Aciphex belongs to the proton pump inhibitor (PPI) class of antiulcer agents. It exerts its therapeutic effect by:

• Specifically inhibiting the H+/K+-ATPase enzyme system (proton pump) in gastric parietal cells
• Blocking the final step of gastric acid production
• Demonstrating antisecretory effects within 1 hour post-dose
• Reaching peak acid suppression within 2-4 hours after administration

Therapeutic Indications FDA-approved uses include:

• Treatment and maintenance of duodenal ulcers
• Management of gastroesophageal reflux disease (GERD)
• Eradication of Helicobacter pylori (as part of combination therapy)
• Treatment of pathological hypersecretory conditions (Zollinger-Ellison syndrome)
• Healing and maintenance of erosive or ulcerative GERD

Dosage & Administration Standard dosing regimens:

• Active duodenal ulcer: 20 mg once daily for 4-8 weeks
• GERD: 20 mg once daily for 4-8 weeks (up to 16 weeks if needed)
• H. pylori eradication: 20 mg twice daily with antibiotics for 7-10 days
• Hypersecretory conditions: 60 mg once daily (adjust based on acid output)

Administration guidelines:

• Swallow tablets whole with water
• May be taken without regard to meals
• Morning dosing is generally recommended
• Do not crush, chew, or split tablets

Special Populations

• Hepatic impairment:
• Caution advised in severe liver disease
• Consider dose reduction
• Renal impairment:
• No dose adjustment typically needed
• Pediatric use:
• Safety and efficacy not established
• Geriatric use:
• No special dosing requirements
• Pregnancy:
• Category B (use only if clearly needed)
• Lactation:
• Unknown if excreted in breast milk

Contraindications Absolute contraindications include:

• Hypersensitivity to rabeprazole
• Known allergy to substituted benzimidazoles
• Concomitant use with rilpivirine-containing products

Adverse Effects Common side effects (≥1% incidence):

• Headache
• Abdominal pain
• Diarrhea
• Nausea
• Flatulence
• Constipation
• Dry mouth
• Dizziness

Serious adverse reactions:

• Clostridium difficile-associated diarrhea
• Acute interstitial nephritis
• Cutaneous lupus erythematosus
• Vitamin B12 deficiency (with long-term use)
• Hypomagnesemia (with prolonged therapy)

Drug Interactions Clinically significant interactions:

• Drugs requiring gastric acid for absorption:
• Ketoconazole
• Itraconazole
• Iron salts
• Dasatinib
• Nilotinib
• (Reduced absorption and efficacy)
• Drugs affected by pH changes:
• Digoxin (increased absorption)
• Methotrexate (possibly increased toxicity)
• Other notable interactions:
• Warfarin (monitor INR)
• Tacrolimus (possible increased levels)
• Clopidogrel (possible reduced efficacy)

Clinical Pharmacology Pharmacokinetic properties:

• Absorption: Rapid but incomplete (52%)
• Protein binding: 96.3%
• Metabolism: Hepatic (non-enzymatic)
• Half-life: 1-2 hours
• Excretion: Renal (90%)

Patient Counseling Points Important instructions for patients:

• Complete full course of therapy
• Report persistent diarrhea or new joint pain
• Be aware of potential long-term risks
• Do not stop medication without consulting provider
• Recognize symptoms of low magnesium:
• Muscle spasms
• Irregular heartbeat
• Seizures

Overdose Management While overdose experience is limited:

• No specific antidote exists
• Hemodialysis not effective
• Provide symptomatic and supportive care
• Contact Poison Control (1-800-222-1222)

Storage Requirements Proper storage conditions:

• Maintain at 15-30°C (59-86°F)
• Protect from moisture and light
• Keep in original container
• Ensure secure storage away from children

Monitoring Parameters Recommended clinical monitoring:

• Efficacy monitoring:
• Symptom improvement
• Endoscopic healing (when applicable)
• Safety monitoring:
• Magnesium levels (prolonged use)
• Vitamin B12 status (long-term therapy)
• Renal function (if interstitial nephritis suspected)

This professional summary contains essential information but does not replace individualized medical advice. Consult prescribing information and healthcare providers for specific recommendations.