Rabeprazole

Overview

Aciphex is used to treat erosive or ulcerative gastrointestinal acid reflux disease (GERD). It's also used to heal duodenal uclers, and in combination with amoxicillin and clarithromycin, it is prescribed to get rid of H. pylori.

People's Pharmacy Perspective

Suppressing acid is big business. Drug companies have made billions on a category of drugs called proton pump inhibitors (PPIs). These are medications such as Aciphex, Nexuium, Prevacid, Prilosec and Protonix. They are prescribed almost like candy because physicians perceive them as highly effective and totally safe.

Patients love such drugs because heartburn hurts. A wonderful meal can turn into a nightmare, especially if reflux wakes you in the middle of the night. And there is concern that repeated reflux (with its corrosive chemicals) can scar the esophagus and increase the risk of cancer. So what’s not to love about acid suppressing drugs?

Have you ever asked yourself why we make acid in the first place? A healthy stomach is incredibly efficient at churning out acid. And it’s not just humans. Most animals also make acid in their stomachs. That’s right, dogs, cats, cows, snakes, sheep and even snails make acid. Scientists suspect that vertebrates have been making acid in their stomachs for at least 300 million years.

Is this just a giant mistake? Did Mother Nature mess up? Well, according to the drug companies that make PPIs it must have all been a cosmic joke, because now that they can stop the acid, all should be well with the universe. But perhaps Mother Nature was on to something and shutting down acid production has some unintended consequences.

For one thing, acid serves as a powerful barrier to bacterial infection. Even with our obsession with cleanliness, there are a lot of nasty bugs out there. We swallow this stuff with our food and we stick our fingers in our mouths and they are loaded with germs. There is growing concern that PPIs are associated with an increased risk of pneumonia (Archives of Internal Medicine, May 14, 2007) and serious digestive tract infections (World Journal of Gastroenterology, Apr 7, 2009).

There are other concerns that have arisen with long-term acid suppression. Absorption of vitamin B12 is best accomplished in an acid stomach environment. Concerns have been raised that PPIs like Aciphex may make it harder for some people to absorb this crucial nutrient from the diet (Basic & Clinical Pharmacology & Toxicology, online, Jan. 2006). Another controversial issue that has the gastroenterology community up in arms is a report in the Journal of the American Medical Association (JAMA, Dec. 27, 2006) linking long-term PPI therapy at high doses to an increased risk of hip fracture. Whether this is due to poor calcium absorption remains unclear (American Journal of Gastroenterology, Mar., 2009.

Stopping PPIs can be quite a challenge. Since the stomach seems to “think” that acid is essential for good health, the cells there try extra hard to make acid even with a PPI on board. When such drugs are discontinued abruptly, the acid-making cells go into hyperdrive. For days, and sometimes weeks (or months), the stomach churns our extra acid. Think about your nose if your overuse a nasal spray. When you stop, there is something called rebound nasal congestion. The blood vessels overcompensate and leave you feeling totally stopped up. So to rebound acid production in the stomach can lead to horrific heartburn. There are very few “official” recommendations about how to get off PPIs without experiencing serious reflux discomfort.

Bottom line: Proton Pump Inhibitors like Aciphex and Nexium are very good at suppressing the production of stomach acid and reducing symptoms of GERD and healing stomach ulcers. Whether the unanticipated adverse effects described above will turn out to be of serious concern remains to be determined. In the meantime, millions pop their PPIs without knowing the long-term consequences. We hope this story turns out well because the stakes are high.

Common Side Effects

• Headache
• Nausea
• Diarrhea
• General abdominal discomform
• Gas 
• Dry mouth and/or sore throat
  

Serious Side Effects

• Blood problems (thrombocytopenia, etc)
• Liver issues
• Serious allergic reactions
• Severe skin reactions
• Irritation of the pancreas (pancreatitis)
• Muscle break down (rhambomyolysis)
• Broken hips (rare and controversial and only linked to long-term use)
  

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9287

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Aciphex 

For Drug Interaction Information check out iGuard:

http://www.iguard.org/