Proton pump inhibitor Pregnancy: Contraindicated during pregnancy. There are no data on the safety of rabeprazole in human pregnancy; reproduction studies in rats and rabbits revealed no evidence of impaired fertility or harm to the foetus, although low foeto-placental transfer occurs in rats. Should not be used during breast-feeding — it is not known whether rabeprazole is excreted in human breast milk and no studies in lactating women have been performed, but it is excreted in rat mammary secretions.

Rabeprazole sodium

Brand names: Pariet

Rabeprazole is a proton pump inhibitor used for gastro-oesophageal reflux disease, peptic ulcer disease, and as part of Helicobacter pylori eradication regimens.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 20 mg (active duodenal ulcer, active benign gastric ulcer, and erosive or ulcerative GORD)

Route: Oral — swallow tablets whole, do not chew or crush

Frequency: Once daily in the morning, before eating

Max: 120 mg/day in Zollinger-Ellison syndrome (a 120 mg dose may require divided doses of 60 mg twice daily)

Adults/elderly. Active duodenal ulcer and active benign gastric ulcer: 20 mg once daily in the morning — most duodenal ulcers heal within four weeks (a few patients require a further four weeks); most benign gastric ulcers heal within six weeks (a few require a further six weeks). Erosive or ulcerative gastro-oesophageal reflux disease: 20 mg once daily for four to eight weeks. GORD long-term maintenance: 20 mg or 10 mg once daily depending on patient response. Symptomatic treatment of moderate to very severe GORD without oesophagitis: 10 mg once daily; if symptom control has not been achieved within four weeks the patient should be further investigated; once symptoms have resolved, subsequent control can be achieved with an on-demand regimen of 10 mg once daily when needed. Zollinger-Ellison syndrome: recommended adult starting dose 60 mg once a day, titrated upwards to 120 mg/day based on individual patient needs; single daily doses up to 100 mg/day may be given; treatment should continue for as long as clinically indicated. Eradication of H. pylori: rabeprazole sodium 20 mg twice daily plus clarithromycin 500 mg twice daily plus amoxicillin 1 g twice daily, given for 7 days. Paediatric population: not recommended for use in children, as there is no experience of its use in this group.

Dose adjustments

Renal

No dosage adjustment is necessary for patients with renal or hepatic impairment. Exercise caution when treatment is first initiated in patients with severe hepatic dysfunction, as there are no clinical data in this group (SPC 4.4).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance, substituted benzimidazoles or to any of the excipients
Pregnancy and lactation

Side effects

Headache (common)
Diarrhoea (common)
Abdominal pain (common)
Asthenia (common)
Flatulence (common)
Rash and dry mouth (common/uncommon)

Interactions

Atazanavir — co-administration with rabeprazole sodium is not recommended (SPC 4.4)
Digoxin and drugs that may cause hypomagnesaemia (e.g. diuretics) — for patients expected to be on prolonged PPI treatment or taking these drugs, consider measuring magnesium levels before starting and periodically during treatment (SPC 4.4)
Note: SPC section 4.5 was not captured in this source bundle — interactions above are drawn from section 4.4

Clinical monograph

How it works

It inhibits the gastric H+/K+-ATPase (proton pump) in parietal cells — binding somewhat more reversibly than other proton pump inhibitors — suppressing both basal and stimulated acid secretion.

Prescribing in practice

Acid suppression may mask the symptoms of gastric malignancy, so investigate alarm features such as weight loss, dysphagia, or gastrointestinal bleeding before attributing them to benign reflux.
Long-term use is associated with hypomagnesaemia, increased fracture risk, and an increased risk of Clostridioides difficile infection.
Proton pump inhibitors may reduce the absorption of drugs requiring an acidic environment and can interact with agents metabolised by hepatic enzymes.

Monitoring

Review the ongoing need for treatment periodically and consider checking magnesium during prolonged therapy or with other magnesium-lowering drugs.

Counselling the patient

Take the tablet before food and swallow it whole.
Report persistent diarrhoea, as it may indicate a bowel infection.

Evidence & guidelines

Proton pump inhibitors are recommended by NICE as first-line acid suppression for reflux disease and peptic ulcer healing.

Reference: NICE CG184; MHRA; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Omeprazole (Elderly) · Proton Pump Inhibitor

Pathways