Rabeprazole
ACIPHEX
What it isProton pump inhibitor; GERD and ulcer disease.
Why this oneThe least CYP2C19-dependent PPI, so genotype affects it least.
What limits itThe same long-term class costs: B12, magnesium, fracture and enteric infection.
FDA-approved for
- GERD (1999)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Healing of erosive/ulcerative GERD | Adults | 20 mg QD | 20 mg QD x4-8 wk | |
| Maintenance of healing of erosive/ulcerative GERD | Adults | 20 mg QD | 20 mg QD | |
| Symptomatic GERD | Adults | 20 mg QD | 20 mg QD up to 4 wk | |
| Healing of duodenal ulcers | Adults | 20 mg QD after the morning meal | 20 mg QD up to 4 wk | |
| H. pylori eradication (with amoxicillin 1000 mg + clarithromycin 500 mg) | Adults | 20 mg BID with meals x7 days | 20 mg BID x7 days | |
| Pathological hypersecretory conditions (incl. Zollinger-Ellison) | Adults | 60 mg QD | adjust to need; up to 100 mg QD or 60 mg BID | |
| Symptomatic GERD | Adolescents >=12 y | 20 mg QD | 20 mg QD up to 8 wk |
Renal Undefined
Hepatic Undefined
Instructions
- Swallow whole; do not chew, crush, or split
- For duodenal ulcers, take after the morning meal
- Not recommended for children 1 to <12 y (20 mg tablet exceeds recommended dose); use another rabeprazole formulation
Contraindications
- Concomitant use with rilpivirine-containing products
Cautions
- Symptomatic response does not preclude gastric malignancy
- Increased INR/PT with warfarin
- Acute tubulointerstitial nephritis
- C. difficile-associated diarrhea
- Bone fracture with long-term/high-dose use
- Severe cutaneous adverse reactions
- Cutaneous/systemic lupus erythematosus
- Vitamin B-12 deficiency with long-term use
- Hypomagnesemia
- Elevated methotrexate levels with concomitant use
- Fundic gland polyps
Adverse reactions
- Adults (>2%): pain, pharyngitis, flatulence, infection, constipation
- Adolescents (>=2%): headache, diarrhea, nausea, vomiting, abdominal pain
Pregnancy No human data; animal studies showed no adverse developmental effects at exposures well above the human dose.
Lactation Undefined
NO BOXED WARNINGS
Principal riskLong-term use: B12 deficiency, hypomagnesemia, fracture
Cost, est. cash$5–$150/month
Generic entry2013
Classes and tags
Clinical profile
Legacy pregnancy categoryB
Defining liabilityLong-term infection, magnesium/B12 and bone risks; selected agents have clinically important CYP interactions.
Mechanism of action: Rabeprazole ballicule
