Aciphex

Action

Reduces gastric acid secretion and increases gastric mucus and bicarbonate production, creating a protective coating on gastric mucosa

Availability

Tablets (delayed-release): 20 mg

Indications and dosages

➣ Erosive or ulcerative gastroesophageal reflux disease (GERD)

Adults: 20 mg P.O. daily for 4 to 8 weeks. If healing doesn't occur within 8 weeks, another 8 weeks of therapy may be considered. Maintenance dosage is 20 mg P.O. daily.

➣ GERD

Adults: 20 mg P.O. daily for 4 weeks. If symptoms don't resolve after 4 weeks, another course of therapy may be considered.

➣ Short-term treatment of symptomatic GERD

Adolescents ages 12 and older: 20 mg P.O. daily for up to 8 weeks

➣ Hypersecretory conditions, including Zollinger-Ellison syndrome

Adults: Initially, 60 mg P.O. daily; adjust dosage as needed up to 100 mg P.O. daily as a single dose or 60 mg P.O. b.i.d. Maximum daily dosage is 120 mg.

➣ Duodenal ulcer

Adults: 20 mg P.O. daily for up to 4 weeks

➣ Helicobacter pylori eradication

Adults: 20 mg P.O. b.i.d. for 7 days (given with amoxicillin and clarithromycin)

Off-label uses

• Dyspepsia

• Benign gastric ulcer

Contraindications

• Hypersensitivity to drug, its components, or benzimidazoles

Precautions

Use cautiously in:

• severe hepatic impairment

• concurrent use of atazanavir (not recommended)

• pregnant patients

• breastfeeding patients (not recommended)

• children (safety not established).

Administration

• Don't crush or split tablets.

• Give without regard to food.

Adverse reactions

CNS: headache

Metabolic: hypomagnesemia

Musculoskeletal: fractures of hip, wrist, spine (with long-term daily use)

Interactions

Drug-drug. Atazanavir: substantially decreased atazanavir plasma concentration and reduced therapeutic effect Combined administration of rabeprazole, amoxicillin, and clarithromycin: increased rabeprazole and 14-hydroxyclarithromycin plasma concentrations

Gastric pH-dependent drugs (such as digoxin, ketoconazole): increased or decreased absorption

Methotrexate: possibly elevated and prolonged methotrexate serum level

Warfarin: increased risk of bleeding

Drug-diagnostic tests. Magnesium: decreased level

Patient monitoring

• Stay alert for symptomatic response, but know that a positive response doesn't rule out gastric cancer.

• Monitor magnesium level before starting therapy and periodically thereafter in patients expected to be on prolonged therapy or who take proton pump inhibitors with drugs such as digoxin or drugs that may cause hypomagnesemia (such as diuretics).

Patient teaching

• Tell patient he may take with or without food. Instruct him not to crush, chew, or split tablets.

• Caution female patient not to breastfeed during therapy.

• As appropriate, review all significant adverse reactions and interactions, especially those related to the drugs mentioned above.