Hyperacidity, GERD, and ulcers:
Indications for ACIPHEX:
Triple therapy (w. amoxicillin + clarithromycin) for H. pylori eradication in duodenal ulcer disease. Short-term treatment of erosive or ulcerative gastroesophageal reflux disease (GERD) or duodenal ulcers. Short-term treatment of symptomatic GERD in patients ≥12yrs of age. Maintenance of healing and reduction in relapse rates of heartburn symptoms in erosive or ulcerative GERD. Long-term treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome). Treatment of GERD in pediatric patients 1–11yrs of age.
Swallow tabs whole. ≥18yrs: Triple therapy: rabeprazole 20mg + amoxicillin 1g + clarithromycin 500mg, all twice daily (w. AM and PM meals) for 7 days. GERD healing: 20mg once daily for 4–8 weeks; may repeat for 8 more weeks. GERD symptoms: 20mg once daily for 4 weeks; may repeat for 4 more weeks. GERD maintenance: 20mg once daily. Duodenal ulcer healing: 20mg once daily after breakfast for up to 4 weeks. Hypersecretory conditions: initially 60mg once daily; titrate; doses up to 100mg once daily or 60mg twice daily have been used.
Sprinkle caps: take 30 mins before meal. Open capsule and sprinkle contents on a small amount of soft food (eg, applesauce, fruit or vegetable based baby food, yogurt) or into a small amount of liquid (eg, infant formula, apple juice, pediatric electrolyte solution). <1yr: not recommended. Treatment of GERD: 1–11yrs (<15kg): 5mg once daily for up to 12 weeks; may increase to 10mg if inadequate response; (≥15kg):10mg once daily for up to 12 weeks. Tabs: swallow whole. Treatment of symptomatic GERD: ≥12yrs: 20mg tab once daily for up to 8 weeks.
Concomitant rilpivirine-containing products.
Symptomatic response does not preclude gastric malignancy. Discontinue and evaluate if acute tubulointerstitial nephritis, cutaneous/systemic lupus erythematosus occurs. Long-term therapy (eg, >3yrs) may lead to malabsorption/deficiency of Vit. B12. Monitor magnesium levels during prolonged therapy. Increased risk of fundic gland polyps with long-term use (esp. >1yr) or osteoporosis-related fractures (hip, wrist or spine) with long-term (>1yr) and multiple daily dose PPI therapy. Use lowest dose for shortest duration appropriate to condition. Severe hepatic impairment: not recommended. Pregnancy. Nursing mothers.
Proton pump inhibitor.
See Contraindications. May antagonize atazanavir, nelfinavir (avoid). May potentiate saquinavir, digoxin, methotrexate (consider temporary withdrawal of the PPI), tacrolimus; monitor. May alter absorption of pH-dependent drugs (eg, iron, erlotinib, dasatinib, nilotinib, mycophenolate mofetil, ketoconazole, itraconazole). Caution with digoxin or drugs that may cause hypomagnesemia (eg, diuretics); monitor. Monitor warfarin. May interfere with neuroendocrine tumor diagnostic tests; discontinue rabeprazole at least 14 days prior to CgA level assessment. Interrupt therapy at least 14 days before secretin stimulation test. May cause false (+) urine screening tests for THC.
Pain, pharyngitis, flatulence, infection, constipation; possible C. difficile-associated diarrhea; rare: hypomagnesemia. Also children: vomiting, abdominal pain, diarrhea, headache, nausea.
Note: See Amoxil entry for more information on amoxicillin. See Biaxin entry for more information on clarithromycin.