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rabeprazole sodium

(rah beh' pray zol)


Aciphex

Pregnancy Category B

Drug classes
Antisecretory agent
Proton pump inhibitor

Therapeutic actions
Gastric acid-pump inhibitor: Suppresses gastric acid secretion by specific inhibition of
the hydrogen and potassium ATPase enzyme system at the secretory surface of the gastric
parietal cells; blocks the final step of acid production.

Indications
• Healing and maintenance of erosive or ulcerative gastric esophageal reflux
disease (GERD; 4–8 wk therapy; may use additional 8 wk as necessary)
• Treatment of daytime and nighttime heartburn and other symptoms of GERD
• Maintenance of healing of erosive or ulcerative GERD and reduction of relapse
rates
• Healing of duodenal ulcers as short-term treatment < 4 wk
• Treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison
syndrome, multiple adenomas, systemic mastocytosis)
• Eradication of Helicobacter pylori infection when used in combination with
amoxicillin and clarithromycin

Contraindications and cautions


• Contraindicated with hypersensitivity to any proton pump inhibitor or any drug
components.
• Use cautiously with pregnancy, lactation.

Available forms
DR tablet—20 mg

Dosages
ADULTS
• Healing of GERD: 20 mg PO daily for 4–8 wk.
• Maintenance of GERD: 20 mg daily PO.
• Healing of duodenal ulcer: 20 mg PO daily for up to 4 wk.
• Pathological hypersecretory conditions: 60 mg PO daily to bid for as long as
clinically indicated.
• Eradication of H. pylori infection: Rabeprazole 20 mg PO bid for 7 days with
amoxicillin 1,000 mg PO bid for 7 days and clarithromycin 500 mg PO bid for 7
days; take all three drugs twice a day, with the morning and evening meals.
PEDIATRIC PATIENTS < 18 YR
Safety and efficacy not established.
PATIENTS WITH HEPATIC IMPAIRMENT
Use extreme caution with severe hepatic dysfunction.

Pharmacokinetics
Route Onset Peak
Oral l hr 3–5 hr

Metabolism: Hepatic; T1/2: 1.5 hr


Distribution: Crosses placenta; may enter breast milk
Excretion: Urine and feces

Adverse effects
• CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety,
paresthesias, dream abnormalities
• Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin
• GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue
atrophy
• Respiratory: URI symptoms, cough, epistaxis
• Other: Cancer in preclinical studies, back pain, fever

Interactions
Drug-drug
• Increased serum levels and potential increase in toxicity of benzodiazepines
when taken concurrently
• Risk of hypoglycemia if combined with gemfibrozil; use caution if this
combination is used and monitor patient closely
• Risk of severe hypoglycemia if combined with gemfibrozil and itraconazole;
avoid this combination

Nursing considerations
Assessment
• History: Hypersensitivity to any proton pump inhibitor or any drug components;
pregnancy; lactation
• Physical: Skin lesions; body T; reflexes, affect; urinary output, abdominal exam;
respiratory auscultation

Interventions
• Administer once a day. Caution patient to swallow tablets whole, not to cut, chew,
or crush them.
• Symptomatic improvement does not rule out gastric cancer.
• If administering antacids, they may be administered concomitantly with
rabeprazole.
• Maintain supportive treatment as appropriate for underlying problem.
• Provide additional comfort measures to alleviate discomfort from GI effects or
headache.

Teaching points
• Take the drug once a day. Swallow the tablets whole—do not chew, cut, or crush
them. This drug will need to be taken for up to 4 wk (short-term therapy) or for a
prolonged period depending on the condition being treated.
• Arrange to have regular medical follow-up care while you are using this drug.
• Maintain all of the usual activities and restrictions that apply to your condition. If
this becomes difficult, consult with your nurse or physician.
• These side effects may occur: Dizziness (avoid driving a car or performing
hazardous tasks); headache (consult with your nurse if these become bothersome;
medications may be available to help); nausea, vomiting, diarrhea (proper
nutrition is important, consult with your dietitian to maintain nutrition; ensure
ready access to bathroom facilities); symptoms of upper respiratory tract
infection, cough (it may help to know that this is a drug effect, do not self-
medicate, consult with your health care provider if this becomes uncomfortable).
• Report severe headache, worsening of symptoms, fever, chills.

Adverse effects in Italic are most common; those in Bold are life-threatening.