App + Web from F.A. Davis and Unbound Medicine covers 5000+ trade name and generic drugs. Includes App for iPhone, iPad, and Android smartphone + tablet. Handbook covers dosage, side effects, interactions, uses. Davis Drug Guide PDF. .