Rabeprazole

[Guest guest]

Pam, it's a good thing you asked about the long-term effects of

rabeprazole and other PPIs because the more detailed picture is

interesting.

I had in mind the basic impression that PPIs had to be avoided

long-term. This is due to the fact that my mother had been taking

rabeprazole for some time, and we began noticing some modification of

parameters of her kidney function on lab tests ; that was not an

alarming modification, but if the trend had kept going on for long the

way it was, it might have resulted in kidney damage ; so we stopped the

rabeprazole.

In order to give you a more complete answer, I have done a little

research, and I think we can sum it up as follows :

Rabeprazole is a generally safe drug, with a good track record both on

the short term (a few weeks) and on the long term (a year +).

See for instance : http://www.rxlist.com/aciphex-drug.htm (and then go

to page 3 and further).

See also PubMed (PMID: 18977444).

However, as all drugs, it can induce side effects in a number of

patients, and even severe side effects in a small or very small number

of these.

As for moderate side effects, RxList (see above) mentions : headache,

pain, pharyngitis, flatulence, infection, constipation. Flatulence and

constipation are logical, since food doesn't get broken down as well in

a stomach that is less acidic than normal. Inefction is also logical

because some bugs don't get killed anymore by the higher stomach pH.

You will find a good number of patients' experiences on this great

site :

http://www.askapatient.com/viewrating.asp?drug=20973 & name=ACIPHEX & page=1

and see that some long term users have no side-effect at all, while a

good many others do have complaints. Tolerance and rebound effect on

stopping are mentioned several times, among others. Vitamin B12

deficiency is also evoked, and it might be behind a few of the side

effects (my hypothesis). One patient mentioned successfully using

probiotics after stopping PPIs.

Of interest is the fact that PPIs in general are suspected to predispose

patients to an increased number of respiratory infections. This is due

to the fact that a lower gastric pH means that more bacteria can live

there, and cause (by reflux or by other means ?) respiratory infections.

See for instance : PMID: 18818790, where a trend was evidenced, although

it failed to reach statistical significance level.

However, PPIs on the other hand may help patients of some respiratory

pathologies, even sinusitis sufferers. For instance, rabeprazole

improves symptoms of exercise-triggered asthma (PMID: 18688720). Other

examples can surely be found.

As for major side effects, there are many possible, but generally on a

small number of patients.

One of the most notable is the possibility of kidney damage. For

instance, this a reported case of an old lady who developed acute

interstitial nephropathy as a result of rabeprazole use : PMID:

18395944. Then, there is this assertion from the University of Sydney,

about a similar case, that « acute interstitial nephritis is an

uncommon but important cause of acute renal failure. Proton pump

inhibitors are now thought to be the most common class of drugs

implicated in drug-induced acute interstitial nephritis. This is the

first reported case of rabeprazole-induced acute interstitial nephritis.

» (PMID: 15705174). A meta-analysis spoke of a definitely real, but

« low-prevalence association » (PMID : 17661758), adding this

side-effect may happen, but is rare and difficult to predict.

Probably even rarer is a reported case of psychiatric illness (PMID :

15089012).

What happens may also depend on other drugs you may be taking.

Forinstance, http://www.drugs.com/drug_interactions.php describes

stronginteractions between Aciphex and antiretrovirals such as

atazanavir,nelfinavir, Reyataz, Viracept, and moderate interactions

betweenAciphex and a long list of other drugs. In this case, any side

effectmay not necessarily come from rabeprazole itself, but from the

factthat it may interfere with the absorption of these drugs.

So, what is to be made of all this ? I would say that if you experience

no particular problem, available litterature makes it sound quite safe

to stay on rabeprazole, at least for 1 year, and maybe more. However, as

in the case of long-term drug use, it would be prudent to check

regularly the kidney and liver function, because you have no way of

knowing in advance if you have a (mis)chance of belonging to the small

number of patients who, for one reason or another, seem prone to

side-effects, including very serious ones. Also, some serious side

effects may not be kidney- or liver-related, so it would be a good idea

to keep check of other functions as well. The use of probiotics and some

vitamin (including B12) supplementation may be of interest. And if you

decided at any point to stop, an acid-reflux rebound effect would be

likely and should be anticipated and managed (gradual slowing of doses,

switching to a less acidic diet , etc).