Proton pump inhibitor (PPI)
Updated · Methodology
First line
First-line for GERD per 2022 and the Spanish AEG 2024. Dose 20 mg once daily for 4–8 weeks. Compared with omeprazole, more convenient in patients on clopidogrel and CYP2C19 rapid metabolizers. Efficacy across PPIs is comparable per the 2019 Cochrane meta-analysis.
Sources
ICD-10: K21 · ICD-11: DA22
First line
First-line for gastric and duodenal ulcer, including H. pylori eradication (rabeprazole 20 mg twice daily + amoxicillin + clarithromycin or metronidazole for 10–14 days).
Sources
ICD-10: K27 · ICD-11: DA61
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Rabeprazole is prescribed for gastric protection to healthy people without diagnosed GERD or peptic ulcer, including for single NSAID or antibiotic courses. 2022 and 2022 confine PPIs to patients with GI-bleed risk factors. Systematic low-risk-population use increases fracture, hypomagnesemia, B12-deficiency, CDI and acid-rebound risk.
A benzimidazole that covalently binds gastric parietal cell H+/K+-ATPase. Compared with other PPIs, faster onset (1 hour vs 2–3 with omeprazole), stable pharmacokinetics in CYP2C19 slow and rapid metabolizers (metabolized largely non-enzymatically). Fewer clopidogrel interactions than omeprazole.
AEMPS summary of product characteristics (section 4.6): there are no data on the safety of rabeprazole in pregnant women. Reproduction studies in rats and rabbits found no fetal harm from rabeprazole sodium, although low feto-placental transfer occurs in rats. Rabeprazole is contraindicated during pregnancy.
Compatible with breastfeeding.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Verbatim lines from the interaction sections, in the language of the label
«No se recomienda la co-administración de atazanavir con Rabeprazol Tecnigen (ver sección 4.5).»AEMPS, section 4.4 · Open on CIMA
«DRUG INTERACTIONS: Intervention: Rilpivirine-containing products: Concomitant use with Rabeprazole Sodium delayed-release tablets is contraindicated [see Contraindications (4) ] . See prescribing…»FDA, section 7 · Open on DailyMed
«DRUG INTERACTIONS: Intervention: Monitor digoxin concentrations. Dose adjustment of digoxin may be needed to maintain therapeutic drug concentrations. See prescribing information for digoxin.»FDA, section 7 · Open on DailyMed
«Rabeprazol sódico produce una intensa y prolongada inhibición de la secreción de ácido gástrico. Se podría producir una interacción con compuestos cuya absorción depende del pH. La administración…»AEMPS, section 4.5 · Open on CIMA
«Rabeprazol sódico produce una intensa y prolongada inhibición de la secreción de ácido gástrico. Se podría producir una interacción con compuestos cuya absorción depende del pH. La administración…»AEMPS, section 4.5 · Open on CIMA
«DRUG INTERACTIONS: Intervention: A temporary withdrawal of Rabeprazole Sodium delayed-release tablets may be considered in some patients receiving high dose methotrexate administration.»FDA, section 7 · Open on DailyMed
«DRUG INTERACTIONS: Intervention: Mycophenolate mofetil (MMF): Co-administration of PPIs in healthy subjects and in transplant patients receiving MMF has been reported to reduce the exposure to the…»FDA, section 7 · Open on DailyMed
«DRUG INTERACTIONS: Intervention: Monitor tacrolimus whole blood trough concentrations. Dose adjustment of tacrolimus may be needed to maintain therapeutic drug concentrations. See prescribing…»FDA, section 7 · Open on DailyMed
«DRUG INTERACTIONS: Intervention: Monitor INR and prothrombin time. Dose adjustment of warfarin may be needed to maintain target INR range. See prescribing information for warfarin.»FDA, section 7 · Open on DailyMed
«En ensayos clínicos se han administrado antiácidos concomitantemente con Rabeprazol Tecnigen sin que se haya observado interacción alguna con antiácidos líquidos en un ensayo específico de…»AEMPS, section 4.5 · Open on CIMA
«DRUG INTERACTIONS: Drugs Dependent on Gastric pH for Absorption (e.g., iron salts, erlotinib, dasatinib, nilotinib, mycophenolate mofetil, ketoconazole, itraconazole)»FDA, section 7 · Open on DailyMed
«DRUG INTERACTIONS: Drugs Dependent on Gastric pH for Absorption (e.g., iron salts, erlotinib, dasatinib, nilotinib, mycophenolate mofetil, ketoconazole, itraconazole)»FDA, section 7 · Open on DailyMed
«La co-administración de atazanavir 300 mg/AEMPS, section 4.5 · Open on CIMA
«La co-administración de atazanavir 300 mg/AEMPS, section 4.5 · Open on CIMA
«La co-administración de atazanavir 300 mg/AEMPS, section 4.5 · Open on CIMA
«Pharmacokinetic Drug Interactions: Rabeprazole 29% 19%»FDA, section 7 · Open on DailyMed
«Medicamentos para los trans tornos relacionados con la acidez: Antiácidos (aluminio, calcio, magnesio o bicarbonato de sodio), Antagonistas del receptor-H2 (p.ej., cimetidina, ranitidina)…»AEMPS, section 4.5 · Open on CIMA
«Medicamentos metabolizados por el citocromo P450: En las personas que son metabolizadores lentos de CYP2C19, los niveles plasmáticos de sertralina se aumentan aproximadamente en un 50% en comparación…»AEMPS, section 4.5 · Open on CIMA
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Rabeprazole is evaluated for the following indications with varying evidence strength: Gastroesophageal reflux disease (evidence tier A), Peptic ulcer disease (evidence tier A), PPI for NSAID gastric prophylaxis in low-risk patients (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Rabeprazole (≥ 1 in 100): Headache, Diarrhea or constipation, Nausea, Abdominal pain, Flatulence, Skin rash. See the Safety section for uncommon and serious reactions.
AEMPS summary of product characteristics (section 4.6): there are no data on the safety of rabeprazole in pregnant women. Reproduction studies in rats and rabbits found no fetal harm from rabeprazole sodium, although low feto-placental transfer occurs in rats. Rabeprazole is contraindicated during pregnancy.
Compatible with breastfeeding.
Rabeprazole is contraindicated in: Rabeprazole or other PPI hypersensitivity; Concomitant rilpivirine; Pregnancy – with caution. Full list in the Safety section.
Direct links to regulator labels. Open in a new tab.
Slippery elm (inner bark), Sodium alginate, Almagate, Deglycyrrhizinated licorice (DGL), Lansoprazole, Mastic gum, Esomeprazole, Famotidine