Overview
Rabeprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion by irreversibly inhibiting the H+/K+ ATPase enzyme system in gastric parietal cells. It is used for healing and maintenance of erosive GERD, duodenal ulcers, symptomatic GERD, H. pylori eradication, and pathological hypersecretory conditions. Clinical effects begin within one hour and provide sustained acid suppression despite a short plasma half-life.
Mechanism of Action
Rabeprazole is a substituted benzimidazole that acts as a proton pump inhibitor. It suppresses gastric acid secretion by specifically inhibiting the H+/K+ ATPase enzyme system at the secretory surface of gastric parietal cells, leading to irreversible inhibition of acid production.
Indications
- Healing of erosive or ulcerative gastroesophageal reflux disease (GERD)
- Maintenance of healing of erosive GERD
- Symptomatic GERD
- Healing of duodenal ulcers
- Eradication of H. pylori to reduce risk of duodenal ulcer recurrence (in combination with amoxicillin and clarithromycin)
- Pathological hypersecretory conditions including Zollinger-Ellison syndrome
Common Doses
- 20 mg
- 40 mg
Dosage
Adults: Typically 20 mg once daily for GERD (4-8 weeks for healing, maintenance as needed), duodenal ulcers (20 mg once daily after morning meal for up to 4 weeks), and symptomatic GERD (up to 4 weeks). For H. pylori eradication: 20 mg rabeprazole plus 1,000 mg amoxicillin and 500 mg clarithromycin twice daily with meals for 7 days. For Zollinger-Ellison syndrome: Starting dose 60 mg once daily, adjusted to patient needs (up to 100 mg once daily or 60 mg twice daily). Adolescents 12+ years: 20 mg once daily for symptomatic GERD up to 8 weeks.
Contraindications
- Known hypersensitivity to rabeprazole, substituted benzimidazoles, or any component of the formulation
- Concomitant use with rilpivirine-containing products
- Hypersensitivity to clarithromycin or amoxicillin when used in combination therapy
Side Effects
- Headache
- Diarrhea
- Nausea
- Abdominal pain
- Flatulence
- Constipation
- Dry mouth
- Dizziness
- Rash
- Increased liver enzymes
- Acute tubulointerstitial nephritis
- Clostridium difficile-associated diarrhea
- Bone fracture risk
- Hypomagnesemia
- Vitamin B12 deficiency
Interactions
- Rilpivirine: Contraindicated (decreased antiretroviral exposure)
- Atazanavir: Avoid concomitant use (decreased exposure)
- Warfarin: Monitor INR/prothrombin time (increased bleeding risk)
- Methotrexate: May increase serum levels (risk of toxicity)
- Digoxin: Monitor concentrations (increased exposure)
- Drugs dependent on gastric pH: Reduced absorption (iron salts, ketoconazole, itraconazole, erlotinib, dasatinib, nilotinib)
- Mycophenolate mofetil: Reduced exposure to active metabolite
- Tacrolimus: Increased exposure, especially in CYP2C19 poor metabolizers
Counseling Points
- Swallow tablets whole; do not chew, crush, or split
- Take as directed, usually once daily
- For duodenal ulcers, take after morning meal
- For H. pylori eradication, take all medications with morning and evening meals
- Report severe diarrhea, abdominal pain, or signs of kidney problems
- Long-term use may require monitoring of magnesium and vitamin B12 levels
- Inform healthcare provider of all medications being taken