Rabeprazole - A review of its use in acid-related gastrointestinal disorders

Rabeprazole is an inhibitor of the gastric proton pump. It causes dose-depe ndent inhibition of acid secretion and has a more rapid onset of action tha n omeprazole. Duodenal ulcers healed faster after treatment with rabeprazole 20 or 40 mg/ day than placebo or ranitidine 150mg 4 times daily and at a generally simil ar rate to omeprazole 20 mg/day in patients with duodenal ulcers; rabeprazo le was similar or superior to these agents in relieving symptoms. Rabeprazo le 20 and 40 mg/day healed gastric ulcers faster than placebo, and rabepraz ole 20 mg/day healed ulcers at a similar healing rate, to omeprazole 20 mg/ day in well controlled Ci-week studies. Gastric ulcer symptom relief with r abeprazole was similar or superior to that provided by omeprazole or placeb o. In 8-week studies in patients with gastrooesophageal reflux disease (GER D), rabeprazole 10, 20 and 40 mg/day were more effective than placebo, rabe prazole 20 mg/day was more effective than ranitidine 150mg twice daily, and rabeprazole 20 mg/day was similar in efficacy to omeprazole 20 mg/day. Sym ptom relief with rabeprazole in X-week trials in patients with GERD was sup erior to that provided by placebo, and similar to ranitidine or omeprazole. Rabeprazole was similar to omeprazole and superior to placebo in both main tenance of healing and prevention of symptoms in patients with healed GERD in 1-year studies. One-week triple therapy with rabeprazole 20mg twice dail y plus 2 antibacterial agents achieved greater than or equal to 90% Helicob acter pylori eradication, but, as would be expected, a regimen of rabeprazo le 20mg twice daily plus 1 antibacterial agent was less successful. The dru g was as effective as omeprazole and lansoprazole as part of triple therapy for H. pylori eradication. Rabeprazole successfully reduced acid output to target levels and prevented further pathological changes in 10 patients with Zollinger-Ellison syndrom e. Usual dosages of rabeprazole are 20 mg/day for 4 weeks to treat duodenal ul cers, 6 weeks for gastric ulcers and 8 weeks for GERD, although some patien ts with duodenal ulcer may respond to a 10 mg/day dosage. For long term mai ntenance of GERD healing, 10 or 20mg daily doses are adequate. Patients wit h hypersecretory states may need individualised dosages starting at 60 mg/d ay. The drug was well tolerated in clinical trials, with headache, rash, in fection, diarrhoea and flu syndrome as the most common adverse events. In conclusion, rabeprazole appears to be a well tolerated proton pump inhib itor with a rapid onset of action and a low potential for drug interactions . The drug may be used to achieve healing and the relief of symptoms of duo denal ulcer, gastric ulcer and GERD, maintain GERD healing, and can form pa rt of effective regimens to eradicate H. pylori.