Rabeprazole

Rabeprazole can be taken by adults but it is not generally recommended in pregnancy or while breastfeeding. Rabeprazole is not suitable for some people. To make sure that it is safe for you, tell your doctor if you:

• have had an allergic reaction to rabeprazole or any other medicines in the past
• are due to have an endoscopy

Ask your doctor if you should stop taking rabeprazole a few weeks before your endoscopy. This is because rabeprazole may hide some of the problems that would usually be spotted during an endoscopy.

Pregnancy and breastfeeding

Rabeprazole is not usually recommended during pregnancy as there is no firm evidence it is safe.

A medicine called omeprazole which is similar to rabeprazole, is safe in pregnancy. However, if you are pregnant, it is better to try to treat symptoms of acid reflux and heartburn without taking a medicine.

Your doctor or midwife may suggest eating smaller meals more often and avoiding fatty and spicy foods.

They may also suggest raising the head of your bed 10 to 20cm by putting something under your bed or mattress, so that your chest and head are above your waist. This helps stop stomach acid travelling up towards your throat.

If these lifestyle changes do not work, your doctor may prescribe omeprazole to help ease your symptoms.

Rabeprazole and breastfeeding

It is not known if rabeprazole passes into breast milk.

A medicine called omeprazole, which is similar to rabeprazole, is safe to take while breastfeeding.

Speak to your doctor to discuss what is best for you and your baby.

Important

Tell your doctor if you are trying to get pregnant, are already pregnant or breastfeeding.

It is usual to take rabeprazole once a day, first thing in the morning.

If your doctor prescribes rabeprazole twice a day, take 1 dose in the morning and 1 dose in the evening.

It is best to take rabeprazole before a meal. Swallow tablets whole with a drink of water.

How much will I take?

Each tablet contains 10mg or 20mg of rabeprazole.

The usual dose to treat:

• heartburn, acid reflux and gastro-oesophageal reflux disease is 10mg to 20mg a day
• stomach ulcers is 20mg a day
• Zollinger-Ellison syndrome is 60mg to 120mg a day

Will my dose go up or down?

Sometimes your doctor will increase your dose of rabeprazole if it is not working well enough.

Depending on the reason you take rabeprazole, you may take a higher dose to begin with, usually for a month or two. After this, your doctor may recommend that you take a lower dose.

How long will I take it for?

Depending on your illness, you may only take it for a few weeks or months. Sometimes you might need to take it for longer, even many years.

Some people do not need to take rabeprazole every day and take it only when they have symptoms. Once you feel better (often after a few days or weeks), you can stop taking it. Taking rabeprazole in this way is not suitable for everyone though. Speak to your doctor about what is best for you.

What if I forget to take it?

If you usually take it:

• Once a day – take the missed dose as soon as you remember, unless your next dose is due in less than 12 hours, in which case skip the missed dose. Then take your next dose as normal.
• Twice a day – take the missed dose as soon as you remember, unless your next dose is due in less than 4 hours, in which case skip the missed dose. Then take your next dose as normal

Do not take a double dose to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicine.

What if I take too much?

It is very unlikely that taking 1 or 2 extra doses by accident will cause any problems. However, you should check with your doctor if you have taken too much and have any of these symptoms:

• flushed skin
• feeling sweaty
• a fast heartbeat
• feeling sleepy
• blurred vision
• feeling confused or agitated

Most people who take Rabeprazole do not have any side effects. If you do get a side effect, it is usually mild and will go away when you stop taking rabeprazole.

Common side effects

Common side effects may happen in more than 1 in 100 people. Talk to your doctor or pharmacist if these side effects bother you or do not go away:

• headaches
• diarrhoea or being sick (vomiting)
• feeling sick
• constipation
• stomach pain or wind

Serious side effects

Some of these serious side effects are more common than others. Call a doctor straight away if you have:

• joint pain and abnormal changes in your skin, especially in parts of your body exposed to the sun, such as a red, raised rash on your arms that can spread, blisters, or a red rash on your cheeks and nose. These can be signs of a rare condition called subacute cutaneous lupus erythematosus. This can happen even if you have been taking rabeprazole for a long time
• stomach pain that gets worse, yellow skin (or the whites of your eyes turn yellow) or dark pee. These could be signs of liver problems
• pain when you pee, peeing less, lower back pain, swollen ankles, and rash or fever. These could be signs of a kidney problem
• frequent infections, such as a sore throat or high temperature (38C or above), or ulcers in your mouth or throat

Serious allergic reaction

In rare cases, it is possible to have a serious allergic reaction (anaphylaxis) to rabeprazole.

• You can get a skin rash that may include itchy, red, swollen, blistered or peeling skin
• You are wheezing
• You get tightness in the chest or throat
• You have trouble breathing or talking
• Your mouth, face, lips, tongue or throat start swelling.

These are symptoms suggesting that you could be having a serious allergic reaction and may need immediate treatment in hospital. Call for an ambulance or go to the nearest hospital.

These are not all the side effects of rabeprazole. For a full list see the leaflet inside your medicines packet.

How to cope with side effects

What to do about:

• Headaches – make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of taking rabeprazole. Talk to your doctor if they last longer than a week or are severe.
• Feeling sick – it may help if you to avoid rich or spicy food while you are taking rabeprazole.
• Diarrhoea or being sick (vomiting) – drink plenty of water by having small, frequent sips to avoid dehydration. Signs of dehydration include peeing less than usual or having strong-smelling pee.
• Constipation – get more fibre in the diet such as fresh fruit and vegetables and cereals, and drink plenty of water. Try to exercise for example, by going for a daily walk or run. If this does not help, talk to your pharmacist or doctor.
• Stomach pain or wind – steer clear of foods that cause wind like lentils, beans and onions. It might also help to eat smaller and more frequent meals, eat and drink slowly, and exercise regularly. Some pharmacy remedies, such as simethicone, may relieve the symptoms of wind.

Cautions with other medicines

Some medicines can interfere with rabeprazole and make it more likely that you will have side effects.

Tell your doctor if you are taking these medicines before you start taking rabeprazole:

• digoxin (a heart medicine)
• antifungal medicines such as itraconazole, ketoconazole or posaconazole
• methotrexate (for cancer and conditions like psoriasis and rheumatoid arthritis)
• HIV medicines
• rifampicin (an antibiotic)
• antidepressants, such as fluvoxamine

These are not all the medicines that may not mix well with rabeprazole. For a full list see the leaflet inside your medicines packet.

Mixing rabeprazole with herbal remedies and supplements

Do not take St John’s wort, the herbal remedy for depression, while you are taking rabeprazole. St John’s wort may stop rabeprazole working as well as it should.

Important

Tell your pharmacist or doctor if you are taking other medicines including herbal remedies, vitamins or supplements.

How does Rabeprazole work?

Rabeprazole is a type of medicine called a proton pump inhibitor (PPI). Proton pumps are tiny substances in the lining of the stomach that help it make acid to digest food. Rabeprazole prevents proton pumps from working properly. This reduces the amount of acid your stomach makes.

When will I feel better?

You should start to feel better within 2 to 3 days. But it may take up to 4 weeks for rabeprazole to work properly so you may still have some symptoms during this time.

Is it safe to take Rabeprazole for a long time?

If you take rabeprazole for more than 3 months, the levels of magnesium in your blood may fall. This can make you feel tired, confused and dizzy, and cause muscle twitches, shakiness and an irregular heartbeat. If you get any of these symptoms, tell your doctor.

Taking rabeprazole for more than a year may increase your chances of certain side effects, including:

• bone fractures
• gut infections
• vitamin B12 deficiency – symptoms include feeling very tired, a sore and red tongue, mouth ulcers and pins and needles

If you take rabeprazole for longer than a year, your doctor will regularly check your health to see if you should carry on taking it.

It is not known if rabeprazole works less well the longer you take it. If you feel it is not working any more, talk to your doctor.

Does taking Rabeprazole for a long time cause stomach cancer?

A Hong Kong study published in 2017 suggested that people taking proton pump inhibitors (PPIs) like rabeprazole for at least 3 years have a very small increased chance of developing stomach cancer. For every 10,000 people taking a PPI long term, it was thought an extra 4 people get stomach cancer.

However, the study did not prove that PPIs were causing stomach cancer. People who take PPIs regularly should not be particularly concerned by this study. However, PPIs, like most medicines, have side effects, so it is best to take them for the shortest time possible. Speak to your doctor or pharmacist if you are concerned.

How do I come off Rabeprazole?

Usually, you can stop taking rabeprazole without reducing the dose first.

If you have taken rabeprazole for a long time, speak to your doctor before you stop taking it. Stopping the medicine suddenly could make your stomach produce a lot more acid, and make your symptoms return.

Reducing the dose gradually before stopping completely will prevent this happening.

Are there similar medicines?

There are 4 other medicines that are similar to rabeprazole. They are:

• lansoprazole
• omeprazole
• esomeprazole
• pantoprazole

Like rabeprazole, these medicines are proton pump inhibitors (PPIs). They work in the same way as rabeprazole to reduce acid in your stomach. They generally work as well as and have similar side effects to rabeprazole. However, they may be given in different doses to rabeprazole.

Sometimes, if rabeprazole is not working or does not agree with you, your doctor may suggest trying a different PPI.

Are there other indigestion medicines?

There are other pharmacy and prescription medicines for indigestion and heartburn.

Antacids, like calcium carbonate (Tums), sodium bicarbonate, Maalox and Milk of Magnesia, relieve indigestion and heartburn by neutralising the acid in your stomach. They give quick relief that lasts for a few hours. They are ideal for occasional bouts of stomach acid symptoms.

Some antacids, such as Gaviscon, have an extra ingredient called alginic acid. They work by lining your stomach so that juices from it do not splash up into your food pipe. They are especially good for relieving acid reflux.

Antacids are available from pharmacies and supermarkets. Histamine antagonists (commonly called H2 blockers) reduce the amount of acid made in your stomach, but they do this in a different way to proton pump inhibitors (PPIs).

They include famotidine (Pepcid), ranitidine (Zantac), cimetidine (Tagamet) and nizatidine (Axid).

In general, PPIs like rabeprazole are used first because they are better than H2 blockers at reducing stomach acid. However, if you do not get on with a PPI (for example, because of side effects), your doctor may prescribe an H2 blocker.

You can buy famotidine and ranitidine without a prescription from pharmacies.

Can I take Rabeprazole with an antacid?

You can take rabeprazole with an antacid, for example Gaviscon. Take it 2 hours before or after your dose of rabeprazole.

Can I take painkillers with it?

Yes, it is safe to take painkillers, such as paracetamol or ibuprofen at the same time as rabeprazole.

It is best to take ibuprofen with, or just after, a meal so it does not upset your stomach.

Will it affect my fertility?

There is no firm evidence to suggest that taking rabeprazole will reduce fertility in either men or women.

However, speak to a pharmacist or your doctor if you are trying to get pregnant. They may want to review your treatment.

Will it affect my contraception?

Rabeprazole does not affect any type of regular contraception including the combined pill.

It may reduce the effectiveness of one type of morning after pill called ellaOne (ulipristal) so a different form of emergency contraceptive may be recommended instead.

Can I drive or ride a bike?

Occasionally rabeprazole can make you feel dizzy or sleepy, or affect your vision. If this happens to you, do not drive, cycle or use machinery or tools until you feel better.

Can I drink alcohol with it?

Yes, you can drink alcohol with rabeprazole. However, drinking alcohol makes your stomach produce more acid than normal. This can irritate your stomach lining and make your symptoms worse.

Is there any food or drink I need to avoid?

You can eat and drink normally while taking rabeprazole, but it is best to take it before a meal.

However, you should avoid foods that seem to make your symptoms worse, such as rich, spicy and fatty foods. You should also cut down on caffeinated drinks, such as tea, coffee and cola, as well as alcohol.

Can lifestyle changes help?

It may be possible to ease symptoms caused by too much stomach acid by making a few changes to your diet and lifestyle:

• maintain a healthy weight by eating healthily
• do not eat foods that can make your symptoms worse, such as rich, spicy and fatty foods, and acidic foods like tomatoes, citrus fruits, salad dressings and fizzy drinks
• cut down on caffeinated drinks, such as tea, coffee and cola, as well as alcohol and smoking
• if you have symptoms at night, try not to eat for at least 3 hours before you go to bed
• raise the head of your bed 10 to 20cm so that your chest and head are above your waist