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(ra-BE-pray-zole)
Aciphex
Tablets, delayed-release: 20 mg
Class: Gastrointestinal, Proton Pump Inhibitor

 Action Suppresses gastric acid secretion by blocking “acid (proton) pump” within gastric parietal cells.

 Indications Short-term treatment in healing and symptomatic relief of duodenal ulcers and erosive or ulcerative gastroesophageal reflux disease (GERD); maintaining healing and reducing relapse rates of heartburn symptoms in patients with GERD; treatment of daytime and nighttime heartburn and other symptoms associated with GERD; long-term treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome in combination with amoxicillin and clarithromycin to eradicate H. pylori .

 Contraindications Known hypersensitivity to substituted benzimidazoles.

 Route/Dosage

Treatment of Erosive or Ulcerative GERD

Adults: PO 20 mg/day for 4 to 8 wk, an additional 8 wk may be considered for patients who do not heal.

Maintenance of Erosive or Ulcerative GERD

Adults: PO 20 mg/day.

Healing of Duodenal Ulcers

Adults: PO 20 mg/day after the morning meal for 4 wk, additional therapy may be required for some patients.

Treatment of Pathological Hypersecretory Conditions

Adults: PO 60 mg/day. Doses up to 100 mg qd or 60 mg bid have been administered.

H. Pylori Eradication to Reduce Risk of Duodenal Ulcer Recurrence

Adults: PO 20 mg rabeprazole plus amoxicillin 1000 mg plus clarithromycin 500 mg bid for 7 days with morning and evening meals.

 Interactions

Drugs dependent on gastric pH for absorption (eg, digoxin, ketoconazole): Plasma levels of digoxin may be increased, while ketoconazole concentrations may be decreased.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Hypertension; MI; ECG abnormalities; migraine; syncope; angina pectoris; bundle branch block; palpitation; sinus bradycardia; tachycardia. CNS: Headache; insomnia; anxiety; dizziness; depression; nervousness; somnolence; hypertonia; neuralgia; vertigo; convulsion; extrapyramidal syndrome; hyperkinesias. DERMATOLOGIC: Rash; pruritus; sweating; urticaria; alopecia. EENT: Cataract; amblyopia; glaucoma; dry eyes; abnormal vision; tinnitus; otitis media. GI: Diarrhea; nausea; abdominal pain; vomiting; dyspepsia; flatulence; constipation; dry mouth; eructation; gastroenteritis; rectal hemorrhage; melena; anorexia; mouth ulceration; stomatitis; dysphagia; gingivitis; increased appetite; abnormal stools; proctitis; colitis; esophagitis; glossitis; pancreatitis; cholelithiasis; cholecystitis. GU: Cystitis; urinary frequency; dysmenorrhea; dysuria; kidney calculus; metrorrhagia; polyuria. HEMATOLOGIC: Anemia; ecchymosis; lymphadenopathy; hypochromic anemia. METABOLIC: Hyperthyroidism; hypothyroidism; peripheral edema; edema; weight gain/loss; gout; dehydration. RESPIRATORY: Dyspnea; asthma; epistaxis; laryngitis; hiccough; hyperventilation. OTHER: Asthenia; fever; allergic reaction; chills; malaise; substernal chest pain; neck rigidity; photosensitivity reaction; myalgia; arthritis; leg cramps; bone pain; arthrosis; bursitis.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy not established. Gastric malignancy: Symptomatic response to rabeprazole does not preclude gastric malignancy.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Give prescribed dose once daily, at least 1 hr before eating.
  • Do not chew, crush, or split. Instruct patient to swallow tablet whole.
  • Store tablets at controlled room temperature. Protect from moisture.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note history of liver disease.
  • Assess for bloody or coffee ground emesis and black tarry stools.
  • Assess for symptoms of esophageal reflux (eg, heart burn, acid regurgitation) or peptic ulcer activity (eg, indigestion, abdominal pain, nausea).
  • Monitor patient for CNS, GI, musculoskeletal, and general body side effects. Report to health care provider if noted and significant.

 Patient/Family Education

  • Explain name, dose, action, and potential side effects of drug.
  • Advise patient to not chew, crush, or split medication; swallow the tablet whole.
  • Remind patient to take each dose at least 1 hr before eating.
  • Inform patients that antacids may be taken concurrently with rabeprazole.
  • Remind patient that rabeprazole is to be taken every day and not “as needed” nor only when symptoms are present.
  • Instruct women to notify health care provider if pregnant, planing to become pregnant, or breastfeeding.
  • Advise patient to report any of the following events: bloody or coffee ground emesis, black tarry stools, recurrent heart burn, recurrent indigestion or abdominal pain, increasing need for antacid use.

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