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Efficacy of Rabeprazole in Gastric acid-Induced Disorders

Rabifine 20 (Rabeprazole sodium)

Efficacy of rabeprazole in gastric acid-induced disorders

Pharmacodynamic data of rabeprazole (a proton pump inhibitor) demonstrated that it can achieve an optimal acid suppression since the first dose and is able to maintain this advantage in the following days of therapy. Furthermore, rabeprazole has the highest pKa (~ 5.0, the pH at which a drug becomes 50% protonated) and for this reason the molecule can be activated at higher pH levels much faster than other PPIs.

Owing to its peculiar catabolic pathway which is a prevalent metabolism by a non-enzymatic pathway, rabeprazole is less susceptible to the influence of genetic polymorphisms for CYP2C19, which leads to minor influences on its pharmacokinetics and pharmacodynamics. Rabeprazole 20 mg UID or 10 mg BID produced healing rates comparable to those obtained with omeprazole 20 mg UID in erosive esophagitis patients, at 8 weeks.

"Rabeprazole is also being used successfully in the treatment of some atypical GERD manifestations, including dysphagia associated with GERD, GERD- related asthma and chest-pain, and in the therapy of Barrett’s esophagus"

However, in NERD patients, doses of 10 or 20 mg are corresponding and both are superior to placebo at 2 and 4 weeks. On-demand treatment with rabeprazole 10 mg daily seems to be ideal to prevent symptomatic relapse due to its fast onset of action. Studies conducted on NERD patients have reported it to be superior to placebo. However, regular treatment for up to 5 years appears to achieve superior results than on-demand therapy, especially in patients with esophagitis.

Moreover, it is being discussed whether half  dose  (10  mg)  is  equivalent  to  full  dose  (20  mg)  in  patients  with Barrett’s esophagus. Rabeprazole is also being used successfully in the treatment of some atypical GERD manifestations, including dysphagia associated with GERD, GERD-related asthma and chest-pain, and  in  the  therapy of Barrett’s esophagus.

To conclude, rabeprazole attains equivalent Helicobacter pylori eradication rates compared to omeprazole and lansoprazole when co-administrated with low or high doses of antibiotics (amoxicillin and clarithromycin). Besides, low doses of rabeprazole (10 mg/bid) may be efficient in eliminating the pathogen.

Source: Pace F, Pallotta S, Casalini S, Porro GB. A review of rabeprazole in the treatment of acid-related diseases. Ther Clin Risk Manag. 2007 Jun;3(3): 363-79.