Pariet (rabeprazole sodium) is a proton pump inhibitor (PPI) engineered for potent and sustained suppression of gastric acid secretion. It is clinically indicated for the treatment of conditions such as gastroesophageal reflux disease (GERD), duodenal and gastric ulcers, and Zollinger-Ellison syndrome. By specifically targeting the proton pumps in the stomach’s parietal cells, Pariet offers a targeted mechanism of action that promotes rapid symptomatic relief and facilitates the healing of acid-related mucosal damage. Its optimized pharmacokinetic profile ensures reliable 24-hour acid control with a single daily dose, making it a cornerstone in modern gastroenterological therapy for both acute management and maintenance treatment.

Features

• Active Pharmaceutical Ingredient: Rabeprazole sodium (10 mg or 20 mg enteric-coated tablets).
• Pharmacological Class: Substituted benzimidazole; Proton Pump Inhibitor (PPI).
• Mechanism of Action: Selective and irreversible inhibition of H+/K+ ATPase (the proton pump) at the secretory surface of gastric parietal cells.
• Dosage Form: Delayed-release enteric-coated tablets to ensure drug delivery past the acidic environment of the stomach.
• Onset of Action: Rapid activation with a significant antisecretory effect observable within one hour of administration.
• Duration of Action: Provides extended suppression of gastric acid secretion for over 24 hours.
• Bioavailability: Approximately 52% and is not significantly altered by food intake, though standard administration is recommended before a meal.

Benefits

• Achieves profound and prolonged acid suppression, creating an optimal environment for the healing of erosive esophagitis and peptic ulcers.
• Provides rapid and effective relief from the painful symptoms of GERD, including heartburn and regurgitation.
• Reduces the risk of ulcer recurrence in patients requiring maintenance therapy or those on long-term NSAID treatment (when co-prescribed).
• Offers a favorable pharmacokinetic profile with minimal potential for interactions with other drugs metabolized by the CYP450 system, compared to some older PPIs.
• Enables convenient once-daily dosing for most indications, supporting high levels of patient adherence to treatment regimens.
• Serves as a critical component in Helicobacter pylori eradication regimens, significantly improving success rates when combined with antibiotics.

Common use

Pariet is prescribed for a range of acid-related disorders. Its primary uses include the treatment and maintenance of healing of erosive gastroesophageal reflux disease (GERD). It is also indicated for the healing of duodenal ulcers and gastric ulcers, as well as for the long-term treatment of pathological hypersecretory conditions, such as Zollinger-Ellison syndrome. Furthermore, it is a key element in combination therapy for the eradication of Helicobacter pylori infection in patients with peptic ulcer disease, which is a leading cause of ulcer recurrence.

Dosage and direction

The dosage of Pariet is contingent upon the specific condition being treated and individual patient response. Administration is typically oral, once daily.

• Erosive GERD or Ulcer Healing: The usual adult dose is 20 mg once daily for 4 to 8 weeks. For maintenance therapy, 10 mg or 20 mg once daily may be used.
• H. pylori Eradication: Pariet 20 mg is taken twice daily (morning and evening) for 7 days, in combination with two antibiotics (e.g., amoxicillin and clarithromycin).
• Zollinger-Ellison Syndrome: The initial dose is 60 mg once daily. The dosage may be titrated upwards based on patient response; some patients require divided doses.
• Administration: Tablets must be swallowed whole and should not be chewed, crushed, or split. They can be taken with or without food, but are most effective when taken before a meal, typically in the morning.

Precautions

• Symptom Masking: Response to therapy does not preclude the presence of gastric malignancy. Pariet can alleviate symptoms, potentially delaying the diagnosis of a underlying gastric cancer. Appropriate diagnostic measures should be performed prior to initiation of therapy to exclude malignancy.
• Bone Fracture: Long-term and high-dose PPI therapy may be associated with an increased risk of osteoporosis-related fractures of the hip, wrist, or spine. Use the lowest effective dose and shortest duration of therapy appropriate for the condition being treated.
• Hypomagnesemia: Symptomatic and asymptomatic hypomagnesemia (low magnesium levels in the blood) has been reported rarely with prolonged PPI use (typically >1 year). Monitoring magnesium levels prior to initiation of long-term therapy and periodically thereafter should be considered.
• Acute Tubulointerstitial Nephritis: This form of kidney inflammation has been observed in patients taking PPIs and may occur at any time during therapy. Discontinue Pariet if this condition develops.
• Clostridioides difficile-Associated Diarrhea (CDAD): PPI use may increase the risk of developing CDAD, especially in hospitalized patients. Consider a diagnosis of CDAD in patients who develop diarrhea that does not improve.
• Cutaneous and Systemic Lupus Erythematosus: New onset or exacerbation of existing lupus has been reported with PPI use. Discontinue Pariet if signs or symptoms of lupus occur.
• Cyanocobalamin (Vitamin B12) Deficiency: Long-term PPI use (beyond 3 years) may lead to malabsorption of vitamin B12 due to hypochlorhydria.

Contraindications

Pariet is contraindicated in patients with known hypersensitivity to rabeprazole, any substituted benzimidazole, or to any of the excipients in the formulation. Concomitant use with rilpivirine-containing products is contraindicated due to the potential for decreased rilpivirine absorption and loss of virologic response.

Possible side effect

Like all medicines, Pariet can cause side effects, although not everybody gets them. Most are mild to moderate in severity.

• Very Common (≥1/10): Headache.
• Common (≥1/100 to <1/10): Diarrhea, nausea, vomiting, abdominal pain, flatulence, constipation, dry mouth, dizziness, insomnia, somnolence, cough, pharyngitis, rhinitis, back pain, weakness/fatigue.
• Uncommon (≥1/1,000 to <1/100): Anorexia, gastritis, taste perversion, nervousness, chest pain, urinary tract infection, increased hepatic enzymes.
• Rare (≥1/10,000 to <1/1,000): Leukopenia, thrombocytopenia, hypersensitivity reactions (e.g., rash, urticaria, pruritus), blurred vision, hepatitis, jaundice, hepatic failure, anaphylaxis, angioedema, interstitial nephritis, increased sweating, fever, depression, hallucinations, confusion (particularly in severely ill patients), muscle pain, joint pain, fractures.

Drug interaction

Rabeprazole is metabolized primarily by non-enzymatic processes and has a lower potential for CYP450-mediated drug interactions than omeprazole or lansoprazole. However, significant interactions include:

• Drugs Dependent on Gastric pH for Absorption: Pariet-induced hypochlorhydria may alter the absorption of drugs where gastric pH is an important determinant of bioavailability. This includes drugs such as ketoconazole, itraconazole, erlotinib, and iron salts (ferrous sulfate), leading to reduced absorption and efficacy.
• Warfarin: Increased INR and prothrombin time have been reported with concomitant use of warfarin and PPIs. Monitoring of INR is recommended, particularly during initiation and withdrawal of Pariet therapy.
• Methotrexate: Concomitant use of PPIs with methotrexate (primarily at high dose) may elevate methotrexate serum levels, increasing its toxicity. This is thought to be due to competition for renal tubular secretion.
• Digoxin: A slight increase in digoxin bioavailability has been observed.
• Atazanavir and Nelfinavir: PPIs significantly reduce the absorption and plasma concentrations of these HIV protease inhibitors, leading to a loss of therapeutic effect. Concomitant use is not recommended.
• Tacrolimus: Potential increase in tacrolimus whole blood levels.

Missed dose

If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. A double dose should not be taken to make up for a missed one. Maintaining a consistent daily schedule is important for optimal acid control.

Overdose

Experience with rabeprazole overdose is limited. Reported doses have varied, and no specific antidote is known. Rabeprazole is extensively protein-bound and is, therefore, not readily dialyzable. The standard management of overdose should be applied, which includes monitoring and supportive care. Treatment should be symptomatic.

Storage

Store below 25°C (77°F). Keep the tablets in their original blister pack or bottle to protect them from moisture. Keep out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the carton and blister after “EXP.”

Disclaimer

This information is for educational and informational purposes only and does not constitute medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided is based on the product’s Summary of Product Characteristics (SmPC) and may not be exhaustive or fully updated.

Reviews

• Clinical Efficacy (Gastroenterologist): “In my practice, Pariet has been a reliable first-line PPI for managing severe GERD. Its rapid onset of action is particularly beneficial for providing patients with prompt symptomatic relief. I find its efficacy in healing erosive esophagitis to be on par with other leading PPIs, and the 20mg dose is often sufficient for maintenance in the majority of my patients.”
• Patient Experience (Long-term GERD sufferer): “After struggling with persistent heartburn for years, my doctor switched me to Pariet. The difference was noticeable within a few days. I can now eat meals without the constant fear of reflux. The once-daily dosing is easy to remember, and I have experienced no significant side effects over the past 18 months of use.”
• H. pylori Eradication (Clinical Study Data): “Combination therapy incorporating rabeprazole has consistently demonstrated high eradication rates for H. pylori in numerous clinical trials. Its potent acid suppression creates a more favorable environment for antibiotic efficacy, which is crucial for the success of the triple therapy regimen and for preventing ulcer recurrence.”