Some evidence for use of proton-pump inhibitors (e.g., omeprazole) for gastric acid suppressive therapy as an adjunct in the management of upper GI Crohn's disease,† including esophageal, gastroduodenal, and jejunoileal disease.
Administer orally; may give without regard to meals, but manufacturer recommends administration after morning meal in patients with duodenal ulcer.
When used in combination with clarithromycin and amoxicillin for treatment of H. pylori infection and duodenal ulcer disease, take all 3 drugs twice daily with morning and evening meals.
Swallow tablets intact; do not chew, crush, or split.
Antacids may be used concomitantly as needed for pain relief.
Dosage
Available as rabeprazole sodium; dosage expressed in terms of the salt.
Adults
GERD
GERD without Erosive Esophagitis
Oral
20 mg once daily for 4 weeks; may give additional 4 weeks if symptoms are not completely resolved.
Treatment of Erosive Esophagitis
Oral
20 mg once daily for 4–8 weeks. If not healed after 8 weeks, consider additional 8 weeks of therapy (up to 16 weeks for a single course).
Maintenance of Healing of Erosive Esophagitis
Oral
20 mg once daily. Chronic, lifelong therapy may be appropriate.
Duodenal Ulcer
Treatment of Active Duodenal Ulcer
Oral
20 mg once daily for up to 4 weeks; some patients may require additional therapy.
Helicobacter pylori Infection and Duodenal Ulcer Disease
Oral
Triple therapy: 20 mg twice daily for 7 days in conjunction with amoxicillin and clarithromycin.
Pathologic GI Hypersecretory Conditions (e.g., Zollinger-Ellison Syndrome)
Oral
60 mg once daily. Dosages up to 100 mg once daily or 60 mg twice daily have been used. Divided doses may be required. Adjust dosage as needed, continue treatment as long as necessary. Has been used continuously for up to 1 year.
Cautions
Contraindications
Known hypersensitivity to rabeprazole, any ingredient in the formulation, or other substituted benzimidazoles (e.g., esomeprazole, lansoprazole, pantoprazole, omeprazole).
Warnings/Precautions
General Precautions
GI Effects
Response to rabeprazole does not preclude presence of occult gastric neoplasm.
Respiratory Effects
Administration of proton-pump inhibitors has been associated with an increased risk for developing certain infections (e.g., community-acquired pneumonia).
Specific Populations
Pregnancy
Category B.
Lactation
Not known whether rabeprazole is distributed into milk; discontinue nursing or the drug.
Pediatric Use
Safety and efficacy not established in children <18 years of age.
Geriatric Use
No substantial differences in safety or efficacy relative to younger adults, but increased sensitivity cannot be ruled out.
Hepatic Impairment
Use with caution in patients with severe impairment.
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