Drug reference

Rabeprazole sodium

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 109, 110, 111

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Benign gastric ulcer ▶BY MOUTH ▶Adult: 20 mg daily for 8 weeks, dose to be taken in the morning Duodenal ulcer ▶BY MOUTH ▶Adult: 20 mg daily for 4 weeks, dose to be taken in the morning NSAID-associated peptic ulcer disease ▶BY MOUTH ▶Adult: 20 mg once daily for 8 weeks Gastro-oesophageal reflux disease ▶BY MOUTH ▶Adult: 20 mg once daily for 4-8 weeks; maintenance 10–20 mg daily Gastro-oesophageal reflux disease (symptomatic treatment in the absence of oesophagitis) ▶BY MOUTH ▶Adult: 10 mg daily for up to 4 weeks, then 10 mg daily if required Severe oesophagitis ▶BY MOUTH ▶Adult: 20 mg once daily for 8 weeks, continue as maintenance treatment if appropriate Severe oesophagitis, refractory to initial treatment ▶BY MOUTH ▶Adult: 20 mg twice daily Functional dyspepsia ▶BY MOUTH ▶Adult: 10 mg once daily for 4 weeks Uninvestigated dyspepsia ▶BY MOUTH ▶Adult: 20 mg once daily for 4 weeks Zollinger–Ellison syndrome ▶BY MOUTH ▶Adult: Initially 60 mg once daily, adjusted according to response, doses above 100 mg daily given in 2 divided continued → doses; maximum 120 mg per day Helicobacter pylori eradication [in combination with other drugs (see Helicobacter pylori infection p. 89)] ▶BY MOUTH Gastro-intestinal system ▶Adult: 20 mg twice daily for 7 days for ﬁrst- and second-line eradication therapy; 10 days for third-line eradication therapy l UNLICENSED USE Rabeprazole may be used as detailed below, although these situations are considered outside the scope of its licence: . g treatment of NSAID-associated peptic ulcer disease, h see Peptic ulcer disease p. 76 for further information; . g treatment of severe oesophagitis and severe oesophagitis, refractory to initial treatment, h see Gastro-oesophageal reﬂux disease below for further information; . g treatment of functional and uninvestigated dyspepsia, h see Dyspepsia p. 72 for further information. g Combination regimens and durations for Helicobacter pylori eradication may differ from product literature but adhere to national guidelines. h See Helicobacter pylori infection p. 89 for further information.

PDF pages 109, 110

Safety

Interactions

→Appendix 1: proton pump inhibitors

PDF page 110

Side Effects

▶Common or very common Asthenia. cough. increased risk of infection. inﬂuenza like illness. pain ▶Uncommon Burping. dyspepsia. leg cramps. nervousness ▶Rare or very rare Appetite decreased. hepatic encephalopathy. leucocytosis. neutropenia. weight increased ▶Frequency not known Chest pain. chills. fever

PDF page 110

Pregnancy

Manufacturer advises avoid—no information available.

PDF page 110

Breast Feeding

Manufacturer advises avoid—no information available.

PDF page 110

Hepatic Impairment

Manufacturer advises caution in severe impairment (no information available).

PDF page 110

Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Gastro-resistant tablet CAUTIONARY AND ADVISORY LABELS 25 ▶Rabeprazole sodium (Non-proprietary) Rabeprazole sodium 10 mg Rabeprazole 10mg gastro-resistant tablets | 28 tablet P £11.56 DT = £1.40 Rabeprazole sodium 20 mg Rabeprazole 20mg gastro-resistant tablets | 28 tablet P £19.55 DT = £1.70 ▶Pariet (Eisai Ltd) Rabeprazole sodium 10 mg Pariet 10mg gastro-resistant tablets | 28 tablet P £5.78 DT = £1.40 Rabeprazole sodium 20 mg Pariet 20mg gastro-resistant tablets | 28 tablet P £11.34 DT = £1.70 4.3 Gastro-oesophageal reflux disease Gastro-oesophageal reflux disease Description of condition Gastro-oesophageal reﬂux disease (GORD) is usually a chronic condition where there is reﬂux of gastric contents (particularly acid, bile, and pepsin) back into the oesophagus, causing symptoms of heartburn and acid regurgitation. Less common symptoms such as chest pain, hoarseness, cough, wheezing, asthma and dental erosions can also occur if acid reﬂux reaches the oropharynx and/or respiratory tract. GORD can be classiﬁed as non-erosive when a person has symptoms of GORD but the endoscopy is normal or erosive oesophagitis when oesophageal inﬂammation and mucosal erosions are seen at endoscopy. Certain factors may contribute to the risk of developing GORD. These include consumption of trigger and fatty foods, pregnancy, hiatus hernia, family history of GORD, increased intra-gastric pressure from straining and coughing, stress, anxiety, obesity, drug side-effects, smoking and alcohol consumption. Complications of GORD include oesophageal inﬂammation (oesophagitis), ulceration, haemorrhage and stricture formation, anaemia due to chronic blood loss, aspiration pneumonia, and Barrett’s oesophagus. Aims of treatment The aim of treatment is to manage the symptoms of GORD and reduce the risk of recurrence and complications associated with the disease. Non-drug treatment g Lifestyle measures, such as healthy eating, weight loss (if obese), avoiding trigger foods, eating smaller meals, eating the evening meal 3–4 hours before going to bed, raising the head of the bed, Smoking cessation p. 520, and reducing alcohol consumption may improve symptoms. Assess the patient for stress and anxiety as these conditions may exacerbate symptoms. Urgent endoscopic investigation is required for patients with dysphagia, signiﬁcant acute gastrointestinal bleeding, or in those aged 55 years and over with unexplained weight loss and symptoms of upper abdominal pain, reﬂux or dyspepsia. Endoscopy can be considered to diagnose Barrett’s oesophagus if the patient has GORD. Patient preference and individual risk factors should be taken into account. h Drug treatment Initial management g Drugs that may cause or exacerbate the symptoms of GORD, such as alpha-blockers, anticholinergics, benzodiazepines, beta-blockers, bisphosphonates, calcium- channel blockers, corticosteroids, non-steroidal anti- inﬂammatory drugs (NSAIDs), nitrates, theophyllines, and tricyclic antidepressants should be reviewed. The lowest effective dose should be used and if appropriate, stopped. Long term continuous use of antacids is not recommended for the treatment of GORD. Patients with uninvestigated symptoms which suggest GORD should be managed as uninvestigated Dyspepsia p. 72. In patients with an endoscopy conﬁrmed diagnosis of GORD, a proton pump inhibitor (PPI), should be offered for 4 or 8 weeks. h If there is no response to a PPI, then offer a histamine2-receptor antagonist (H2-receptor antagonist). g Severe oesophagitis should be treated with a PPI for 8 weeks, taking into consideration patient preference and factors such as underlying health conditions and possible interactions with other drugs. h Follow up management g For patients with refractory GORD, new alarm symptoms should be assessed and alternate diagnoses considered. Other options include prescribing a further course of the initial PPI dose for 1 month, double the initial PPI dose for 1 month or the addition of a H2-receptor antagonist at bedtime for nocturnal symptoms or for short term use. The patient’s adherence to initial management should also be checked and lifestyle advice reinforced. For patients diagnosed with GORD in whom symptoms recur after initial treatment, a PPI should be given at the lowest dose that can achieve symptom control and self management on an “as-needed” basis should be discussed. If treatment for severe oesophagitis fails, a higher dose of the same PPI should be used or switching to another PPI should be considered taking into account patient preference, tolerability, underlying health conditions and possible interactions with other drugs. For patients with severe oesophagitis that fail to respond to long term maintenance PPI therapy a clinical review and switching to another PPI can be considered and/or specialist advice can be sought. Patients with severe oesophagitis or who have had dilatation of an oesophageal stricture should remain on long-term PPI therapy taking into consideration the factors mentioned above. h GORD in pregnancy g Heartburn and acid reﬂux are symptoms of Dyspepsia p. 72 in pregnancy commonly caused by GORD. Dietary and lifestyle advice should be given as ﬁrst-line management. If this approach fails to control symptoms, an antacid or an alginate can be used. If this is ineffective or symptoms are severe omeprazole p. 85 or ranitidine p. 80 (unlicensed) may help to control symptoms. h Useful Resources Gastro-oesophageal reﬂux disease and dyspepsia in adults: investigation and management. National Institute for Health and Care Excellence. NICE clinical guideline 184. September 2014, updated October 2019. www.nice.org.uk/guidance/cg184 NICE Patient Decision Aid: Option grid to help people make decisions about long term heartburn treatment www.nice.org.uk/about/what-we-do/our-programmes/nice- guidance/nice-guidelines/shared-decision-making Other drugs used for Gastro-oesophageal reflux disease Cimetidine, p. 79. Esomeprazole, p. 83. Famotidine, p. 79. Lansoprazole, p. 84. Nizatidine, p. 80. Pantoprazole, p. 86. Rabeprazole sodium, p. 87 ANTACIDS › ALGINATE

PDF pages 110, 111

Dose text by age group

Adult

20 mg daily for 8 weeks, dose to be taken in the

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

20 mg daily for 4 weeks, dose to be taken in the

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

20 mg once daily for 8 weeks

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

20 mg once daily for 4-8 weeks; maintenance

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

10 mg daily for up to 4 weeks, then 10 mg daily if

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

20 mg once daily for 8 weeks, continue as

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

20 mg twice daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

10 mg once daily for 4 weeks

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

20 mg once daily for 4 weeks

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

Initially 60 mg once daily, adjusted according to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

20 mg twice daily for 7 days for ﬁrst- and

First-line fragment. Read the complete Indications and Dose section above.

PDF page 110

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Rabeprazole sodium

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 109, 110, 111

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF pages 109, 110

Safety

Interactions

→Appendix 1: proton pump inhibitors

PDF page 110

Side Effects

PDF page 110

Pregnancy

Manufacturer advises avoid—no information available.

PDF page 110

Breast Feeding

Manufacturer advises avoid—no information available.

PDF page 110

Hepatic Impairment

Manufacturer advises caution in severe impairment (no information available).

PDF page 110

Dose and formulations

Medicinal Forms

PDF pages 110, 111

Dose text by age group

Adult

20 mg daily for 8 weeks, dose to be taken in the

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

20 mg daily for 4 weeks, dose to be taken in the

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

20 mg once daily for 8 weeks

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

20 mg once daily for 4-8 weeks; maintenance

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

10 mg daily for up to 4 weeks, then 10 mg daily if

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

20 mg once daily for 8 weeks, continue as

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

20 mg twice daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

10 mg once daily for 4 weeks

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

20 mg once daily for 4 weeks

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

Initially 60 mg once daily, adjusted according to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 109

Adult

20 mg twice daily for 7 days for ﬁrst- and

First-line fragment. Read the complete Indications and Dose section above.

PDF page 110

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.