Ontime (Tablets) Instructions for Use

ATC Code

A02BC04 (Rabeprazole)

Active Substance

Rabeprazole (Rec.INN WHO registered)

Clinical-Pharmacological Group

H⁺-K⁺-ATPase inhibitor. Antiulcer drug

Pharmacotherapeutic Group

Proton pump inhibitor

Pharmacological Action

Proton pump inhibitor. Rabeprazole belongs to the class of antisecretory compounds that are chemically substituted benzimidazoles.

Rabeprazole inhibits the activity of the H+/K+ ATPase enzyme (proton pump), thereby blocking the final stage of hydrochloric acid production.

This effect is dose-dependent and leads to the inhibition of both basal and stimulated gastric acid secretion, regardless of the stimulus.

It does not exhibit anticholinergic properties.

Pharmacokinetics

After oral administration, it is absorbed from the gastrointestinal tract.

For a 20 mg dose, C_max is achieved in 3.5 hours.

Changes in C_max and AUC are linear (within the dose range of 10 mg to 40 mg).

The absolute bioavailability is approximately 52% due to the first-pass effect through the liver.

The bioavailability of rabeprazole does not increase with repeated administration.

Food intake and time of day do not affect the absorption of rabeprazole.

Plasma protein binding is 97%.

Rabeprazole sodium undergoes a first-pass effect.

It is metabolized in the liver by isoenzymes of the CYP system.

The main metabolites (thioether and carboxylic acid) and minor metabolites (sulfone, dimethyl thioether, and mercapturic acid conjugate) are present in low concentrations.

Indications

Adults aged 18 years and older: gastric ulcer in the acute phase and anastomotic ulcer; duodenal ulcer in the acute phase; erosive GERD or reflux esophagitis, maintenance therapy for GERD, non-erosive GERD; Zollinger-Ellison syndrome and other conditions characterized by pathological hypersecretion; in combination with antibacterial therapy for the eradication of Helicobacter pylori in patients with peptic ulcer disease.

Adolescents aged 12 years and older: GERD.

ICD codes

Dosage Regimen

Administer tablets orally, swallowed whole with water. Do not chew or crush the tablets.

For duodenal ulcer and gastric ulcer in the acute phase, the dose is 20 mg once daily for 4 to 8 weeks. Consider a maintenance dose of 10 mg or 20 mg once daily for recurrent cases.

For erosive GERD or reflux esophagitis, the dose is 20 mg once daily for 4 to 8 weeks. For long-term maintenance therapy of GERD, use 10 mg or 20 mg once daily.

For symptomatic treatment of GERD (non-erosive), the dose is 10 mg once daily for 4 weeks. If symptoms persist, consider an additional 4-week course.

For Zollinger-Ellison syndrome and other hypersecretory conditions, the initial dose is 60 mg once daily. Adjust the dose individually; some patients may require divided doses. Doses up to 100 mg daily have been used.

For Helicobacter pylori eradication in peptic ulcer disease, use 20 mg twice daily as part of a combination therapy regimen for 7 days. Administer with amoxicillin 1000 mg and clarithromycin 500 mg, both twice daily.

For adolescents aged 12 years and older with GERD, the dose is 10 mg once daily for up to 8 weeks. For severe esophagitis, use 20 mg once daily for up to 8 weeks.

Take the dose in the morning before a meal. Dosage adjustment is not typically required for elderly patients or those with mild to moderate hepatic or renal impairment. Use with caution in patients with severe hepatic impairment.

Adverse Reactions

Immune system disorders: rarely – acute systemic allergic reactions.

Blood and lymphatic system disorders: rarely – thrombocytopenia, neutropenia, leukopenia.

Metabolism and nutrition disorders: rarely – hypomagnesemia.

Hepatobiliary disorders: infrequently – increased liver enzyme activity; rarely – hepatitis, jaundice, hepatic encephalopathy.

Renal and urinary disorders: very rarely – interstitial nephritis.

Skin and subcutaneous tissue disorders: rarely – bullous eruptions, urticaria; very rarely – erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome;

Musculoskeletal and connective tissue disorders: rarely – myalgia, arthralgia.

Reproductive system and breast disorders: very rarely – gynecomastia.

Contraindications

Hypersensitivity to rabeprazole or substituted benzimidazoles; pregnancy, breastfeeding period; children under 12 years of age (for all indications), children and adolescents under 18 years of age (except for indications for adolescents over 12 years).

With caution in severe renal impairment.

Use in Pregnancy and Lactation

Contraindicated for use during pregnancy and lactation (breastfeeding).

Use in Hepatic Impairment

No dose adjustment is required for patients with hepatic impairment; however, Rabeprazole should be used with caution in patients with severe hepatic impairment.

Use in Renal Impairment

Should be used with caution in patients with severe renal impairment.

Pediatric Use

Contraindicated for use in all indications in children under 12 years of age.

Contraindicated for use in children and adolescents under 18 years of age (except for indications for adolescents over 12 years).

Geriatric Use

Patients aged 55 years and older should consult a doctor if symptoms appear or change during therapy with rabeprazole.

Special Precautions

Before starting therapy, it is necessary to exclude malignant neoplasms of the stomach, because the use of rabeprazole may mask symptoms and delay correct diagnosis.

No dose adjustment is required for patients with hepatic or renal impairment; however, Rabeprazole should be used with caution in patients with severe hepatic impairment.

Proton pump inhibitor therapy may lead to an increased risk of gastrointestinal infections caused by Clostridium difficile.

When used concomitantly with rabeprazole, the doses of ketoconazole and digoxin should be adjusted.

Patients with long-term recurring symptoms of indigestion or heartburn should be regularly monitored by a doctor.

Patients over 55 years of age who daily use over-the-counter medications to relieve symptoms of heartburn and indigestion should inform their attending physician.

Rabeprazole should not be used concomitantly with other acid-reducing agents, such as H₂-receptor blockers or proton pump inhibitors.

In experimental studies, no carcinogenic effect of rabeprazole was established; however, ambiguous results were obtained in mutagenicity studies.

Tests on mouse lymphoma cells were positive, while the in vivo micronucleus test and the in vivo and in vitro DNA repair tests were negative.

Drug Interactions

Concomitant use with digoxin may lead to a slight to moderate increase in the plasma concentration of digoxin.

Concomitant use with ketoconazole reduces its bioavailability.

Storage Conditions

Store at 2°C (36°F) to 25°C (77°F). Keep in original packaging, protected from light. Keep out of reach of children.

Dispensing Status

Rx Only

Important Safety Information

This information is for educational purposes only and does not replace professional medical advice. Always consult your doctor before use. Dosage and side effects may vary. Use only as prescribed.