Rabeprazole

INTRODUCTION

Indications

Gastroesophageal reflux disease (GERD). Duodenal ulcers (including combination therapy with clarithromycin and amoxicillin to eradicate Helicobacter pylori and prevent recurrence). Pathologic hypersecretory conditions, including Zollinger-Ellison syndrome.

Action

Binds to an enzyme in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen. Therapeutic Effects: Diminished accumulation of acid in the gastric lumen, with lessened acid reflux. Healing of duodenal ulcers and esophagitis. ↓ acid secretion in hypersecretory conditions.

Adverse Reactions/Side Effects

CNS: dizziness, headache, malaise. GI: abdominal pain, constipation, diarrhea, nausea. Derm: photosensitivity, rash. MS: neck pain. Misc: allergic reactions, chills, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor improvements in GI symptoms (gastritis, heartburn, and so forth) to help determine if drug therapy is successful.

• Monitor signs of allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor any neck pain to rule out musculoskeletal pathology; that is, attempt to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

Interventions

• In cases of NSAID-induced gastritis, implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and decrease the need for aspirin and other NSAIDs.

• Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.

Patient/Client-Related Instruction

• Advise patient to avoid alcohol and foods that may cause an increase in GI irritation.

• Instruct patient to report bothersome or prolonged side effects, including headache, chills, fever, malaise, or GI effects (nausea, diarrhea, constipation, abdominal pain).

Pharmacokinetics

Absorption: Delayed-release tablet is designed to allow rabeprazole, which is not stable in gastric acid, to pass through the stomach intact. Subsequently 52% is absorbed after oral administration.

Distribution: Unknown.

Protein Binding: 96.3%.

Metabolism and Excretion: Mostly metabolized by the liver (hepatic cytochrome P450 3A and 2C19 enzyme systems); 10% excreted in feces; remainder excreted in urine as inactive metabolites.

Half-life: 1–2 hr.