rabeprazole sodium

rabeprazole sodium

(rah beh' pray zol)

Aciphex

Pregnancy Category B

Drug classes

Antisecretory drug

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 GERD; 4–8 wk therapy; may use additional 8 wk as needed

·        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

·        Unlabeled use: Treatment of gastric ulcers

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; T_1/2: 1.5 hr

Distribution: Crosses placenta; may enter breast milk

Excretion: Feces, urine

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

·        WARNING: Risk of severe hypoglycemia if combined with gemfibrozil and itraconazole; avoid this combination

·        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

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 examination; respiratory auscultation

Interventions

·        Administer once a day. Caution patient to swallow tablets whole, not to cut, chew, or crush.

·        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 such as from GI effects or headache.

Teaching points

·        Take the drug once a day. Swallow the tablets whole—do not chew, cut, or crush. This drug will need to be taken for up to 4 weeks (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 your health care provider.

·        You may experience these side effects: Dizziness (avoid driving a car or performing hazardous tasks); headache (consult your health care provider if these become bothersome; medications may be available to help); nausea, vomiting, diarrhea (proper nutrition is important, consult a 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.