rabeprazole, Aciphex (cont.)

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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).



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