Rabeprazole Digoxin

Rabeprazole (AcipHex) [Antiulcer Agent/Proton Pump Inhibitor] Uses PUD, GERD, ZE H. pylori Action Proton pump inhibitor Dose 20 mg/d may T to 60 mg/d H. pylori 20 mg PO bid X 7 d (w/ amoxicillin and clarithromycin) do not crush/chew tabs Caution [B, /—] Disp Tabs SE HA, fatigue, GI upset Interactions t Effects OF cyclosporine, digoxin -1- effects OF ketoconazole EMS None OD May cause N, tach, dry mouth, and drowsiness symptomatic and supportive... 

Drug interactions with omeprazole are of particular concern in patients who are considered slow metabolizers, as found in approximately 3% of the Caucasian population. Unfortunately, it is unclear which patients have the polymorphic gene variation that makes them slow metabolizers. Like omeprazole, the metabolism of esomeprazole may also be altered in patients with this polymorphic gene variation. Rabeprazole increases digoxin trough concentrations by approximately 20%. Patients on potentially interacting drugs should be monitored closely for potential problems. 

A small rise in serum digoxin levels may occur with omeprazole, pantoprazole or rabeprazole, but this is not thought to be clinically significant. One case of digoxin toxicity has been reported with omeprazole. 

A preliminary report, giving few details, states that rabeprazole increased the minimum digoxin levels by about 20%, and increased the AUC and maximum level. The US manufacturer states that rabeprazole increased the AUC and maximum level of digoxin by 19%, and 29%, respectively. However, these changes are thought to be within the normal variations of digoxin levels and so are not considered clinically significant. See also Lansoprazole, above. 

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