Medicines

Rabeprazole sodium and domperidone capsules uses in acidity, heartburn and gas

Rabeprazole sodium and domperidone capsules Posted On
Posted By SUMIT SHARMA

Introduction

Hello everyone! Today, I will review the most commonly prescribed gastrointestinal medicines – rabeprazole and domperidone. Here, we will discuss rabeprazole sodium and domperidone capsule’s uses, dosage, mechanism, side effects, warnings or precautions.

Guys! Our lifestyle is changing day by day. Due to this, we generally suffer gastrointestinal problems like – 

  • Acidity
  • Heartburn 
  • Indigestion
  • Burning sensation in the chest
  • Regurgitation of food
  • Gas, bloating, and flatulence 

Rabeprazole sodium and domperidone capsules

Nowadays, we are living a stressful life. According to a study, stress is strongly associated with gastric ulcers. 

People generally prefer spicy or oily food instead of healthy foods (such as fruits or vegetables), which could be another reason for heartburn, indigestion, bloating, etc. 

You might have observed that most physicians prescribe an anti-ulcer medicine with other groups of drugs. 

Have you ever tried to know? 

Because some medicines may also cause gastric ulcers like – 

 

Some bacteria (such as H. Pylori) also cause gastric disturbances. So, multiple factors cause gastrointestinal problems. 

Although many anti-ulcer drugs are available in the market. Here, I will review the most effective anti-ulcer (rabeprazole) and anti-emetic (domperidone) drug.

You will learn about rabeprazole sodium and domperidone capsules used in stomach-related problems like acidity, ulcer & gas. 

So, let’s get started – 

 

What are rabeprazole sodium and domperidone capsules used for?

Rabeprazole is an anti-ulcer drug, whereas domperidone comes in the anti-emetic (or prokinetic) category. This combination of rabeprazole and domperidone medicines reliefs in various medical conditions if – 

  • You have peptic ulcer diseases like oesophagus, stomach, and intestinal ulcers.
  • You are feeling a burning sensation in the chest, regurgitation of food, and acid reflux. These symptoms indicate GERD (Gastro-esophageal Disease)
  • You are feeling a bloated stomach, flatulence, and gas problem.
  • Your stomach is making the extremely high acid amount, called Zollinger-Ellison Syndrome.
  • You have an H. Pylori infection.
  • You are taking painkiller medicines like NSAIDs (Ibuprofen, indomethacin, ketorolac, piroxicam, lornoxicam, etc.)
  • You are taking antibiotics like amoxicillin, clarithromycin, etc. 

 

Is rabeprazole a proton pump inhibitor (PPI)? 

Yes. Rabeprazole belongs to the proton pump inhibitors (PPIs) class. This medicine suppresses the excess acid in your stomach by inhibiting the proton pump.  

PPIs are that class of drugs which end with “prazole.” This class also includes – 

  • Omeprazole
  • Esomeprazole
  • Pantoprazole
  • Lansoprazole

 

PPIs are super-effective drugs that have surpassed H2 blockers (like ranitidine, famotidine, cimetidine, and roxatidine). 

Among these, rabeprazole is a newer proton pump inhibitor drug that strongly stops gastric acid secretion.

Many studies have claimed that rabeprazole is a potent and fastest acid suppression than other PPIs.

It starts to work within 5 minutes. Whereas lansoprazole and omeprazole take 30 minutes to do action. 

 

Why is rabeprazole combined with domperidone?

The combination of rabeprazole and domperidone is commonly used for treating ulcers and gastroesophageal reflux disease (GERD). 

Rabeprazole also comes with other medicines like – 

  • Levosulpiride (an antipsychotic drug)
  • Mosapride (antiemetic or prokinetic drug)

 

Here are some examples of rabeprazole sodium and domperidone capsules brand names –

  • Cyra D (Rabeprazole sodium and domperidone capsules)
  • Rekool-L (Rabeprazole 20 mg and levosulpiride 25 mg)
  • Rekool D (Rabeprazole sodium and domperidone SR capsules)
  • Veloz-M (Rabeprazole sodium and mosapride citrate SR capsules)
  • Veloz D (Rabeprazole sodium and domperidone SR capsules)
  • Rabium DSR (Rabeprazole sodium and domperidone SR capsule)
  • MAC RD (Rabeprazole sodium and domperidone SR capsules)
  • Rabicip D (Rabeprazole sodium and domperidone SR capsule)

 

But you should not take the combination of rabeprazole and domperidone (or mosapride or levosulpiride) if you have loose stool or diarrhoea. 

Since domperidone is a prokinetic drug that increases the peristalsis of your intestine and worsens your diarrhoea condition. 

In this condition, you should take only rabeprazole or other PPIs. 

  • Pariet 10, 20 (Rabeprazole sodium gastro-resistant tablet 10 or 20 mg)
  • Rabium 10, 20 (Rabeprazole sodium tablet 10 or 20 mg)
  • Rabicip 10, 20 (Rabeprazole sodium tablet 10 or 20 mg)
  • Rabez 20 (Rabeprazole sodium tablet 10 or 20 mg)
  • Reblet (Rabeprazole sodium gastro-resistant tablet 20 mg)
  • Veloz (Rabeprazole sodium 20 tablet)

Rabeprazole sodium and domperidone capsules

Rabeprazole sodium and domperidone capsules

How is acid secreted in the stomach?

Generally, the human stomach secretes 1.5 litres of hydrochloric acid daily. This acid is also called gastric acid or gastric juice

Stomach acid is necessary for the digestion of your foods (protein or starch) and kills microorganisms. But sometimes, overproduction of acid in your stomach may cause gastric problems like hyperacidity, gastritis, and acid reflux.

The overproduction of stomach acid is due to an imbalance of aggressive and defensive factors. 

  • Aggressive factors – acid, pepsin, and H.pylori
  • Defensive factors – gastric mucus, bicarbonate, and prostaglandins

 

Prostaglandin is a major defensive factor that stimulates the production of mucus and bicarbonate secretion. 

The gastric mucus prevents damage to the stomach from acid. And the bicarbonate neutralizes the acid, which secretes from the pancreas. 

If you get a hyperacidity problem, then the prostaglandin level decreases. In contrast, the acid/pepsin level increases. 

The primary risk factors for the overproduction of stomach acid are – 

  • Smoking
  • Alcohol
  • Spicy foods
  • Being overweight and obese
  • Stress
  • Chocolate, cheese, and coffee
  • Empty stomach for a long time
  • Taking painkillers like NSAIDs (Lornoxicam, aspirin, Ibuprofen, etc.)

 

These factors increase stomach acid production that may rise towards the oesophagus. It may disturb your valve-lower oesophageal sphincter (LES).

If your LES is not working correctly, you may feel burning in the chest, nausea, sour burps, a bloated stomach, and flatulence. 

Later, these symptoms may develop into a peptic ulcer, GERD, and Zollinger-Ellison syndrome. 

The main component of stomach acid is a proton (H+) and chloride (Cl). When they fuse together and make HCL. 

Your stomach acid (HCL) may vary in pH from 1.5 to 3.5 in the stomach lumen. The acidic level of your stomach is maintained by the proton pump H+K+ ATPase enzyme. 

Stomach acid (HCL) is usually produced from the parietal cells of the stomach. The parietal cells are widely distributed in the entire wall of the stomach. 

Parietal cells become activated by gastrin (via CCK receptors), histamine (via H2 receptors), and acetylcholine (via M1 receptors). 

Rabeprazole sodium and domperidone capsules

 

Hydrogen ion (H+) is transported into the lumen of the stomach with an exchange of potassium ions (K+) by the H+K+ ATPase enzyme

Bicarbonate ions (HCO3) go into the blood by transporter protein. These bicarbonate ions exchange with chloride ions (Cl) via a chloride channel. 

Then, chloride ions are transported into the stomach lumen. 

Finally, opposite charge ions – hydrogen ion (H+) and chloride ions (Cl) fuse together into your stomach lumen. It makes hydrochloric acid (HCL). 

 

What is the mode of action of rabeprazole and domperidone? 

The primary culprit of your stomach problem (acidity and acid reflux) is hydrochloric acid (HCL). 

Rabeprazole reduces the excess acid content of your stomach by blocking the proton pump H+K+ ATPase enzyme. That’s why it is known as a proton pump inhibitor. 

Rabeprazole is also called an antisecretory drug as it stops acid secretion. 

On the other hand, domperidone is a dopamine receptor blocker. It blocks the DA2 receptor, which causes a gastrokinetic effect.

Generally, the excess amount of dopamine may cause vomiting. It binds to the DA2 receptor. It activates the chemoreceptor trigger zone (CTZ), which is present in the medulla oblongata. Then, CTZ sends the impulse to the vomiting center and induces vomiting. 

Domperidone blocks the DA2 receptor and stops the sensation of nausea or vomiting. But, domperidone does not cross the blood-brain barrier (BBB) and works peripherally. 

It increases peristalsis by contraction of the gastrointestinal mucosa. So, domperidone is also called a prokinetic agent. 

 

What are rabeprazole sodium and domperidone capsules dosages? 

The dose of rabeprazole depends on the type and severity of the disease. 

 

Diseases Starting dose Frequency
Zollinger Ellison syndromeRabeprazole 60 mg

 

Once a day
Twice a day (if not controlled)
Intestinal and stomach ulcerRabeprazole 20   mg

 

Once a day
GERDRabeprazole 20   mg

 

Once a day
Rabeprazole 10 mg (If symptoms controlled)
H. Pylori infectionRabeprazole 20   mg

+

Clarithromycin 500 mg

+

Amoxicillin 1 g

Twice a day

 

If you are having symptoms of nausea and vomiting with gastric ulcer or GERD. In this case, you can take a combination of rabeprazole sodium 20 mg and domperidone 30 mg capsules. 

Rabeprazole is usually preferred for an empty stomach. Because it is more effective if you take an empty stomach once daily in the morning.

Taking any PPI drugs 30 minutes before a meal is always best. 

If you take this medicine after food, it decreases the absorption of rabeprazole. 

Rabeprazole is also available in injection form – 

  • Rablet 20 mg injection (Rabeprazole sodium injection)
  • Rabeloc-IV Inj. (Rabeprazole injection 20mg – lyophilized)

 

Why should you take rabeprazole on an empty stomach?

Rabeprazole is a prodrug (inactive drug) that requires an acidic environment for its activation. 

According to Peyton Berookim, MD, a gastroenterologist from the Gastroenterology Institute of Southern California, acid contents are usually high on an empty stomach, especially in the morning.

When you take a Rabeprazole sodium tablet or capsule on an empty stomach, it goes into your bloodstream. And it gets converted into the active form of sulphenamide (sulfenamide). 

This active form inhibits the proton pump H+K+ ATPase enzyme. In this way, it helps in acid suppression. 

 

What are enteric-coated rabeprazole sodium and domperidone?

Rabeprazole or all PPIs are acid labile. It means the drug gets destroyed in the presence of gastric hydrochloric acid (HCL). 

To avoid gastric HCL, pharmaceutical engineers make rabeprazole granules or tablets with a special polymer coating. This polymer coating protects the drug (rabeprazole) from destroying gastric HCL. 

As a result, rabeprazole gets degranulated and dissolves in the small intestine. Then enters the bloodstream through the intestinal mucosa. 

This particular type of polymer coating is called enteric-coated or gastro-resistant drugs.

That’s why it is named rabeprazole sodium gastro-resistant tablets.

 

What are the rabeprazole sodium and domperidone capsule side effects?

Rabeprazole has minimal side effects. It may cause mild to moderate side effects like – 

  • Abdominal discomfort like nausea, vomiting, constipation, diarrhoea, flatulence 
  • Headaches 
  • Dizziness

 

A study published in the journal of clinical biochemistry and nutrition 2015 assessed rabeprazole’s long-term safety and efficacy. 

In this double-blind clinical trial study, rabeprazole 10 mg was given to patients once daily for up to 78 weeks. These patients were already taking low-dose aspirin. It was observed that there was no peptic ulcer or gastric bleeding during the long-term use of rabeprazole sodium.

Rabeprazole is safe to use in the long term even if you take clopidogrel, aspirin, warfarin, and other anticoagulant drugs. 

But long-term use of rabeprazole sodium decreases the absorption of calcium, iron, and vitamin B12. These supplements need an acidic medium for better absorption. 

Some studies suggest that long-term use of rabeprazole sodium may cause – 

  • Osteoporosis or chance of bone fractures due to lack of calcium absorption
  • Anaemia due to deficiency of vitamin B12 and iron
  • Nephritis (inflammation of the kidney)
  • Low magnesium level in blood

 

As far as the concern of domperidone, it has the potential to cause cardiac arrhythmia (prolonged QT interval), but it rarely happens. 

 

Are rabeprazole sodium and domperidone capsules used in pregnancy?

Despite that, rabeprazole falls into category B drugs. However, this drug is contraindicated in pregnancy and breastfeeding. 

Since rabeprazole is a newer agent of proton pump inhibitor. To date, it has no precise safety data on pregnancy and breastfeeding. 

The use of rabeprazole sodium is not recommended in pregnancy and breastfeeding. It should be used if clearly needed. 

Omeprazole has more fetal safety data as it is an older agent and a first-generation drug. Currently, omeprazole is considered a drug of choice in pregnancy

You should not use rabeprazole if you are pregnant or planning to become pregnant. 

On the other hand, domperidone has shown teratogenicity in pregnant animals. So, the use of domperidone should be avoided during pregnancy. 

 

Which proton pump inhibitor is the best?

Although, all proton pump inhibitor (PPI) drugs have almost similar efficacy and safety profile. But clinically, rabeprazole has shown better results than other PPIs. 

Rabeprazole vs esomeprazole

A comparative study of rabeprazole and esomeprazole published in the journal of pharmacology and pharmacotherapeutics, 2011 evaluated that rabeprazole (40 mg) is a better choice than esomeprazole (40 mg) for mild-to-moderate GERD. 

Because rabeprazole has better efficacy and safety profile than esomeprazole. 

 

Rabeprazole vs pantoprazole

A cross-over randomized control trial study published in Alimentary pharmacology and therapeutics, 2010 observed that rabeprazole 20 mg is significantly more effective than pantoprazole 40 mg in patients with nocturnal GERD symptoms. 

 

Rabeprazole vs omeprazole 

A meta-analysis study published in gastroenterology research and practice, 2013 suggested that rabeprazole is a more superior and effective drug than omeprazole. 

Rabeprazole and omeprazole are both well-tolerated drugs. But rabeprazole has shown more clinical advantage over omeprazole in the healing of GERD. 

 

Rabeprazole vs lansoprazole

According to a study, rabeprazole and lansoprazole have similar efficacy and safety profile in Helicobacter pylori infection. Both drugs are well tolerated and have good patient compliance. 

 

What are the contraindications for the use of rabeprazole sodium and domperidone capsules?

Before taking rabeprazole and domperidone, you must consult your doctor if – 

  • Your age is less than 12 years.
  • You are allergic to rabeprazole sodium and domperidone-like medicines. 
  • You are pregnant or planning for pregnancy. 
  • You are a breastfeeding mother.
  • You have severe liver disease
  • You are a patient with heart diseases like congestive heart failure and cardiac arrhythmia. 
  • You have inadequate vitamin B12 
  • You have a low amount of magnesium in the blood. 
  • Your age is more than 65 years as increased risk of fracture.  
  • You are on medicines like antiarrhythmic drugs (such as amiodarone, sotalol, quinidine etc.), antidepressants (e.g., citalopram, escitalopram), antipsychotics (haloperidol), certain antibiotics (e.g., erythromycin, levofloxacin, moxifloxacin), ketoconazole, itraconazole, methotrexate, atazanavir etc. 

 

Conclusion 

Rabeprazole sodium is a well-tolerated, effective and safe proton pump inhibitor.  

Based on clinical experience and few clinical trials, rabeprazole is considered stronger and more powerful than other PPIs.

In addition to providing satisfying relief of symptoms of GERD, rabeprazole sodium and domperidone capsules are also well tolerated.

The use of rabeprazole sodium and domperidones capsules are not recommended in children, the elderly, liver disease, heart disease, pregnancy, and breastfeeding.

Since it is a prescription-based medicine, so you don’t take self-medication. You must consult your doctor before taking a rabeprazole sodium and domperidone capsules

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