Pharmacologic class: Proton pump inhibitor
Therapeutic class: Gastric antisecretory agent
Pregnancy risk category B
Reduces gastric acid secretion and increases gastric mucus and bicarbonate production, creating a protective coating on gastric mucosa
Tablets (delayed-release): 20 mg
Indications and dosages
➣ Erosive or ulcerative gastroesophageal reflux disease (GERD)
Adults: 20 mg P.O. daily for 4 to 8 weeks. If healing doesn't occur within 8 weeks, another 8 weeks of therapy may be considered. Maintenance dosage is 20 mg P.O. daily.
Adults: 20 mg P.O. daily for 4 weeks. If symptoms don't resolve after 4 weeks, another course of therapy may be considered.
➣ Short-term treatment of symptomatic GERD
Adolescents ages 12 and older: 20 mg P.O. daily for up to 8 weeks
➣ Hypersecretory conditions, including Zollinger-Ellison syndrome
Adults: Initially, 60 mg P.O. daily; adjust dosage as needed up to 100 mg P.O. daily as a single dose or 60 mg P.O. b.i.d. Maximum daily dosage is 120 mg.
➣ Duodenal ulcer
Adults: 20 mg P.O. daily for up to 4 weeks
➣ Helicobacter pylori eradication
Adults: 20 mg P.O. b.i.d. for 7 days (given with amoxicillin and clarithromycin)
• Benign gastric ulcer
• Hypersensitivity to drug, its components, or benzimidazoles
Use cautiously in:
• severe hepatic impairment
• concurrent use of atazanavir (not recommended)
• pregnant patients
• breastfeeding patients (not recommended)
• children (safety not established).
• Don't crush or split tablets.
• Give without regard to food.
Musculoskeletal: fractures of hip, wrist, spine (with long-term daily use)
Drug-drug. Atazanavir: substantially decreased atazanavir plasma concentration and reduced therapeutic effect Combined administration of rabeprazole, amoxicillin, and clarithromycin: increased rabeprazole and 14-hydroxyclarithromycin plasma concentrations
Gastric pH-dependent drugs (such as digoxin, ketoconazole): increased or decreased absorption
Methotrexate: possibly elevated and prolonged methotrexate serum level
Warfarin: increased risk of bleeding
Drug-diagnostic tests. Magnesium: decreased level
• Stay alert for symptomatic response, but know that a positive response doesn't rule out gastric cancer.
• Monitor magnesium level before starting therapy and periodically thereafter in patients expected to be on prolonged therapy or who take proton pump inhibitors with drugs such as digoxin or drugs that may cause hypomagnesemia (such as diuretics).
• Tell patient he may take with or without food. Instruct him not to crush, chew, or split tablets.
• Caution female patient not to breastfeed during therapy.
• As appropriate, review all significant adverse reactions and interactions, especially those related to the drugs mentioned above.