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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Rabeprazole: Drug information

Rabeprazole: Drug information
(For additional information see "Rabeprazole: Patient drug information" and see "Rabeprazole: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Aciphex;
  • AcipHex Sprinkle [DSC]
Brand Names: Canada
  • APO-Rabeprazole;
  • DOM-Rabeprazole EC [DSC];
  • JAMP-RABEprazole;
  • Pariet;
  • PMS-Rabeprazole EC;
  • PRO-Rabeprazole;
  • RIVA-Rabeprazole EC [DSC];
  • SANDOZ Rabeprazole;
  • TARO-Rabeprazole;
  • TEVA-Rabeprazole EC [DSC]
Pharmacologic Category
  • Proton Pump Inhibitor;
  • Substituted Benzimidazole
Dosing: Adult

Note: Do not administer concomitantly with other antisecretory agents, such as H2-receptor antagonists (H2RAs), prostaglandin analogues (eg, misoprostol), or somatostatin analogues (eg, octreotide), due to decreased acid-inhibitory effects; if another antisecretory agent is needed, allow a sufficient time interval between administration (ie, morning rabeprazole and bedtime H2RA) (ACG [Katz 2013]; Wolfe 2000; Wolfe 2021).

Aspiration prophylaxis in patients undergoing anesthesia

Aspiration prophylaxis in patients undergoing anesthesia (off-label use):

Note: May be considered in patients at high risk for aspiration (ASA 2017).

Oral: 20 mg given the night before surgery and 20 mg given the morning of surgery (Puig 2012; Uesugi 2002).

Barrett esophagus

Barrett esophagus (off-label use):

Oral: 20 mg once daily; may increase the dose to 20 to 40 mg twice daily if needed to eliminate gastroesophageal reflux disease (GERD) symptoms or heal reflux esophagitis. Long-term maintenance therapy is recommended (ACG [Shaheen 2016]; Babic 2015; Spechler 2021; Yachimski 2015).

Dyspepsia, functional

Dyspepsia, functional (off-label use):

Note: For patients who test negative for H. pylori infection or have persistent symptoms following H. pylori eradication (ACG/CAG [Moayyedi 2017]; Longstreth 2022).

Oral: 20 mg once daily for up to 8 weeks (Dewan 2011; Iwakiri 2013; Pinto-Sanchez 2017); can be continued for a longer duration in patients with symptom improvement. Some experts recommend attempting to discontinue every 6 to 12 months to minimize the long-term risk of therapy (ACG/CAG [Moayyedi 2017).

Eosinophilic esophagitis

Eosinophilic esophagitis (off-label use): Oral: 20 mg twice daily for an 8-week trial (Laserna-Mendieta 2020; Lucendo 2016; Vazquez-Elizondo 2013). Once 8-week trial is complete and remission is achieved, the dose may be gradually lowered to an individualized maintenance level (Laserna-Mendieta 2020). Some experts initiate with 20 mg once daily and increase to twice-daily dosing after 4 weeks if symptoms fail to improve (Bonis 2021).

Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD):

Initial therapy:

Mild/intermittent disease (<2 episodes/week) and no evidence of erosive esophagitis:

Note: Some experts reserve proton pump inhibitors (PPIs) for patients who have residual acid reflux symptoms despite twice-daily H2RA (Kahrilas 2021).

Oral: 20 mg once daily. Where available, may start with 10 mg once daily and increase to 20 mg once daily after 4 to 8 weeks, if necessary. Discontinue once asymptomatic for 8 weeks (Kahrilas 2021).

Severe and/or frequent symptoms (≥2 episodes/week), and/or erosive esophagitis:

Oral: 20 mg once daily; once symptoms are controlled, continue for at least 8 weeks (Kahrilas 2021; Wolfe 2000). Subsequently, patients without erosive esophagitis or Barrett esophagus can taper to the lowest dose necessary to control symptoms (and/or switch to an H2RA blocker), then discontinue acid suppression once asymptomatic. Patients with erosive esophagitis or Barrett esophagus should continue long-term maintenance therapy with 20 mg once daily (Kahrilas 2021; Ramakrishnan 2002; Spechler 2021).

Residual symptoms despite 20 mg once daily therapy:

Note: Referral to a specialist is recommended.

Oral: Options include splitting the dose to 10 mg twice daily, increasing the dose to 20 mg twice daily, or switching to another PPI (ACG [Katz 2013]; Fass 2021).

H. pylori eradication

H. pylori eradication:

Oral: 20 or 40 mg twice daily as part of an appropriate combination regimen with antibiotics. Dose depends on selected regimen (ACG [Chey 2017]; Fallone 2016; Lamont 2021).

Hypersecretory conditions

Hypersecretory conditions (including Zollinger-Ellison syndrome): Oral: Initial: 60 mg once daily. If needed, may titrate upward early in therapy, using divided doses as appropriate; once acid output has been controlled, gradual dose reductions are usually possible; continue as long as clinically indicated (Bergsland 2021; Morocutti 2006). Doses as high as 100 mg once daily and 60 mg twice daily have been used.

Nonsteroidal anti-inflammatory drugs–induced ulcers, primary prevention

Nonsteroidal anti-inflammatory drugs (including aspirin)–induced ulcers, primary prevention (off-label use):

Note: For select patients at moderate or high risk for GI toxicity. These include patients with a history of GI ulcer, on dual antiplatelet therapy (eg, aspirin plus a P2Y12 inhibitor), on concurrent anticoagulant therapy, or with multiple additional risk factors (eg, corticosteroid use, high nonsteroidal anti-inflammatory drug [NSAID] dose, H. pylori infection) (Feldman 2021a; Holmes 2021). For patients on dual antiplatelet therapy, some experts reserve prophylaxis for those with additional risk factors (ACCF/ACG/AHA [Abraham 2010]; ESC [Ibanez 2018]). If present, H. pylori infection should be treated first (ACG [Lanza 2009]; Feldman 2021a).

Oral: 20 mg once daily for the duration of high-risk NSAID use. Where available, may consider 10 mg once daily (Lin 2011; Tamura 2011).

Peptic ulcer disease, treatment and secondary prevention

Peptic ulcer disease, treatment and secondary prevention:

Note: For patients on NSAIDs (including aspirin), the NSAID should be discontinued, if possible (Feldman 2021b). If present, H. pylori infection should be treated first; uncomplicated H. pylori–associated ulcers may not need PPI treatment beyond that included in the eradication regimen (Vakil 2021b).

Uncomplicated ulcer: Oral: 20 mg once daily. Duration depends on the size, location, and cause of ulcer and ranges from 4 to 8 weeks. In patients with refractory or recurrent disease, may increase the dose to 20 mg twice daily (Boparai 2008; Cloud 1998; Dekkers 1998; Vakil 2021b; Vakil 2021c; Wolfe 2000).

Complicated ulcer (perforation, penetration, or gastric outlet obstruction) (off-label use): Oral: 20 mg twice daily for 2 weeks, followed by 20 mg once daily. Duration depends on the location and etiology of ulcer (Vakil 2021a).

Bleeding ulcer:

Initial therapy: Note: Optimal pre-endoscopic PPI therapy is uncertain. Some experts suggest initiating therapy with a high-dose IV PPI using continuous or intermittent dosing in patients with suspected active upper GI bleed prior to endoscopy (Saltzman 2022). Following endoscopy, for patients with high-risk stigmata of recent bleeding (eg, active bleed, visible vessel, adherent clot), a continuous infusion of an IV PPI for at least 72 hours before transitioning to an oral PPI is recommended (ACG [Laine 2021]; Barkun 2019). Patients without high-risk stigmata of recent bleeding can be switched to an oral PPI immediately after endoscopy (Saltzman 2022).

Patients with high-risk stigmata of recent bleeding on endoscopy (following IV PPI therapy): Oral: 20 mg twice daily to complete 14 days of twice-daily PPI therapy, followed by 20 mg once daily (ACG [Laine 2021]; Barkun 2019; Saltzman 2022).

Patients with no high-risk stigmata of recent bleeding on endoscopy: Oral: 20 mg once daily (Saltzman 2022).

Duration: The total duration of treatment depends on size, location, and cause of the ulcer and ranges from 4 to 12 weeks (Barkun 2019; Saltzman 2022; Vakil 2021b; Vakil 2021c).

Maintenance therapy/secondary prevention (off-label use):

Note: For select high-risk patients (eg, idiopathic ulcers, frequently recurrent ulcers, need for continued NSAID use).

Oral: 20 mg once daily for 12 to 24 weeks or as long as the NSAID is used (Feldman 2021b); where available, may consider 5 or 10 mg once daily (Iwakiri 2014; Sanuki 2012).

Discontinuation of therapy: Oral: In patients who have received continuous therapy for >6 months, some experts gradually taper therapy until discontinuation to avoid worsening or rebound GERD symptoms. There is no single agreed upon discontinuation strategy. If the patient is receiving 20 mg once or twice daily, some experts decrease the dose by 50% every week. For patients receiving twice-daily dosing, the first dose reduction can be achieved by decreasing to once-daily AM dosing. Once patients are on the lowest dose for 1 week, discontinue therapy (Wolfe 2021). An alternative strategy is to decrease the dose by 50% over 2 weeks to 4 weeks, then discontinue. If the patient is already on the lowest possible dose, alternate day therapy may be considered (Kim 2018). In addition, as-needed therapy with an H2RA or an antacid can be used during the taper (Haastrup 2014).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

No dosage adjustment necessary.

Dosing: Hepatic Impairment: Adult

Mild-to-moderate impairment (Child-Pugh class A or B): No dosage adjustment necessary.

Severe impairment (Child-Pugh class C): Avoid use; if treatment is necessary, monitor for adverse reactions.

Dosing: Pediatric

(For additional information see "Rabeprazole: Pediatric drug information")

GERD, symptomatic

GERD, symptomatic: Note: Guidelines recommend a 4- to 8-week treatment course; if improvement seen after 4 to 8 weeks, consider possible wean; if no response after 4 to 8 weeks, reevaluate diagnosis and consider referral to pediatric GI specialist (NASPGHAN/ESPGHAN [Rosen 2018]).

Infants: Limited data available: Oral: Sprinkle capsules: 5 to 10 mg once daily; dosing based on a double-blind, placebo-controlled trial which randomized patients aged 1 to 11 months (n=268) with symptomatic GERD to 10 mg, 5 mg, or placebo (n=88, n=90, n=90, respectively); the study found no difference in the degree of improvement with rabeprazole (at any dose) compared to those receiving placebo (Hussain 2014).

Children ≤11 years: Oral: Sprinkle capsules:

<15 kg: 5 mg once daily; if inadequate response may increase to 10 mg once daily.

≥15 kg: 10 mg once daily; higher doses of 20 mg/day have also been described (Haddad 2014).

Children ≥12 years and Adolescents: Oral: Tablets: 20 mg once daily.

Helicobacter pylori eradication

Helicobacter pylori eradication: Limited data available: Note: Usual duration of therapy is 14 days as part of triple therapy; use in combination with 2 antimicrobials (eg, clarithromycin, metronidazole, amoxicillin); preferred agents determined by susceptibility. Bismuth may be added to regimens as an alternative if resistance is present or susceptibility is unknown (NASPGHAN/ESPGHAN [Jones 2017]).

Children and Adolescents <16 years: Note: Dosing based on a pharmacokinetic modeling study to determine a dose that achieved AUC comparable to adults receiving 20 mg twice daily (Kimko 2015).

6 to <10 kg: Oral: 10 mg twice daily.

10 to <30 kg: Oral: 15 mg twice daily.

≥30 kg: Oral: 20 mg twice daily.

Discontinuation of therapy: Oral: Based on experience in adults, some experts recommend a step-down approach in order to avoid worsening or rebound symptoms. One recommendation is to decrease the dose by 50% over 2 to 4 weeks. If the patient is already on the lowest possible dose, alternate day therapy may be considered. If symptoms worsen during treatment or after discontinuation, patient should be reevaluated (Kim 2018).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Children and Adolescents: There are no dosage adjustments provided in the manufacturer's labeling; however, pharmacokinetic studies in adults with end-stage renal disease (CrCl ≤5 mL/minute) on hemodialysis showed no clinically significant pharmacokinetic differences.

Dosing: Hepatic Impairment: Pediatric

Children and Adolescents:

Mild to moderate: No dosage adjustments are recommended.

Severe impairment: Avoid use; if treatment is necessary, monitor for adverse reactions.

Dosing: Older Adult

Refer to adult dosing.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule Sprinkle, Oral, as sodium:

AcipHex Sprinkle: 5 mg [DSC] [contains carrageenan, fd&c blue #2 (indigo carm) aluminum lake]

AcipHex Sprinkle: 10 mg [DSC] [contains carrageenan, fd&c yellow #6 (sunset yellow)]

Generic: 10 mg

Tablet Delayed Release, Oral, as sodium:

Aciphex: 20 mg

Generic: 20 mg

Generic Equivalent Available: US

Yes

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet Delayed Release, Oral:

Pariet: 10 mg

Generic: 10 mg

Tablet Delayed Release, Oral, as sodium:

Pariet: 20 mg

Generic: 20 mg

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and as follows, must be dispensed with this medication:

Aciphex: https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/020973s042lbl.pdf#page=34

Aciphex Sprinkle: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/204736s012lbl.pdf#page=21

Administration: Adult

Oral: May be administered with an antacid.

Capsules: Administer 30 minutes before a meal. Open capsule and sprinkle entire contents on a small amount of soft food (eg, applesauce, fruit or vegetable based baby food, yogurt) or empty contents into a small amount of liquid (eg, infant formula, apple juice, pediatric electrolyte solution); food or liquid should be at or below room temperature. Do not swallow capsule whole, or chew or crush granules; administer whole dose within 15 minutes of preparation (do not store for future use).

Tablets: Swallow whole; do not crush, split, or chew; may administer with or without food. However, when used for the treatment of duodenal ulcers, administer after a meal; when used for the eradication of H. pylori, administer with the morning and evening meals.

Bariatric surgery: Tablet, delayed release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. Delayed-release tablet should be swallowed whole. Do not chew or crush. Oral capsule sprinkle formulation is available. If safety and efficacy can be effectively monitored, no change in formulation or administration is required after bariatric surgery; however, for patients with refractory acid reflux, esophagitis, Barrett esophagus, or ulcer, consider switching to the capsule sprinkle formulation that can be opened and administered with food or liquid. If there is inadequate response, consider escalation of therapy to twice a day or conversion to food-independent proton pump inhibitor (omeprazole/sodium bicarbonate or dexlansoprazole).

Administration: Pediatric

Oral: May administer with an antacid.

Sprinkle capsules: Administer 30 minutes before a meal. Open capsule and sprinkle contents on a small amount of soft food (eg, applesauce, fruit- or vegetable-based baby food, yogurt) or empty contents into a small amount of liquid (eg, infant formula, apple juice, pediatric electrolyte solution); food or liquid should be at or below room temperature. Do not swallow capsule whole or chew or crush granules; administer whole dose within 15 minutes of preparation; do not store for future use.

Tablets: May be administered without regard to food; best if taken 30 minutes before a meal when treating GERD (Lightdale 2013). Tablets should be swallowed whole; do not chew, crush, or split.

Use: Labeled Indications

Gastroesophageal reflux disease (GERD):

Treatment of erosive or ulcerative esophagitis (tablets only): Short-term treatment in the healing and symptomatic relief of erosive or ulcerative esophagitis in adult patients.

Maintenance healing of erosive or ulcerative esophagitis: Maintenance of healing of erosive or ulcerative esophagitis and reduction in relapse rates of heartburn symptoms in adult patients.

Symptomatic GERD: Treatment of heartburn and other symptoms associated with GERD in children ≥12 years of age, adolescents, and adult patients (tablets only) and children 1 to 11 years of age (capsules only).

Helicobacter pylori eradication (tablets only): Treatment of H. pylori infection and duodenal ulcer disease (active or history of within the past 5 years) in adults as part of an appropriate combination regiment with antibiotics.

Pathological hypersecretory conditions (tablets only): Long-term treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome in adults.

Peptic ulcer disease, treatment of uncomplicated duodenal ulcers (tablets only): Short-term (4 weeks or fewer) treatment in the healing and symptomatic relief of duodenal ulcers in adults.

Note: Patients diagnosed with a duodenal ulcer should be tested for H. pylori infection and, if positive, offered H. pylori treatment with a defined course of combined antibiotic and proton pump inhibitor therapy (ACG [Chey 2017]).

Use: Off-Label: Adult

Aspiration prophylaxis in patients undergoing anesthesia; Barrett esophagus; Dyspepsia, functional; Eosinophilic esophagitis; Nonsteroidal anti-inflammatory drug (including aspirin)–induced ulcers, primary prevention; Peptic ulcer disease, maintenance therapy/secondary prevention; Peptic ulcer disease, treatment of bleeding ulcers; Peptic ulcer disease, treatment of complicated ulcers; Peptic ulcer disease, treatment of uncomplicated gastric ulcers

Medication Safety Issues
Sound-alike/look-alike issues:

AcipHex may be confused with Acephen, Accupril, Aricept, pHisoHex

RABEprazole may be confused with ARIPiprazole, donepezil, lansoprazole, omeprazole, raloxifene

Older Adult: High-Risk Medication:

Beers Criteria: Proton pump inhibitors are identified in the Beers Criteria as potentially inappropriate medications to be avoided (as scheduled use for more than 8 weeks) in patients 65 years and older due to their risk of C. difficile infection and bone loss/fractures unless given for high-risk patients (eg, oral corticosteroid or chronic NSAID use), patients with erosive esophagitis, Barrett's esophagitis, a pathological hypersecretory condition, or if the patient has demonstrated a need for maintenance therapy (eg, failure of drug discontinuation trial or failure of H2 blockers) (Beers Criteria [AGS 2019]).

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. As reported for adults unless otherwise specified.

>10%: Gastrointestinal: Abdominal pain (children: 16%; adolescents and adults: ≤4%), diarrhea (children and adolescents: 5% to 21%; adults: <2%), vomiting (children: 10% to 14%; adolescents: 4%)

1% to 10%:

Cardiovascular: Peripheral edema (<2%)

Gastrointestinal: Constipation (2%), flatulence (3%), nausea (children and adolescents: 2% to 9%), xerostomia (<2%)

Hepatic: Hepatic encephalopathy (<2%), hepatitis (<2%), increased liver enzymes (<2%)

Infection: Infection (2%)

Nervous system: Dizziness (<2%), headache (children and adolescents: 5% to 10%; adults: <2%), pain (3%)

Neuromuscular & skeletal: Arthralgia (<2%), myalgia (<2%)

Respiratory: Pharyngitis (3%)

Postmarketing:

Dermatologic: Acute generalized exanthematous pustulosis, bullous rash, cutaneous lupus erythematous, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis

Endocrine & metabolic: Hyperammonemia, hypocalcemia, hypokalemia, hypomagnesemia, hyponatremia, increased thyroid stimulating hormone level

Gastrointestinal: Clostridioides difficile associated diarrhea, colitis (microscopic) (Verhaegh 2016)

Hematologic & oncologic: Agranulocytosis, hemolytic anemia, leukopenia, pancytopenia, polyp (fundic gland), thrombocytopenia

Hepatic: Hepatotoxicity (idiosyncratic) (Chalasani 2014), jaundice

Hypersensitivity: Anaphylaxis, angioedema

Immunologic: Drug reaction with eosinophilia and systemic symptoms

Nervous system: Coma, delirium, disorientation, vertigo

Neuromuscular & skeletal: Bone fracture, rhabdomyolysis, systemic lupus erythematosus

Ophthalmic: Blurred vision

Renal: Interstitial nephritis (including acute interstitial nephritis), renal disease (chronic; Lazarus 2016)

Respiratory: Pneumonia (interstitial)

Contraindications

Hypersensitivity (eg, anaphylaxis, anaphylactic shock, angioedema, bronchospasm, acute tubulointerstitial nephritis, urticaria) to rabeprazole, other substituted benzimidazoles, or any component of the formulation; concomitant use with rilpivirine-containing products

Warnings/Precautions

Concerns related to adverse effects:

• Atrophic gastritis: Long-term omeprazole therapy has caused atrophic gastritis (by biopsy); this may also occur with rabeprazole.

• Carcinoma: No reports of adenomatoid, dysplastic or neoplastic changes of enterochromaffin-like (ECL) cells in the gastric mucosa have occurred.

• Clostridioides difficile-associated diarrhea (CDAD): Use of proton pump inhibitors (PPIs) may increase risk of CDAD, especially in hospitalized patients; consider CDAD diagnosis in patients with persistent diarrhea that does not improve. Use the lowest dose and shortest duration of PPI therapy appropriate for the condition being treated.

• Cutaneous and systemic lupus erythematosus: Has been reported as new onset or exacerbation of existing autoimmune disease; most cases were cutaneous lupus erythematosus (CLE), most commonly, subacute CLE (occurring within weeks to years after continuous therapy). Systemic lupus erythematosus (SLE) is less common (typically occurs within days to years after initiating treatment) and occurred primarily in young adults up to the elderly. Discontinue therapy if signs or symptoms of CLE or SLE occur and refer to specialist for evaluation; most patients improve 4 to 12 weeks after discontinuation of rabeprazole.

• Dermatologic reactions: Severe cutaneous adverse reactions, including acute generalized exanthematous pustulosis, drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, and toxic epidermal necrolysis, have been reported.

• Fractures: Increased incidence of osteoporosis-related bone fractures of the hip, spine, or wrist may occur with proton pump inhibitor (PPI) therapy. Patients on high-dose (multiple daily doses) or long-term therapy (≥1 year) should be monitored. Use the lowest effective dose for the shortest duration of time, use vitamin D and calcium supplementation, and follow appropriate guidelines to reduce risk of fractures in patients at risk.

• Fundic gland polyps: Use of PPIs increases risk of fundic gland polyps, especially with long term use (>1 year). May occur without symptoms but nausea, vomiting, or abdominal pain may occur; gastrointestinal bleeding and/or anemia may occur with ulcerated polyps. Diagnosis of polyps may also increase risk for small intestinal blockage. Use the lowest dose and shortest duration of PPI therapy appropriate for the condition being treated.

• Gastrointestinal infection (eg, Salmonella, Campylobacter): Use of proton pump inhibitors may increase risk of these infections.

• Hypomagnesemia: Reported rarely, usually with prolonged PPI use of ≥3 months (most cases >1 year of therapy). May be symptomatic or asymptomatic; severe cases may cause tetany, seizures, and cardiac arrhythmias. Hypomagnesemia may lead to or exacerbate hypocalcemia in patients at risk (eg, hypoparathyroidism). Hypomagnesemia may also lead to hypokalemia. Hypomagnesemia and hypocalcemia may be corrected by magnesium/calcium supplementation, although discontinuation of rabeprazole may be necessary.

• Tubulointerstitial nephritis: Acute tubulointerstitial nephritis has been observed in patients taking PPIs; may occur at any time during therapy. Patients may present with symptomatic hypersensitivity reaction to nonspecific symptoms of impaired renal function (eg, anorexia, malaise, nausea); may be diagnosed with biopsy and in the absence of extra-renal manifestations (eg, fever, rash, arthralgia). Discontinue and evaluate patients if acute tubulointerstitial nephritis is suspected.

• Vitamin B12 deficiency: Prolonged treatment (>3 years) may lead to vitamin B12 malabsorption and subsequent vitamin B12 deficiency. The magnitude of the deficiency is dose-related and the association is stronger in females and those younger in age (<30 years of age); prevalence is decreased after discontinuation of therapy (Lam 2013).

Disease-related concerns:

• Gastric malignancy: Relief of symptoms does not preclude the presence of a gastric malignancy.

• Hepatic impairment: Avoid use in patients with severe hepatic impairment; if treatment is necessary monitor for adverse reactions.

Concurrent drug therapy issues:

• Clopidogrel: PPIs may diminish the therapeutic effect of clopidogrel, thought to be due to reduced formation of the active metabolite of clopidogrel. The manufacturer of clopidogrel recommends either avoidance of both omeprazole (even when scheduled 12 hours apart) and esomeprazole or use of a PPI with comparatively less effect on the active metabolite of clopidogrel. Avoidance of rabeprazole appears prudent due to potent in vitro CYP2C19 inhibition (Li 2004) and lack of sufficient comparative in vivo studies with other PPIs. In contrast to these warnings, others have recommended the continued use of PPIs, regardless of the degree of inhibition, in patients with a history of GI bleeding or multiple risk factors for GI bleeding who are also receiving clopidogrel since no evidence has established clinically meaningful differences in outcome; however, a clinically significant interaction cannot be excluded in those who are poor metabolizers of clopidogrel (Abraham 2010; Levine 2011).

Other warnings/precautions:

• Appropriate use: Helicobacter pylori eradication: Short-term combination therapy (≤7 days) has been associated with a higher incidence of treatment failure. The American College of Gastroenterology recommends 10 to 14 days of therapy (triple or quadruple) for eradication of H. pylori (Chey 2017).

Warnings: Additional Pediatric Considerations

Use of gastric acid inhibitors, including proton pump inhibitors (PPIs) and H2 blockers, has been associated with an increased risk for development of acute gastroenteritis and community-acquired pneumonia in pediatric patients 4 to 36 months of age (Canani 2006). Routine use in preterm infants is not recommended (AAP [Eichenwald 2018]).

Gastric acid suppression medications have been associated with an increase in Clostridioides difficile infection (CDI) and recurrent CDI in pediatric patients (Nylund 2014). In a retrospective, observational, case control study of pediatric patients 1 to 18 years old who were hospitalized for diarrhea and abdominal pain, the use of PPIs was significantly higher in patients who tested positive for C. difficile compared to patients who tested negative for C. difficile (22.1% vs 5.9%) (Turco 2010). Consider CDI diagnosis in patients with persistent diarrhea that does not improve. Use the lowest dose and shortest duration of PPI therapy appropriate for the condition being treated.

A large retrospective cohort study reviewed records for patients with a low baseline risk for fractures who were initiated on acid suppression therapy in the first year of life and evaluated the fracture risk in the first 5 years of life; a total of 97,286 patients were prescribed acid suppression therapy; 73% were prescribed H2 blockers, 9% were prescribed PPIs, and 18% were prescribed both. H2 blocker use alone was not associated with an increased fracture hazard; however, PPI use was associated with a 21% increase and use of PPI plus H2 blocker was associated with a 30% increase. Longer duration of therapy and earlier age at initiation seemed to also increase the fracture hazard. Study findings do not establish a causal relationship between PPI use and fractures. If acid suppression therapy is necessary in the first year of life, limiting therapy to a single drug and limiting the duration should be considered (Malchodi 2019). A second large cohort study reviewed records for 115,933 children <18 years initiated on a PPI. PPI initiation was associated with a statistically significant 11% relative increase in risk of any fracture in patients ≥6 years. The increased risk also seemed to be more pronounced with a longer cumulative duration of PPI use (Wang 2020).

Metabolism/Transport Effects

Substrate of CYP2C19 (minor), CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential; Inhibits OAT1/3

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Acalabrutinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Acalabrutinib. Risk X: Avoid combination

Amphetamine: Inhibitors of the Proton Pump (PPIs and PCABs) may increase the absorption of Amphetamine. Risk C: Monitor therapy

Atazanavir: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Atazanavir. Management: Avoid use in treatment-experienced patients. In treatment-naive patients, administer boosted atazanavir 12 hours after the PPI and the PPI dose should not exceed the equivalent of 20 mg omeprazole. Monitor for reduced atazanavir efficacy. Risk D: Consider therapy modification

Belumosudil: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Belumosudil. Management: Increase the dose of belumosudil to 200 mg twice daily when coadministered with inhibitors of the proton pump (PPIs and PCABs). Risk D: Consider therapy modification

Bisphosphonate Derivatives: Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the therapeutic effect of Bisphosphonate Derivatives. Risk C: Monitor therapy

Bosutinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Bosutinib. Management: Consider alternatives to proton pump inhibitors and potassium-competitive acid blockers, such as short-acting antacids or histamine-2 receptor antagonists. Administer alternative agents more than 2 hours before or after bosutinib. Risk D: Consider therapy modification

Capecitabine: Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the therapeutic effect of Capecitabine. Risk C: Monitor therapy

Cefditoren: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Cefditoren. Risk X: Avoid combination

Cefpodoxime: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy

Cefuroxime: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the absorption of Cefuroxime. Risk X: Avoid combination

Clofarabine: OAT1/3 Inhibitors may increase the serum concentration of Clofarabine. Risk C: Monitor therapy

Cysteamine (Systemic): Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the therapeutic effect of Cysteamine (Systemic). Risk C: Monitor therapy

Dacomitinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Dacomitinib. Management: Avoid concurrent use of dacomitinib with PPIs and PCABs. Antacids may be used. Histamine H2-receptor antagonists (HR2A) may be used if dacomitinib is given at least 6 hours before or 10 hours after the H2RA. Risk X: Avoid combination

Dasatinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Dasatinib. Management: Antacids (taken 2 hours before or after dasatinib administration) can be used in place of PPIs or PCABs if some acid-reducing therapy is needed. Risk X: Avoid combination

Delavirdine: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Delavirdine. Management: Chronic therapy with PPIs or PCABs should be avoided in patients treated with delavirdine. The clinical significance of short-term PPI or PCAB therapy with delavirdine is uncertain, but such therapy should be undertaken with caution. Risk X: Avoid combination

Dextroamphetamine: Inhibitors of the Proton Pump (PPIs and PCABs) may increase the absorption of Dextroamphetamine. Specifically, the dextroamphetamine absorption rate from mixed amphetamine salt extended release (XR) capsules may be increased in the first hours after dosing. Risk C: Monitor therapy

Dichlorphenamide: OAT1/3 Inhibitors may increase the serum concentration of Dichlorphenamide. Risk C: Monitor therapy

Doxycycline: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the bioavailability of Doxycycline. Risk C: Monitor therapy

Enoxacin: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the absorption of Enoxacin. Risk C: Monitor therapy

Erlotinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Erlotinib. Risk X: Avoid combination

Gefitinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Gefitinib. Management: Avoid use of inhibitors of the proton pump (PPIs or PCABs) with gefitinib when possible. If required, administer gefitinib 12 hours after the PPI/PCAB or 12 hours before the next dose of the PPI/PCAB. Closely monitor clinical response to gefitinib. Risk D: Consider therapy modification

Immune Checkpoint Inhibitors: Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the therapeutic effect of Immune Checkpoint Inhibitors. Risk C: Monitor therapy

Indinavir: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Indinavir. Risk C: Monitor therapy

Infigratinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease serum concentrations of the active metabolite(s) of Infigratinib. Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Infigratinib. Risk X: Avoid combination

Itraconazole: Inhibitors of the Proton Pump (PPIs and PCABs) may increase the serum concentration of Itraconazole. Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Itraconazole. Management: Exposure to Tolsura brand itraconazole may be increased by PPIs or PCABs ; consider itraconazole dose reduction. Exposure to Sporanox brand itraconazole may be decreased. Give Sporanox brand itraconazole at least 2 hrs before or 2 hrs after PPIs or PCABs. Risk D: Consider therapy modification

Ketoconazole (Systemic): Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the absorption of Ketoconazole (Systemic). Ketoconazole (Systemic) may increase the serum concentration of Inhibitors of the Proton Pump (PPIs and PCABs). Management: Administer ketoconazole with an acidic beverage, such as non-diet cola, to increase gastric acidity and improve absorption if concomitant use with proton pump inhibitors or potassium-competitive acid blockers is necessary. Risk D: Consider therapy modification

Ledipasvir: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Ledipasvir. Management: PPI or PCAB doses equivalent to omeprazole 20 mg or lower may be given with ledipasvir under fasted conditions. Use of ledipasvir with higher doses or with food, or 2 hours after a these agents, may reduce ledipasvir bioavailability. Risk D: Consider therapy modification

Levoketoconazole: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the absorption of Levoketoconazole. Levoketoconazole may increase the serum concentration of Inhibitors of the Proton Pump (PPIs and PCABs). Risk X: Avoid combination

Lumacaftor and Ivacaftor: May decrease the serum concentration of Inhibitors of the Proton Pump (PPIs and PCABs). Risk C: Monitor therapy

Methotrexate: Inhibitors of the Proton Pump (PPIs and PCABs) may increase the serum concentration of Methotrexate. Management: Consider temporarily interrupting PPI or PCAB therapy in patients receiving high-dose methotrexate. If coadministered, monitor for increased methotrexate toxicity (eg, mucositis, myalgias) and/or delayed methotrexate elimination. Risk D: Consider therapy modification

Multivitamins/Minerals (with ADEK, Folate, Iron): Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Specifically, the absorption of iron may be decreased. Risk C: Monitor therapy

Mycophenolate: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Mycophenolate. Specifically, concentrations of the active mycophenolic acid may be reduced. Risk C: Monitor therapy

Nelfinavir: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease serum concentrations of the active metabolite(s) of Nelfinavir. Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Nelfinavir. Management: Due to potentially significant reductions in nelfinavir exposure, avoid concurrent use of nelfinavir with a PPI or PCAB when possible. If unavoidable, consider PPI or PCAB use for a short duration (less than 30 days) and closely monitor viral load. Risk D: Consider therapy modification

Neratinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Neratinib. Specifically, proton pump inhibitors may reduce neratinib absorption. Risk X: Avoid combination

Nilotinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Nilotinib. Management: Avoid this combination. Histamine H2 receptor antagonists (H2RAs) given 10 hours before or 2 hours after nilotinib, or antacids given 2 hours before or 2 hours after nilotinib are acceptable alternatives. Risk D: Consider therapy modification

Octreotide: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Octreotide. Risk C: Monitor therapy

Palbociclib: Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the therapeutic effect of Palbociclib. Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Palbociclib. Management: Carefully evaluate potential risks and benefits of coadministration of palbociclib capsules and proton pump inhibitors or potassium-competitive acid blockers due to the risk of reduced palbociclib efficacy. Palbociclib capsules should be taken with food. Risk D: Consider therapy modification

PAZOPanib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of PAZOPanib. Risk X: Avoid combination

Pexidartinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Pexidartinib. Management: Avoid this combination. If acid-reduction is needed, consider administering an antacid 2 hours before or after pexidartinib, or administer pexidartinib 2 hours before or 10 hours after an H2 receptor antagonist. Risk X: Avoid combination

Posaconazole: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Posaconazole. Management: Avoid coadministration of PPIs or PCABs and posaconazole oral suspension. Posaconazole delayed-release tablets do not appear to be sensitive to this interaction and do not required dose adjustment if coadministered with PPIs or PCABs. Risk D: Consider therapy modification

Rilpivirine: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Rilpivirine. Risk X: Avoid combination

Riociguat: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Riociguat. Risk C: Monitor therapy

Risedronate: Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the therapeutic effect of Risedronate. Inhibitors of the Proton Pump (PPIs and PCABs) may increase the serum concentration of Risedronate. This applies specifically to use of delayed-release risedronate. Management: Coadministration of PPIs or PCABs with delayed-release risedronate formulations is not recommended. Limit PPI/PCAB dose and duration during coadministration with risedronate as possible. Patients over age 70 are at higher risk of adverse effects. Risk D: Consider therapy modification

Saquinavir: Inhibitors of the Proton Pump (PPIs and PCABs) may increase the serum concentration of Saquinavir. Risk C: Monitor therapy

Secretin: Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the diagnostic effect of Secretin. Specifically, use of PPIs may cause a hyperresponse in gastrin secretion in response to secretin stimulation testing, falsely suggesting gastrinoma. Management: Avoid concomitant use of PPIs or PCABs and secretin, and discontinue PPIs several weeks prior to secretin administration, with the duration of separation determined by the specific PPI. See full monograph for details. Risk D: Consider therapy modification

Selpercatinib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Selpercatinib. Management: Coadministration of selpercatinib and PPIs or PCABs should be avoided. If coadministration cannot be avoided, selpercatinib and PPIs or PCABs should be administered simultaneously with food. Risk D: Consider therapy modification

SORAfenib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the absorption of SORAfenib. Risk C: Monitor therapy

Sotorasib: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Sotorasib. Risk X: Avoid combination

Sparsentan: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Sparsentan. Risk X: Avoid combination

Tacrolimus (Systemic): Inhibitors of the Proton Pump (PPIs and PCABs) may increase the serum concentration of Tacrolimus (Systemic). Risk C: Monitor therapy

Technetium Tc 99m Sestamibi: Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the diagnostic effect of Technetium Tc 99m Sestamibi. Management: Consider holding/stopping proton pump inhibitor therapy for at least 3 days prior to the use technetium Tc 99m sestamibi in cardiac imaging procedures. Risk D: Consider therapy modification

Technetium Tc 99m Tetrofosmin: Inhibitors of the Proton Pump (PPIs and PCABs) may diminish the diagnostic effect of Technetium Tc 99m Tetrofosmin. Risk C: Monitor therapy

Thiazolidinediones: Inhibitors of the Proton Pump (PPIs and PCABs) may enhance the adverse/toxic effect of Thiazolidinediones. Specifically, the risk of osteoporosis or fracture may be increased. Risk C: Monitor therapy

Tipranavir: May decrease the serum concentration of Inhibitors of the Proton Pump (PPIs and PCABs). These data are derived from studies with Ritonavir-boosted Tipranavir. Risk C: Monitor therapy

Velpatasvir: Inhibitors of the Proton Pump (PPIs and PCABs) may decrease the serum concentration of Velpatasvir. Management: Sofosbuvir/velpatasvir should be administered with food and taken 4 hours before omeprazole 20 mg. Sofosbuvir/velpatasvir/voxilaprevir can be administered with omeprazole 20 mg. Use with other PPIs or PCABs has not been studied. Risk D: Consider therapy modification

Voriconazole: May increase the serum concentration of Inhibitors of the Proton Pump (PPIs and PCABs). Inhibitors of the Proton Pump (PPIs and PCABs) may increase the serum concentration of Voriconazole. Risk C: Monitor therapy

Food Interactions

Prolonged treatment (≥2 years) may lead to malabsorption of dietary vitamin B12 and subsequent vitamin B12 deficiency (Lam, 2013).

Pregnancy Considerations

Recommendations for the treatment of GERD in pregnancy are available. As in nonpregnant patients, lifestyle modifications followed by other medications are the initial treatments (ACG [Katz 2013]; Body 2016; Huerta-Iga 2016; van der Woude 2014). Based on available data, PPIs may be used when clinically indicated (use of agents with more data in pregnancy may be preferred) (Body 2016; Matok 2012; Pasternak 2010; van der Woude 2014).

Breastfeeding Considerations

It is not known if rabeprazole is present in breast milk.

According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy should take into account the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.

Dietary Considerations

Capsules: Take 30 minutes before a meal.

Tablets: When used for the treatment of duodenal ulcers, administer after a meal; when used for the eradication of Helicobacter pylori, administer with the morning and evening meals.

Monitoring Parameters

Magnesium (baseline and periodically thereafter; especially if taking concomitant digoxin, diuretics, or other drugs known to cause hypomagnesemia); calcium (baseline and periodically in patients at risk [eg, hypoparathyroidism]); susceptibility testing recommended in patients who fail H. pylori eradication regimen.

Mechanism of Action

Potent proton pump inhibitor; suppresses gastric acid secretion by inhibiting the parietal cell H+/K+ ATP pump

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Within 1 hour

Duration: 24 hours

Absorption: Oral: Well absorbed within 1 hour; food delayed absorption up to 4 hours or longer

Protein binding: 96.3%

Metabolism: Hepatic via CYP3A and 2C19 to inactive metabolites; CYP2C19 exhibits a known genetic polymorphism due to its deficiency in some subpopulations (3% to 5% of Caucasians and 17% to 20% of Asians) which results in slower metabolism

Bioavailability: Tablet: ~52%

Half-life elimination (dose dependent):

Children ≤11 years: 2.5 hours

Children ≥12 years and Adolescents: 20 mg tablet: 0.97 ± 0.19 hours (James 2007)

Adults: 1 to 2 hours

Time to peak, plasma:

Children ≤11 years: Sprinkle capsule: 2 to 4 hours

Children ≥12 years and Adolescents: 20 mg tablet: 4.1 ± 0.45 hours (James 2007)

Adults: Tablet: 2 to 5 hours; Sprinkle capsule: 1 to 6.5 hours

Excretion: Urine (90% primarily as thioether carboxylic acid metabolites); remainder in feces

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Hepatic function impairment: In mild to moderate hepatic impairment, AUC approximately doubled, total clearance decreased to less than half, and Cmax increased ~20% (not statistically significant) and elimination half-life was 2- to 3-fold higher.

Older adult: AUC values approximately doubled; Cmax increased 60%.

Race/ethnicity: AUCs for Japanese men were 50% to 60% higher.

Pricing: US

Capsule, sprinkles (RABEprazole Sodium Oral)

10 mg (per each): $49.67

Tablet, EC (Aciphex Oral)

20 mg (per each): $27.02

Tablet, EC (RABEprazole Sodium Oral)

20 mg (per each): $10.19 - $11.46

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • Acifix (BD);
  • Acilesol (SG);
  • Aciprazol (AE, CY, IQ, IR, JO, KW, LY, OM, SA, SY, YE);
  • Ares (HR);
  • Barole (PH);
  • Bepra (EG);
  • E-Ulcer (TW);
  • Gastrodine (CL);
  • Gelbra (ES);
  • Happi (LK);
  • Hygigastin (EG);
  • Iniparet (BR);
  • Noflux (CZ);
  • Pacredo (EG);
  • Paliell (KR);
  • Paramet (KR);
  • Parbezol (AU);
  • Paricel (BD);
  • Pariet (AE, AR, AT, AU, BB, BE, BG, BH, BM, BO, BR, BS, CH, CN, CO, CR, CY, DE, DK, DO, EG, ES, FI, FR, GB, GR, GT, GY, HK, HN, ID, IE, IQ, IR, IS, IT, JM, JO, JP, KR, KW, LB, LT, LU, LY, MT, MX, MY, NI, NL, OM, PA, PE, PH, PL, PR, PT, PY, RU, SA, SE, SG, SR, SV, SY, TH, TR, TT, TW, UY, VE, VN, YE, ZA, ZW);
  • Parzol (AU);
  • Prolox (NZ);
  • Promto (VN);
  • Rabe (BD, LK);
  • Rabeact (LK);
  • Rabeact-20 (HK);
  • Rabec (AR, LB);
  • Rabecid (PK);
  • Rabegen (KR);
  • Rabekind (TZ);
  • Rabeloc (IN, VN);
  • Rabemed (ZA);
  • Rabeol (KR);
  • Raberin (KR);
  • Rabesta (KR, PH);
  • Rabestad (HK);
  • Rabet (KR);
  • Rabetra (HK);
  • Rabett (TW);
  • Rabezole (BH, LB, QA, SA);
  • Rabiet (KR);
  • Rabister (KR);
  • Rabium (BD);
  • Rabtas (ZW);
  • Rabzole (AU);
  • Rapeed (PH);
  • Rapoxol (CZ);
  • Rapzol (PH);
  • Rasonix (BD);
  • Raxium (VN);
  • Razit (AU);
  • Razole (IE);
  • Relitaz (RO);
  • Renom (LK);
  • Risol (LK);
  • Veloz (BH);
  • Zabep (AU);
  • Zulbex (CZ, HR, LV, RO)


For country code abbreviations (show table)
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