Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Rabeprazole is an oral drug that is used for
the treatment of conditions caused by acid. It is in a class of drugs called
proton pump inhibitors or PPIs which block the production of acid by the
stomach. Other drugs in the same class include lansoprazole (Prevacid),
omeprazole (Prilosec), pantoprazole (Protonix), esomeprazole (Nexium), and
dexlansoprazole (Dexilant). PPIs are used for the treatment of acid-caused
conditions such as stomach and duodenal ulcers, gastroesophageal reflux disease
(GERD) and Zollinger-Ellison Syndrome. Rabeprazole, like other PPIs, blocks the
pump in the wall of the stomach that secretes acid into the stomach. By blocking
the pump, the secretion of acid into the stomach is decreased, and this allows
ulcers in the stomach and esophagus to heal. The FDA approved rabeprazole in
August 1999.
GENERIC AVAILABLE: Yes
PRESCRIPTION: Yes.
PREPARATIONS: Tablets (Delayed release): 20 mg
STORAGE: Rabeprazole should be stored at room temperature, 15-30 C
(59-86 F) and should be kept away from moisture.
PRESCRIBED FOR: Rabeprazole is used for treating ulcers of the stomach
and duodenum, erosive or ulcerative gastroesophageal reflux disease (GERD) and
Zollinger-Ellison Syndrome (in which there is overproduction of acid caused by
tumors). It also is used with antibiotics for eradicating Helicobacter pylori
infections of the stomach that, along with acid, are responsible for many
ulcers.
DOSING: Tablets should be swallowed whole and should not be crushed,
split or chewed. Rabeprazole can be taken with or without meals since food has
little effect on its absorption.
For healing ulcerating GERD, the recommended dose for adults is 20 mg
daily for 4-8 weeks. If healing does not occur after 8 weeks, another 8 week
course may be considered. The recommended maintenance dose is 20 mg daily.
Heartburn due to GERD is treated with 20 mg daily for 4 weeks and an
additional 4 weeks if symptoms do not resolve.
Ulcers are treated with 20 mg daily for 4 weeks.
For the management of Zollinger-Ellison Syndrome, the starting dose for
adults is 60 mg daily, and the dose is adjusted based on improvement in
symptoms, healing of ulcers, or the effectiveness of acid suppression. Doses
of 100 mg per day and 60 mg twice daily have been used in some patients with
Zollinger-Ellison Syndrome.
The regimen for eradication of Helicobacter pylori is rabeprazole 20 mg,
clarithromycin 500 mg, amoxicillin 1000 mg all given twice daily (morning
and evening) for 7 days.
DRUG INTERACTIONS: There have been reports of an increase in the
effect of the blood thinner, warfarin
(Coumadin), by rabeprazole which theoretically could
lead to increased bleeding. Patients taking warfarin should be monitored more
frequently if they begin taking rabeprazole. Rabeprazole may reduce the
elimination of cyclosporin in the liver, thereby increasing cyclosporin levels
in the blood and potentially leading to cyclosporin toxicity. The absorption of
certain drugs may be affected by changes in stomach acidity. Rabeprazole and
other PPIs that reduce stomach acid reduce the absorption and concentration in
blood of ketoconazole (Nizoral) and increase the absorption and concentration in
blood of digoxin (Lanoxin). This may lead to reduced effectiveness of
ketoconazole or increased digoxin toxicity, respectively. PPIs may decrease
blood levels of atazanavir (Reyataz).
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
A peptic ulcer is an ulcer in the lining of the stomach, duodenum, or esophagus. Ulcer formation is related to Helicobacter pylori bacteria in the stomach, use of anti-inflammatory medications, and cigarette smoking.
Eosinophilic esophagitis is an inflammation of the esophagus. Eosinophilic esophagitis has many causes including acid reflux, heartburn, viruses, medications that become stuck in the esophagus, allergy, asthma, hay fever, allergic rhinitis, and atopic dermatitis. Eosinophilic esophagitis symptoms include difficulty swallowing food, abdominal pain, chest pain, and heartburn.
Gastritis is an inflammation of the stomach lining. Causes of gastritis include drinking too much alcohol, medications such as NSAIDs, ibuprofen, aspirin, H. pylori infection, severe infections, burns, anemia, and autoimmune disorders. Gastritis is diagnosed with endoscopy, blood tests, or stool tests. Treatment depends upon the cause of gastritis.
Barrett's esophagus occurs as a complication of chronic gastroesophageal reflux disease (GERD), primarily in white males. GERD refers to the reflux of acidic fluid from the stomach into the esophagus (the swallowing tube), and is classically associated with heartburn.
Heartburn is a burning sensation experienced from acid reflux (GERD). Symptoms of heartburn include chest pain, burning in the throat, difficulty swallowing, the feeling of food sticking in the throat, and a burning feeling in the chest. Causes of heartburn include dietary habits, lifestyle habits, and medical causes. Treatments for heartburn include lifestyle changes, OTC medication, prescription medication, and surgery.
Acid backing up into the larynx (voice box), it causes reflux laryngitis. Irritation of the lining of the esophagus, larynx, and throat can lead to esophagitis, sinusitis, strictures, hoarseness, throat clearing, swallowing problems, asthma, chronic cough, and more. Typical symptoms of reflux laryngitis include heartburn, hoarseness, or a sensation of a foreign body in the throat. Reflux laryngitis can be treated with OTC medication, prescription medication, and lifestyle changes.
A peptic ulcer is a hole in the gut lining of the stomach,
duodenum, or
esophagus. A peptic ulcer of the stomach is called a gastric
ulcer; of the
duodenum, a duodenal ulcer; and of the esophagus, an esophageal
ulcer. An
ulcer occurs when the lining of these organs is corroded by the
acidic
digestive juices which are secreted by the stomach cells.
Peptic ulcer
disease is common, affecting millions of Americans yearly. The
medical
cost of treating peptic ulcer and its complications runs in the
billions
of dollars annually. Recent medical advances have increased our
understanding of ulcer formation. Improved and expanded
treatment options
are now available.
What are the causes of peptic ulcers?
For many years, excess acid was believed to be the major cause
of ulcer
disease. Accordingly, treatment emphasis was on neutra...
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