Rabeprazole dosing

Comparable daily doses of PPIs are omeprazole 20 mg = esomeprazole 20 mg = lansoprazole 30 mg = rabeprazole 20 mg = pantoprazole 40 mg. The PPIs degrade in acidic environments and are therefore formulated in delayed-release capsules or tablets.16 Lansoprazole, esomeprazole, and omeprazole contain enteric-coated (pH-sensitive) granules in a capsule form. For patients unable to swallow the capsule or in pediatric patients, the contents of the capsule can be mixed in applesauce or placed in orange juice. If a patient has a nasogastric tube, the contents of an omeprazole capsule can be... 

Most patients require standard doses to prevent relapses. H2RAs may be an effective maintenance therapy in patients with mild disease. The PPIs are the drugs of choice for maintenance treatment of moderate to severe esophagitis. Usual once-daily doses are omeprazole 20 mg, lansoprazole 30 mg, rabeprazole 20 mg, or esomeprazole 20 mg. Lower doses of a PPI or alternate-day regimens may be effective in some patients with less severe disease. 

Shimatani, T., Inoue, M., Kuroiwa, T., et al. (2006) Acid-suppressive effects of rabeprazole, omeprazole, and lansoprazole at reduced and standard doses a crossover comparative study in homozygous extensive metabolizers of cytochrome P450 2C19. Clin. Pharmacol. Ther. 79, 144-152. 

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... 

PHENYTOIN PROTON PUMP INHIBITORS Possible t efficacy and adverse effects of phenytoin Unclear possible altered metabolism via CYP2C19 1 dose may be required. Use the proton pump inhibitor regularly, not PRN monitor phenytoin levels when starting or stopping treatment. Patients have received omeprazole for 3 weeks without altered phenytoin levels. Effect not reported with pantoprazole or rabeprazole... 

ANTICOAGULANTS-ORAL PROTON PUMP INHIBITORS Possibly t anticoagulant effect when esomeprazole, lansoprazole or omeprazole is added to warfarin Uncertain at present. Omeprazole and lansoprazole are known to induce CYP1A2, which plays a role in activation of coumarins Monitor INR more closely. 1 dose may be required. If 10%, 20% or 30% over range, omit dose for 1, 2 or 3 days respectively consider i maintenance dose by 10%. Regular dosing of a proton pump inhibitor is preferable if affects INR significantly. Not reported with pantoprazole or rabeprazole... 

RIFAMPICIN H2 RECEPTOR BLOCKERS -CIMETIDINE 1 efficacy of cimetidine t metabolism Change to alternative acid suppression, e.g. rabeprazole, or t dose and/or frequency... 

Omeprazole carries a higher risk for interactions as it has a high affinity for CYP2C19 and a somewhat lower affinity for CYP3A4. Pantoprazole (which is further metabolized by non-saturable phase II reactions after initial metabolism by CYP isoenzymes) has a lower potential for interaction associated with CYP450 inhibition, It is also likely that, despite the limited information, esomeprazole, lansoprazole and rabeprazole also have weaker potential for interaction compared with omeprazole. Pantoprazole has been reported to be used without dose adjustments in critical care patients with organ dysfunction. 

Holtmann G, Bytzer P, Metz M, Loeffler V, Blum AL. A randomized, double-blind, comparative study of standard-dose rabeprazole and high-dose omeprazole in gastro-oesophageal reflux disease. Aliment Pharmacol Ther... 

Williams MP, Blanshard C, MiUson C, Sercombe J, Pounder RE. A placebo-controlled study to assess the effects of 7-day dosing with 10, 20 and 40 mg rabeprazole on 24-h intragastric acidity and plasma gastrin in healthy male subjects. Aliment Pharmacol Ther 2000 14(6) 691-9. 

Rabeprazole 10, 20,30, and 40 mg, dose-dependent inhibition of acid secretion (223) 20 mg in conjunction with antibiotic eradication rates omeprazole, 69% rabeprazole, 84% (224) 52% (224) 1 (143) 95-98% (143) Renal, -90% (224) Hepatic hydmxylation through CYP2C19 and CnfP3A4 (143)... 

Rabeprazole appears to have a faster onset of action after the first dose and maintains the gastric pH >4 for a higher percentage of time during a 24-hour period as compared with omeprazole (45% vs... 

The percentage of time the gastric pH values remained above 4 by day 8 was 60.3% and 50.4%, respectively. However, this was only significant on the first day of therapy." Another smdy showed rabeprazole 20 mg and 40 mg increased mean gastric pH to 4.2 and 4.7, respectively. The percentage of time the esophageal pH was <4 was decreased and fewer reflux episodes were noted with both doses." ... 

The PPIs (omeprazole, esomeprazole, lansoprazole, rabeprazole, and pantoprazole) dose-dependently inhibit basal and stimulated gastric acid secretion. When PPI therapy is initiated, the degree of acid suppression increases over the first 3 to 4 days of therapy, as more and more proton pumps are inhibited. Upon discontinuation of therapy, full restoration of acid secretion takes 3 to 5 days. Because PPIs inhibit only those proton pumps that are actively secreting acid, they are most effective when taken 15 to 30 minutes before meals. ... 

Prilosec, Rapinex, Zegerid) and its S-isomer, esomeprazole (Nexium), lansoprazole (Prevacid), rabeprazole (Aciphex), and pantoprazole (Protonix). These drugs have different substitutions on their pyridine and/or benzimidazole groups but are remarkably similar in their pharmacological properties. Omeprazole is a racemic mixture of R- and S-isomers the S-isomer, esomeprazole (S-omeprazole), is eliminated less rapidly than R-omeprazole, which theoretically provides a therapeutic advantage because of the increased half-life. Despite claims to the contrary, all proton-pump inhibitors have equivalent efficacy at comparable doses. 

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