RABEPRAZOLE

RABEPRAZOLE
(AcipHex®)

DOSING: ADULTS

GERD, erosive/ulcerative: 20 mg once daily for 4-8 weeks; if inadequate response, may repeat up to an additional 8 weeks; maintenance: 20 mg once daily

GERD, symptomatic: 20 mg once daily for 4 weeks; if inadequate response, may repeat for an additional 4 weeks

Duodenal ulcer: 20 mg/day before breakfast for 4 weeks; additional therapy may be required for some patients
H. pylori eradication: 20 mg twice daily for 7 days; to be administered with amoxicillin 1000 mg and clarithromycin 500 mg, also given twice daily for 7 days.

DOSING IN  RENAL IMPAIRMENT — No dosage adjustment required.

DOSING IN  HEPATIC IMPAIRMENT

Mild to moderate: Elimination decreased; no dosage adjustment required.
Severe: Use caution.

DOSAGE FORMS

Tablet, delayed release, enteric coated, as sodium:
AcipHex®: 20 mg

ADMINISTRATION — May be administered with or without food; best if taken before breakfast. Do not crush, split, or chew tablet. May be administered with an antacid.

SIGNIFICANT  ADVERSE REACTIONS

Headache
Diarrhea
Abdominal pain

CONTRAINDICATIONS — Hypersensitivity to rabeprazole, substituted benzimidazoles (ie, esomeprazole, lansoprazole, omeprazole, pantoprazole), or any component of the formulation

DRUG INTERACTIONS

Antifungal agents : Proton pump inhibitors may decrease the absorption and thus the levels/effects of itraconazole and ketoconazole; avoid concomitant use.
Antiretroviral: Proton pump inhibitors may decrease the absorption of atazanavir and Indinavir.
CYP2C8 Substrates: Rabeprazole may increase the levels/effects of CYP2C8 substrates. Example substrates include amiodarone, paclitaxel, pioglitazone, repaglinide, and rosiglitazone.
CYP2C19 inducers: May decrease the levels/effects of rabeprazole. Example inducers include aminoglutethimide, carbamazepine, phenytoin, and rifampin.
CYP2C19 substrates: Rabeprazole may increase the levels/effects of CYP2C19 substrates. Example substrates include citalopram, diazepam, methsuximide, phenytoin, propranolol, and sertraline.
CYP3A4 inducers: CYP3A4 inducers may decrease the levels/effects of rabeprazole. Example inducers include aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins.
HMG-CoA reductase inhibitors: Proton pump inhibitors may increase the serum concentration of HMG-CoA reductase inhibitors; monitor for rhabdomyolysis.
Iron salts : Proton pump inhibitors may decrease the absorption
Methotrexate: Proton pump inhibitors may decrease the excretion of methotrexate; monitor for increased toxic effects

PREGNANCY RISK FACTOR — B

LACTATION — Excretion in breast milk unknown/not recommended.