Pariet

Generic Name: Rabeprazole sodium
Product Name: Pariet

Indication

Pariet is used for the treatment of:

• Stomach ulcers;
• Ulcers in the duodenum (the area of the small intestine that lies just after the stomach);
• The symptoms of gastroesophageal reflux disease.

In combination with two antibiotic agents, Pariet is used for the eradication of Helicobacter pylori. Helicobacter pylori is a bacteria that is strongly linked to stomach ulcerations and chronic gastritis.

Action

Pariet relieves the symptoms of reflux and ulcers by slowing down the secretion of acid by the cells that line the stomach. It does this by inhibiting a single type of enzyme (a protein that allows other chemical reactions to occur faster) called a ‘proton pump’ that is needed to produce acid. So, by inhibiting this enzyme, the final stage in acid production is stopped.

The acid suppression effect of Pariet occurs very quickly (within 2-4 hours) and lasts up to 23 hours after the first dose. Normal acid production can be decreased by 69%. Also at 23 hours, the amount of acid produced when eating food (which is when a lot of acid is created) is reduced by 82%.

The symptoms of many of the conditions treated by Pariet are very similar. Your doctor can sometimes recommend a medical procedure called an endoscopy, where a flexible fibre-optic tube is passed down the throat into the stomach, allowing the gastroenterology doctor to see the exact cause of the symptoms. People are put into a light sleep for the few minutes it takes to do the test, and most people have no recollection of it afterwards.

Dose advice

Dose information

The dosage of Pariet will depend on what condition is being treated. The usual doses are as follows:

The use of Pariet is not recommended in children.

Doses do not need to be adjusted for elderly patients.

Contraindications

Pariet should not be used under certain circumstances. Tell your doctor if you have:

• Allergy to rabeprazole sodium, proton pump inhibitors, or any other ingredient in the product.

Precautions 

Special care needs to be taken when taken Pariet under certain circumstances. Tell your doctor if you have:

• Stomach cancer: Symptomatic response to therapy with Pariet does not exclude the presence of stomach cancer, and therefore the possibility of cancer should be ruled out by your doctor before commencing treatment with Pariet.
• If symptoms persist beyond six months despite maintenance therapy with Pariet, your doctor will initiate further investigations and review your therapy.
• Liver disorder.

Drug interactions

Pariet is metabolised by isoenzymes of CYP450. Tell your doctor if you are taking:

• Cyclosporin;
• Digoxin;
• Ketoconazole;
• Drugs whose absorption depends on gastric pH;
• Any other medications or supplements, including over-the-counter drugs.

Pregnancy

Pariet is a Pregnancy Category B1 medication. Studies have revealed no evidence of impaired fertility or harm to the foetus due to rabeprazole, however, there are no adequate and well-controlled studies in pregnant women, and post-marketing experience is very limited. For this reason, it is recommended that omeprazole is used if a PPI is required in pregnant women, as it appears safe to use, and more human data has been gathered.

Breastfeeding

While it is not known whether Pariet is excreted in human breast milk as there have been no studies conductied on lactating women, it is almost certainly safe to use. Pariet is acid labile and small amounts secreted in milk will likely be destroyed by acid in the infants stomach. There is a lack of evidence, however, and there may be potential adverse reactions to nursing infants from Pariet. A decision should be made to discontinue nursing or discontinue the drug, taking into account the importance of the drug for the mother.

Schedule

Pariet is a Schedule 4 medication.

Common side effects

Side effects from Pariet are generally not serious, but some common side effects can occur in 1-10% of people and include:

• Headache, dizziness
• Diarrhoea, nausea, abdominal pain, flatulence, vomiting, constipation
• Inflammation of the nose and throat, cough
• Nonspecific pain, back pain
• Rash
• Flu-like symptoms, infections, insomnia, chest pain

Uncommon side effects

Less common side effects occur in between 0.1-1% of people, and include:

• Anorexia,
• Inflammation of the stomach,
• Weight gain,
• Inflammation of the tongue,
• Itching,
• Sweating,
• Visual and taste disturbances and
• A raised white cell count.

Consult your doctor if you experience any of the above symptoms, or any other unusual or abnormal symptoms that concern you.

References

1. Rabeprazole [online]. Adelaide, SA: Australian Medicines Handbook; January 2007 [cited 15 March 2007]. Available from: URL link
2. Product Information: Pariet. North Ryde, NSW: Janssen-Cilag Pty Ltd; 2006.
3. Pariet [online]. St Leonards, NSW: MIMS Online; 15 September 2006 [cited 15 March 2007]. Available from: URL link
4. Bytzer P, Blum A, De Herdt D, Dubois D. Six-month trial of on-demand rabeprazole 10 mg maintains symptom relief in patients with non-erosive reflux disease. Aliment Pharmacol Ther. 2004;20(2):181-8. [Abstract | Full text]
5. Bour B, Staub JL, Chousterman M, et al. Long-term treatment of gastro-oesophageal reflux disease patients with frequent symptomatic relapses using rabeprazole: On-demand treatment compared with continuous treatment. Aliment Pharmacol Ther. 2005;21(7):805-12. [Abstract | Full text]
6. Robinson M, Fitzgerald S, Hegedus R, et al. Onset of symptom relief with rabeprazole: A community-based, open-label assessment of patients with erosive oesophagitis. Aliment Pharmacol Ther. 2002;16(3):445-54. [Abstract | Full text]

For further information talk to your doctor.