Home Drug Guide Rabeprazole Sodium

Drug Guide

Generic Name

Rabeprazole Sodium

Brand Names Aciphex, Aciphex Sprinkle

Classification

Therapeutic: Gastroesophageal Reflux Disease (GERD), Zollinger-Ellison Syndrome, erosive esophagitis

Pharmacological: Proton pump inhibitor (PPI)

FDA Approved Indications

Treatment of GERD
Erosive esophagitis
Zollinger-Ellison syndrome

Mechanism of Action

Rabeprazole irreversibly binds to the hydrogen-potassium ATPase enzyme system (the proton pump) in gastric parietal cells, inhibiting gastric acid secretion.

Dosage and Administration

Adult: 20 mg once daily before a meal; dosage may vary based on condition.

Pediatric: Not generally recommended for children under 18 years without specific indication.

Geriatric: Use with caution; adjust dose based on functional renal status.

Renal Impairment: Adjust dose if severe renal impairment.

Hepatic Impairment: No specific adjustment recommended; use caution.

Pharmacokinetics

Absorption: Rapidly absorbed, peak plasma levels in 2-5 hours.

Distribution: Widely distributed; plasma protein binding approximately 97%.

Metabolism: Primarily hepatic, via CYP2C19 and CYP3A4 enzymes.

Excretion: Metabolites excreted mainly in urine and feces.

Half Life: Approximately 1-2 hours.

Contraindications

Hypersensitivity to rabeprazole or other PPIs.

Precautions

Use with caution in patients taking concomitant medications that may increase risk of intestinal infections, osteoporosis, or vitamin B12 deficiency. Long-term use may increase risk of fractures, hypomagnesemia, and clostridium difficile-related diarrhea.

Adverse Reactions - Common

Headache (Common)
Nausea (Common)
Diarrhea (Common)
Abdominal pain (Common)

Adverse Reactions - Serious

Clostridioides difficile-associated diarrhea (Less common)
Severe skin reactions, including Stevens-Johnson syndrome (Rare)
Interstitial nephritis (Rare)

Drug-Drug Interactions

Clopidogrel: May reduce effectiveness; avoid use together or monitor carefully.
Diazepam: Increased sedation potential.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for relief of GERD symptoms, and watch for adverse reactions, especially in long-term therapy.

Diagnoses:

Risk for diarrhea related to altered gastric flora.
Impaired gastrointestinal nutrition related to nausea or abdominal discomfort.

Implementation: Administer before meals, and instruct patients on proper use of sprinkle capsules if indicated.

Evaluation: Assess symptom relief and adverse effects regularly.

Patient/Family Teaching

Take medication as directed, preferably before meals.
Report persistent or severe side effects, including diarrhea or rash.
Do not crush or chew delayed-release capsules.
Maintain adequate calcium and vitamin D intake to prevent osteoporosis.

Special Considerations

Black Box Warnings:

Long-term use may increase risk of fractures, hypomagnesemia, and Clostridioides difficile infection.

Genetic Factors: Cytochrome P450 2C19 polymorphisms may affect metabolism.

Lab Test Interference: Proton pump inhibitors may interfere with serum magnesium, calcium, B12, and gastric pH testing.

Overdose Management

Signs/Symptoms: Nausea, vomiting, dizziness, and abdominal pain.

Treatment: Supportive care, gastric lavage if recent ingestion, and monitoring of electrolytes; no specific antidote.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F); keep in original container.

Stability: Stable for the duration specified on the package.