Description
Latin name
Pariet
Release form
Enteric coated tablets.
packaging 28 pcs
Pharmacological action
Pharmacodynamics
A drug that reduces the secretion of the glands of the stomach – proton pump inhibitor.
Mechanism of action
Rabeprazole sodium belongs to the class of antisecretory substances derived from benzimidazole. Rabeprazole sodium inhibits the secretion of gastric juice by specific inhibition of H + / K + ATPase on the secretory surface of parietal cells of the stomach. H + / K + ATPase is a protein complex that functions as a proton pump, thus rabeprazole sodium is an inhibitor of the proton pump in the stomach and blocks the final stage of acid production.
This effect is dose-dependent and leads to the suppression of both basal and stimulated secretion of acid, regardless of the irritant. Rabeprazole sodium does not have anticholinergic properties.
Antisecretory effect of
After oral administration of 20 mg of rabeprazole sodium, the antisecretory effect develops within an hour. Inhibition of basal and stimulated acid secretion 23 hours after taking the first dose of rabeprazole sodium is 69% and 82%, respectively, and lasts up to 48 hours.
This duration of pharmacodynamic action is much higher than predicted for T1 / 2 (about one hour). This effect can be explained by the prolonged binding of the drug substance to the H + / K + ATPase of the parietal cells of the stomach. The value of the inhibitory effect of rabeprazole sodium on acid secretion reaches a plateau after three days of taking rabeprazole sodium. When you stop taking secretory activity is restored within 1-2 days.
Effect on plasma gastrin level
In clinical trials, patients took 10 or 20 mg of rabeprazole sodium daily for up to 43 months. Plasma gastrin was elevated for the first 2 8 weeks, reflecting an inhibitory effect on acid secretion. The concentration of gastrin returned to its initial level, usually within 1-2 weeks after discontinuation of treatment.
Effect on enterochromatin-like cells
When examining biopsy samples of a human stomach from the antrum and the bottom of the stomach 500 patients who received rabeprazole sodium or a reference drug for 8 weeks, persistent changes in the morphological structure of enterochromin-like cells, the severity of gastritis, the frequency of atrophic gastritis, intestinal metaplasia, or the spread of Helicobacter pylori infection have not been detected.
In a study of more than 400 patients who received rabeprazole sodium (10 mg / day or 20 mg / day) for up to 1 year, the incidence of hyperplasia was low and comparable to that for omeprazole (20 mg / kg). Not a single case of adenomatous changes or carcinoid tumors observed in rats was recorded.
Other effects of
Systemic effects of rabeprazole sodium in relation to the central nervous system, cardiovascular or respiratory systems are not currently detected. It was shown that rabeprazole sodium when taken orally at a dose of 20 mg for 2 weeks does not affect thyroid function, carbohydrate metabolism, the level of parathyroid hormone in the blood, as well as the level of cortisol, estrogen, testosterone, prolactin, glucagon, follicle-stimulating hormone (FSH), luteinizing hormone (LH), renin, aldosterone and growth hormone.
Pharmacokinetics
Absorption
Rabeprazole is rapidly absorbed from the intestine, and its peak plasma concentrations are reached approximately 3.5 hours after a dose of 20 mg. The change in peak plasma concentrations (Cmax) and values of the area under the concentration-time curve (AUC) of rabeprazole are linear in the dose range from 10 to 40 mg.
Absolute bioavailability after oral administration of 20 mg (compared with intravenous administration) is about 52%. In addition, bioavailability does not change with multiple doses of rabeprazole. In healthy volunteers, the T1 / 2 period from plasma is about 1 hour (varying from 0.7 to 1.5 hours), and the total clearance is 3.8 ml / min / kg.
In patients with chronic liver damage, AUC is doubled compared with healthy volunteers, which indicates a decrease in first-pass metabolism, and T1 / 2 from plasma is increased by 2-3 times. Neither the time of taking the drug during the day, nor antacids affect the absorption of rabeprazole. Taking the drug with fatty foods slows down the absorption of rabeprazole for 4 hours or more, however, neither Cmax nor the degree of absorption change.
Distribution of
In humans, the degree of binding of rabeprazole to plasma proteins is about 97%.
Metabolism and excretion of
In healthy people
After administration of a single oral dose of 20 mg of 14C-labeled rabeprazole sodium, unchanged drug was not found in the urine. About 90% of rabeprazole is excreted in the urine mainly in the form of two metabolites: a conjugate of mercapturic acid (M5) and carboxylic acid (M6), as well as in the form of two unknown metabolites identified during toxicological analysis.
The remainder of the rabeprazole sodium taken is excreted in the feces. The total elimination is 99.8%. These data indicate a small excretion of metabolites of rabeprazole sodium with bile. The main metabolite is thioether (M1). The only active metabolite is desmethyl (M3), however, it was observed in low concentration in only one study participant after taking 80 mg of rabeprazole.
End-stage renal failure
In patients with stable end-stage renal failure who require maintenance hemodialysis (creatinine clearance <5ml / min / 1.73m2), excretion of rabeprazole sodium is similar to that for healthy volunteers. AUC and Cmax in these patients were approximately 35% lower than in healthy volunteers. The average T1 / 2 of rabeprazole was 0.82 hours in healthy volunteers, 0.95 hours in patients during hemodialysis, and 3.6 hours after hemodialysis. The clearance of the drug in patients with kidney diseases requiring hemodialysis was approximately two times higher than in healthy volunteers. Chronic compensated cirrhosis Patients with chronic compensated cirrhosis of the liver tolerate sodium rabeprazole at a dose of 20 mg once a day, although the AUC is doubled and Cmax is increased by 50% compared with healthy volunteers of the corresponding gender. Elderly patients In elderly patients, elimination of rabeprazole is somewhat delayed. After 7 days of taking rabeprazole at 20 mg per day in elderly people, the AUC was approximately twice as high, and Cmax increased by 60% compared with young healthy volunteers. However, no signs of cumulation of rabeprazole were noted. CYP2C19 polymorphism In patients with a slow metabolism of CYP2C19 after 7 days of taking rabeprazole at a dose of 20 mg per day, AUC increases by 1.9 times, and Cmax by 1.6 times compared with the same parameters for fast metabolizers , while time as Cmax increases by 40%. Indications Peptic ulcer in step exacerbation and ulcer anastomosis duodenal ulcer in the acute stage erosive GERD or reflux esophagitis maintenance therapy of gastroesophageal reflux disease non-erosive gastroesophageal reflux disease Zollinger-Ellison syndrome and other conditions characterized by pathological hypersecretion of in combination with appropriate antibacterial therapy for eradication of Helicob acter pylori in patients with peptic ulcer. Contraindications Hypersensitivity to rabeprazole, substituted benzimidazoles or to auxiliary components of the preparation pregnancy and lactation period children under 12 years of age. Precautions: use in patients with severe severe renal failure in childhood. Composition Active ingredients: rabeprazole sodium 20 mg, which corresponds to the content of rabeprazole 18.85 mg. Excipients: mannitol (mannitol) – 40.0 mg, magnesium oxide – 63.0 mg, hydroxypropyl cellulose slightly substituted (hyprolose) – 19.5 mg, hydroxypropyl cellulose (hyprolose) – 3.0 mg, srdlpp magnesium – 1.5 mg, ethyl cellulose – 1.0 mg, hypromellose phthalate – 12.0 mg, diacetylated monoglyceride – 1.2 mg, talcum – 1.13 mg, titanium dioxide (E171) – 0.6 mg, iron oxide yellow – 0.07 mg, carnauba wax – 0.025 mg, edible red ink A1 (white shellac, iron oxide red, carnauba wax, glyceric acid ester, ethanol dehydrated, 1-butanol). Dosage and administration The tablets of the drug Pariet should be swallowed whole without chewing or crushing. It was found that neither the time of day nor the meal affects the activity of rabeprazole sodium. For gastric ulcer in the acute stage and anastomosis ulcer It is recommended to take 20 mg orally once a day. Usually, cure occurs after 6 weeks of therapy, but in some cases, the duration of treatment can be increased by another 6 weeks. In case of peptic ulcer in the exacerbation stage It is recommended to take 20 mg orally once a day. The duration of treatment is from 2 to 4 weeks. If necessary, the duration of treatment can be increased by another 4 weeks. In the treatment of erosive gastroesophageal reflux disease (GERD) or reflux esophagitis It is recommended to take 20 mg orally once a day. The duration of treatment is from 4 to 8 weeks. If necessary, the duration of treatment can be increased by another 8 weeks. With maintenance therapy for gastroesophageal reflux disease (GERD) It is recommended that you take orally 20 mg once a day. The duration of treatment depends on the patient’s condition. For non-erosive gastroesophageal reflux disease (NERD) without esophagitis It is recommended to be taken orally at 20 mg once a day. If the symptoms do not disappear after four weeks of treatment, an additional examination of the patient should be performed. After stopping the symptoms, to prevent their subsequent occurrence, the drug should be taken orally once a day upon request. For the treatment of Zollinger-Alison syndrome and other conditions characterized by pathological hypersecretion The dose is selected individually. The initial dose is 60 mg per day, then the dose is increased and the drug is prescribed in a dose of up to 100 mg per day with a single dose or 60 mg twice a day. For some patients, fractional dosing of the drug is preferred. Treatment should continue as needed. In some patients with Zollinger-Alison syndrome, the duration of treatment with rabeprazole was up to one year. For the eradication of Helicobacter pylori It is recommended to be taken orally at 20 mg 2 times a day according to a specific scheme with the appropriate combination of antibiotics. The duration of treatment is 7 days. Patients with Renal and Hepatic Insufficiency Dose adjustment is not required for patients with renal failure. In patients with mild to moderate hepatic insufficiency, the concentration of rabeprazole in the blood is usually higher than in healthy patients. Caution should be exercised when prescribing the drug Pariet to patients with a severe degree of liver failure. Elderly patients Dose adjustment not required. Children Safety and efficacy of rabeprazole sodium 20 mg for short-term (up to 8 weeks) treatment of GERD in children aged 12 years and more is confirmed by extrapolation of the results of adequate and well-controlled studies supporting the efficacy of rabeprazole sodium for adults and safety and pharmacokinetics studies for pediatric patients age. The recommended dose for children aged 12 years or more is 20 mg once a day for up to 8 weeks. Safety and effectiveness of rabeprazole sodium for the treatment of GERD in children under the age of 12 have not been established. Safety and effectiveness of rabeprazole sodium for other indications have not been established in pediatric patients. Side effects Immune system disorders: rarely – acute systemic allergic reactions. Disorders from the blood and lymphatic system: rarely – thrombocytopenia, neutropenia, leukopenia. Disorders from metabolism and nutrition: rarely – hypomagnesemia. Disorders from the hepatobiliary system: increased activity of hepatic enzymes, rarely hepatitis, jaundice, hepatic encephalopathy. Disorders of the kidneys and urinary tract: very rarely – interstitial nephritis. Disorders of the skin and subcutaneous tissue: rarely – bullous rashes, urticaria, very rarely – erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome. Disorders from the musculoskeletal system: rarely – myalgia, arthralgia. Reproductive system disorders: very rarely – gynecomastia. Drug Interaction Cytochrome P450 system Rabeprazole sodium, like other proton pump inhibitors (PPIs), is metabolized by the involvement of the cytochrome P450 (CYP450) system in the liver. In vitro studies on human liver microsomes have shown that rabeprazole sodium is metabolized by the CYP2C19 and CYP3A4 isoenzymes. Research on healthy volunteers has shown that rabeprazole sodium does not have pharmacokinetic or clinically relevant interactions with medicinal products that are metabolized by the cytochrome P450 system – warfarin, phenytoin, theophylline, and diazepam (whether or not patients metabolize diazepam intensely or weakly). A study of combination therapy with antibacterial drugs. This four-way cross-sectional study involved 16 healthy volunteers who received 20 mg of rabeprazole, 1000 mg of amoxicillin, 500 mg of clarithromycin, or a combination of these three drugs (CANCER: rabeprazole, amoxicillin, clarithromycin). The AUC and Cmax rates for clarithromycin and amoxicillin were similar when compared to combination therapy with monotherapy. AUC and Cmax for rabeprazole increased by 11% and 34%, respectively, and for 14-hydroxy-clarithromycin (the active metabolite of clarithromycin) AUC and Cmax increased by 42% and 46%, respectively, for combination therapy compared with monotherapy. This increase in exposure for rabeprazole and clarithromycin was not considered clinically relevant. Interactions due to inhibition of gastric juice secretion Rabeprazole sodium exerts a steady and prolonged suppression of gastric juice secretion. Thus, interactions with substances for which absorption is pH dependent may occur. When co-administered with rabeprazole sodium, ketoconazole absorption is reduced by 30% and digoxin absorption is increased by 22%. Therefore, some patients should be monitored to resolve the need for dose adjustment while co-administered with rabeprazole sodium with ketoconazole, digoxin or other drugs for which absorption is pH dependent. Atazanavir A significant reduction in atazanavir exposure was observed with concomitant administration of atazanavir 300 mg / ritonavir 100 mg with omeprazole (40 mg once daily) or with atazanavir 400 mg with lansoprazole (60 mg once daily). Atazanavir absorption is pH dependent. Although co-administration with rabeprazole has not been studied, similar results are expected for other PPIs. Therefore, concomitant administration of atazanavir with proton pump inhibitors, including rabeprazole, is not recommended. Antacids In clinical studies, antacids were co-administered with rabeprazole sodium. No clinically relevant interactions of rabeprazole sodium with aluminum hydroxide gel or magnesium hydroxide were observed. Food intake In a clinical trial, no clinically relevant interactions were observed during the administration of rabeprazole sodium with low fat foods. Taking rabeprazole sodium at the same time as fat-enriched foods can delay the absorption of rabeprazole for up to 4 hours or more, but Cmax and AUC do not change. cyclosporine In vitro experiments using human liver microsomes showed that rabeprazole inhibited cyclosporine metabolism with IC50 of 62 μmol, ie at a concentration 50 times the Cmax for healthy volunteers after 20 days of taking 20 mg of rabeprazole. The degree of inhibition is similar to that for omeprazole for equivalent concentrations. Methotrexate According to reports of adverse events, According to published pharmacokinetic studies and retrospective data, it can be assumed that the concomitant administration of PPI and methotrexate (primarily in high doses) may increase the concentration of methotrexate and / or its metabolite hydroxymethotrexate and increase T1 / 2. However, no specific studies of the drug interaction of methotrexate with STIs have been performed. overdose Symptoms: data on intentional or accidental overdose are minimal. No cases of severe overdose with rabeprazole were noted. Treatment: The specific antidote for the drug Pariet is unknown. Rabeprazole binds well to plasma proteins, and therefore poorly excreted in dialysis. In case of overdose, symptomatic and supportive treatment should be performed. Storage conditions Store at a temperature not exceeding 25 ° C and do not freeze. Expiration 2 years. Deystvuyuschee substances Rabeprazole dosage form dosage form tablets Bush Pharmaceuticals, Japan
