PARIET 20/MG TAB 14/TAB

Indications

Approved Uses

Erosive or ulcerative GERD (healing), maintenance of healing of erosive/ulcerative GERD, symptomatic GERD, duodenal ulcer (healing), Helicobacter pylori eradication to reduce risk of duodenal ulcer recurrence (in combination with antibiotics), and pathological hypersecretory conditions including Zollinger-Ellison syndrome.

Off-Label Uses

Prevention of NSAID-associated ulcers in high-risk patients, laryngopharyngeal reflux (trial), functional dyspepsia (selected patients), and stress-ulcer prophylaxis in critically ill patients (institution-specific protocols).

Dosage & Administration

Dosing by Condition

Healing of erosive/ulcerative GERD: 20 mg once daily for 4-8 weeks
Maintenance of healing of erosive/ulcerative GERD: 20 mg once daily
Symptomatic GERD: 20 mg once daily for up to 4 weeks
Duodenal ulcer (healing): 20 mg once daily for up to 4 weeks
H. pylori eradication (with antibiotics): 20 mg twice daily for 7 days (with amoxicillin + clarithromycin where appropriate per local resistance guidance)
Pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome): Initial 60 mg once daily; titrate based on acid control/clinical response (may require divided dosing; maximum per labeling varies by jurisdiction)

Initial Dose

20 mg once daily.

Maintenance Dose

10-20mg once daily

Maximum Dose

120mg per day (Zollinger-Ellison syndrome); 20mg per day for standard indications

Children's Dosage

Symptomatic GERD (12 years and older): 20 mg once daily for up to 8 weeks. Use is not recommended in children younger than 12 years of age for tablets.

Dose Adjustment Notes

No dosage adjustment is generally required in renal impairment; no adjustment is usually needed in mild-moderate hepatic impairment, but use caution in severe hepatic impairment. For Zollinger-Ellison/hypersecretory states, titrate to clinical response.

How to Take

Swallow the 20 mg enteric‑coated tablet whole with water; do not crush, chew, or split. May be taken with or without food; commonly taken once daily in the morning (before breakfast is often recommended in practice).

Side Effects

Common Side Effects

Headache, diarrhea, abdominal pain, nausea, flatulence (gas), constipation; less commonly rash and dizziness.

Side Effect Frequency

Common (≥1%): headache, diarrhea, abdominal pain, nausea, vomiting, constipation, flatulence; Uncommon (<1%): rash, dizziness, myalgia/arthralgia, elevated liver enzymes; Rare/serious: acute interstitial nephritis, hypomagnesemia (with prolonged use), severe cutaneous adverse reactions (e.g., SJS/TEN), C. difficile-associated diarrhea, lupus erythematosus

Safety & Warnings

Contraindications

Known hypersensitivity to rabeprazole, substituted benzimidazoles, or any component of the formulation; Concurrent use with rilpivirine-containing products.

Warnings & Precautions

Warnings/precautions: symptomatic improvement does not exclude gastric malignancy (evaluate alarm features/consider malignancy before or during therapy); increased risk of C. difficile-associated diarrhea; long-term use risks hypomagnesemia (monitor in prolonged therapy and in patients on digoxin/diuretics), bone fractures, and vitamin B12 deficiency; risk of acute tubulointerstitial nephritis; use caution in severe hepatic impairment; consider fundic gland polyps with long-term use.

Age Restriction

Not approved under 12 years for tablets.

Driving Warning

Safe

Drug Interactions

Drug Interactions

Key clinically relevant interactions: (1) Rilpivirine-contraindicated (requires gastric acidity for absorption). (2) Atazanavir/nelfinavir-avoid (reduced absorption/exposure). (3) High-dose methotrexate-may increase/delay clearance; consider temporary PPI interruption and monitor. (4) Warfarin-possible increased INR/bleeding; monitor INR. (5) Digoxin-may increase levels (via increased absorption/hypomagnesemia risk); monitor. (6) Azole antifungals (ketoconazole/itraconazole)-reduced absorption; avoid or adjust/monitor. (7) Tacrolimus-may increase levels; monitor troughs. (8) Clopidogrel-interaction less than omeprazole/esomeprazole but possible; prefer alternative PPI if high thrombotic risk and monitor clinically.

Interaction Severity

"MAJOR/CONTRAINDICATED or AVOID: Rilpivirine (contraindicated with PPIs due to marked reduction in absorption); atazanavir and nelfinavir (avoid-reduced antiretroviral exposure with acid suppression).
MODERATE (monitor/adjust as needed): Warfarin (monitor INR), high-dose methotrexate (consider temporary PPI interruption/monitor toxicity), tacrolimus (monitor levels), digoxin (monitor levels-risk increased with hypomagnesemia), clopidogrel (potential reduction in activation-clinical significance less than omeprazole but consider risk/benefit).
MINOR/CLINICALLY RELEVANT IN SOME CASES: Azole antifungals such as ketoconazole/itraconazole (reduced absorption due to increased gastric pH)."

Food Interaction

May be taken with or without food; no clinically meaningful food effect requiring administration with meals.

Alcohol Interaction

Safe

Special Populations

Pregnancy

Consult Doctor

Breastfeeding

Consult Doctor

Children

Symptomatic GERD (12 years and older): 20 mg once daily for up to 8 weeks. Use is not recommended in children younger than 12 years of age for tablets.

Elderly

Standard adult dosing. Use with caution due to higher risk of side effects like C. difficile infection, bone loss, and fractures.

Kidney Impairment

No adjustment needed

Liver Impairment

Mild to moderate hepatic impairment: no dosage adjustment generally required. Severe hepatic impairment: use with caution; no specific evidence-based dose reduction is established-consider lowest effective dose and monitor closely.

Storage & Patient Advice

Missed Dose

Take as soon as remembered; skip if it is almost time for the next dose. Do not take two doses at the same time.

Stopping the Medicine

Can be stopped when clinically appropriate; after prolonged/long-term use, abrupt discontinuation may cause rebound acid hypersecretion-consider tapering (dose reduction or alternate-day dosing) and/or short-term H2RA/antacid support.

Overdose

Overdose data are limited; expected effects are generally an exaggeration of adverse effects (e.g., headache, nausea/vomiting, abdominal pain, diarrhea, dizziness). No specific antidote; manage with supportive/symptomatic care and seek urgent medical/poison center advice; rabeprazole is not meaningfully removed by hemodialysis.

Patient Counseling

Swallow the enteric‑coated tablet whole (do not crush/chew/split). Take once daily as prescribed (often in the morning; can be with or without food). Use for the full prescribed course; seek advice if severe/persistent diarrhea occurs. With long-term use, discuss risks such as low magnesium and fractures and the need for periodic monitoring; report rash or hypersensitivity symptoms. Tell your clinician/pharmacist about all medicines-especially rilpivirine (do not use together), HIV protease inhibitors, warfarin, methotrexate, tacrolimus, and digoxin.

Monitoring Requirements

No routine labs are required for short courses; for long-term therapy consider periodic magnesium (especially if also on diuretics or digoxin) and assess for B12/iron deficiency and fracture risk as clinically indicated; monitor INR if on warfarin and tacrolimus levels if co-administered.

Pharmacology

Mechanism of Action

Proton pump inhibitor that irreversibly inhibits the gastric parietal cell H+/K+-ATPase, blocking the final step of acid secretion and reducing basal and stimulated acid output.

Onset of Action

Initial acid suppression begins within ~1-2 hours after a dose; maximal effect typically requires 2-4 days of daily dosing.

Duration of Effect

Approximately 24 hours (supports once-daily dosing in most patients).

Half-Life

1-2 hours.

Bioavailability

Approximately 52% (single dose; increases with repeated dosing)

Metabolism

Hepatic metabolism primarily via non-enzymatic reduction to a thioether metabolite; secondarily via CYP2C19 and CYP3A4 (forming sulfone and other metabolites)

Excretion

Renal (approximately 90% as metabolites), fecal (approximately 10%)

Protein Binding

Approximately 97% (often cited range ~96-97%)

Product Information

Available Dosage Forms

Enteric‑coated tablet (oral).

Composition per Dose

Each enteric-coated tablet: 20mg rabeprazole sodium

Generic Availability

Yes

OTC Alternatives

OTC options for mild/intermittent symptoms include antacids (e.g., aluminum/magnesium hydroxide, calcium carbonate) and H2 blockers (e.g., famotidine); OTC PPIs (e.g., omeprazole 20 mg) may be available in some countries/markets.

Gi Condition

Acid Reflux/GERD, Ulcer

Legal Disclaimer - Al Mujtama Pharmacy

The product information provided is derived from verified pharmaceutical references and is intended for general health education only. It is not a substitute for professional medical advice, diagnosis, or treatment.

Al Mujtama Pharmacy assumes no legal or medical liability for:

• Any therapeutic decision made based on the information displayed without consulting a licensed physician or pharmacist
• Any discrepancy between the information provided and the product's package insert or SFDA guidelines
• Any misuse of medication resulting from personal interpretation of the content displayed

Important notice: Drug formulations and instructions may vary between production batches. Always rely on the leaflet included inside the product packaging you have, and consult your pharmacist or physician before starting, adjusting, or discontinuing any medication.

By using this content, you acknowledge that you have read this disclaimer and agree that Al Mujtama Pharmacy bears no liability arising from reliance on this information as a substitute for direct medical consultation.

Your health is a trust - always consult your doctor first.