Rabeprazole sodium

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.