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Rabeprazole belongs to the class of medicines called proton pump inhibitors (PPI). PPIs were discovered in 1979 and rabeprazole has been used for over 20 years. PPIs are safe and effective treatments for acid indigestion symptoms, including heartburn and reflux.

Further information: NHS - Rabeprazole.

How does rabeprazole relieve acid reflux/heartburn?

The 'proton pump' is the process which produces digestive acid in the stomach in response to eating a meal. Rabeprazole and other PPIs block the proton pump and so reduce the acidity in the stomach. As there is less acid the symptoms of acid reflux and heartburn are reduced.

How to take rabeprazole

• Take one rabeprazole tablet once a day, in the morning before eating. It is usual to start with a 10mg tablet. If symptoms are not completely controlled increase to either two 10mg tablets or one 20mg tablet in the morning, or take one 10mg tablet twice a day (morning and evening).
• Swallow your tablets whole with a drink of water.
• Do not chew or crush the tablets.
• Use daily for up to 4 weeks. If symptoms do not settle after 2 weeks, consult a GP to discuss further investigation.
• If symptoms come back, continue rabeprazole at the lowest dose needed for control.
• If needing to continue to use rabeprazole more than 4 times a week for over a month, consult a GP.

How soon is rabeprazole effective?

Reduction of acid production occurs within an hour of taking rabeprazole. There should be symptom improvement within a few days. For best results follow the instructions carefully on how to take it - see above and read the patient leaflet supplied in packs.

Consult a GP if symptoms have not significantly settled after 2 weeks.

Who might be suitable for rabeprazole?

Dr Fox supplies rabeprazole 10mg and 20mg to treat dyspepsia and Gastro-oesophageal reflux disease (GORD), with symptoms of acid reflux, acid indigestion, and heartburn in adults over 18.

Rabeprazole can also be used:

• To prevent recurrence in healed oesophagitis.
• To prevent gastroduodenal ulcers due to taking continuous NSAID (non steroidal anti-inflammatory) treatment.
• For other conditions linked to overproduction of stomach acid.

Helicobacter pylori (H. pylori)

H. pylori is a bacterium found in some people's stomachs. It is known to be linked with gastritis, gastric and duodenal ulcers, and gastric cancer. All PPIs, including rabeprazole, can be used in combination with certain antibiotics, to clear H. pylori from the stomach. A GP will often test for H. pylori if symptoms of acid reflux, indigestion, and heartburn do not settle quickly with a PPI or there are home self tests available. The test is usually either a simple stool (poo) test or a breath test. For the test to be reliable, you must not have taken a PPI in the past 2 weeks, or antibiotics in the past 4 weeks.

Is there anyone who cannot take rabeprazole?

There are checks in the online consultation to confirm if rabeprazole is suitable or may affect other medications taken.

If taking phenytoin (for fits) or warfarin type anticoagulants (blood thinners requiring regular blood tests) speak to the GP about extra monitoring before taking rabeprazole.

If taking medication to treat HIV/AIDS or cancer chemotherapy, including methotrexate, do not take rabeprazole without discussing with your specialist as rabeprazole may interfere with your treatment.

Rabeprazole may not be suitable for people with severe liver or kidney problems - consult a GP.

During treatment with rabeprazole, if new symptoms develop such as unintended weight loss, vomiting, swallowing difficulties, blood in vomit, or dark and tarry stools, or new stomach pains you must seek urgent medical attention.

Inform the doctor or nurse if undergoing investigations or blood tests, that you are taking rabeprazole.

Are there any drugs which might interact with rabeprazole?

There are a few medicines which interact with rabeprazole, making one or other less or more effective. Checks for these are carried out in the online consultation.

Do not take rabeprazole if taking:

• Nelfinavir, rilpivirine, atazanavir, saquinavir and ritonavir, tipranivir, or similar - for HIV

Discuss with your GP/specialist before taking rabeprazole if taking:

• Dasatinib, gefitinib, neratinib, erlotinib - cancer chemotherapy.
• Ketoconazole, posaconazole, voriconazole, and itraconazole - antifungals.
• Methotrexate - cancer chemotherapy, rheumatoid arthritis, and psoriasis.

Pregnancy and/or breastfeeding

There is no information about the safety of rabeprazole in pregnancy or breastfeeding so rabeprazole should not be used, without first discussing with a GP or specialist.

Possible side effects of rabeprazole

All medications can cause side effects but not everyone gets them.

Side effects are more commonly reported with rabeprazole than other PPIs, and can include:

• Headache.
• Constipation or diarrhoea.
• Flatulence (wind).
• Nausea/vomiting.
• Stomach pains.
• Insomnia, cough, rhinitis, back pain.
• Small harmless stomach polyps (only seen on endoscopy and settle on stopping the medication).
• Changes to liver enzyme blood tests and to platelet and white cell blood counts. These changes usually settle on stopping rabeprazole.

Further information is in the manufacturer's patient leaflet.

Special warnings/precautions for use

If you are due to have a gastroscopy/endoscopy you will probably be asked to stop taking rabeprazole a few weeks before the procedure - check with your GP.

The following have been reported with long-term (over a year) regular use of PPIs including rabeprazole:

• Slight increase in the risk of fractures at the hip, wrist, and spine, hence patients are recommended to follow national guidelines for prevention and treatment of osteoporosis, and to have an adequate intake of calcium and vitamin D. Risk is increased if also taking regular steroid medication.
• Low levels of vitamin B12. If you already have low vitamin B12 levels, discuss with a GP before taking rabeprazole.
• Low magnesium levels. Symptoms include fatigue, dizziness, confusion, fits, and irregular heart rhythms. More likely if taken with other drugs (e.g. digoxin) which can also lower magnesium levels. Periodic checks of blood magnesium levels may be recommended if taking for longer than 3 months continuously.
• A rare condition 'subacute cutaneous lupus erythematosus' (SCLE). Consult your GP promptly if you develop a skin rash on sunlight exposed areas.
• A slightly higher risk of gastroenteritis such as Campylobacter and Salmonella.
• Some people who have taken PPIs for many years are found to have benign polyps in their stomach when having a routine gastroscopy. These do not usually cause any problems, and settle on stopping the PPI.
• Research published in 2023 seems to show a link with long term use of PPIs and the development of dementia in later life. More research is needed to clarify this.

Very rare effects:

• Dizziness, visual disturbances, and muscular weakness - if affected do not drive or operate heavy machinery.
• In some uncommon cases rabeprazole can lead to blood changes, so if having any blood test, always let your GP or nurse know that you are taking it.

Allergy to rabeprazole and other PPIs

Do not take rabeprazole if you are known to be allergic to other PPIs.

If you have any symptoms or signs suggestive of an acute allergic reaction (anaphylaxis), you must get medical help immediately (telephone 999 if in the UK).

Symptoms/signs of an acute allergic reaction include:

• Difficulty breathing, tight chest, wheezing.
• Swelling of the face, lips, or tongue.
• Skin rash – urticaria/hives.
• Confusion/collapse/unconsciousness.

For more information see NHS - Anaphylaxis.

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