Proton pump inhibitor (PPI)
ATC code: A02BC04 (Rabeprazole)
A benzimidazole that covalently binds gastric parietal cell H+/K+-ATPase. Compared with other PPIs, faster onset (1 hour vs 2–3 with omeprazole), stable pharmacokinetics in CYP2C19 slow and rapid metabolizers (metabolized largely non-enzymatically). Fewer clopidogrel interactions than omeprazole.
First line
First-line for GERD per 2022 and the Spanish AEG 2024. Dose 20 mg once daily for 4–8 weeks. Compared with omeprazole, more convenient in patients on clopidogrel and CYP2C19 rapid metabolizers. Efficacy across PPIs is comparable per the 2019 Cochrane meta-analysis.
First line
First-line for gastric and duodenal ulcer, including H. pylori eradication (rabeprazole 20 mg twice daily + amoxicillin + clarithromycin or metronidazole for 10–14 days).
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Rabeprazole is prescribed for gastric protection to healthy people without diagnosed GERD or peptic ulcer, including for single NSAID or antibiotic courses. 2022 and 2022 confine PPIs to patients with GI-bleed risk factors. Systematic low-risk-population use increases fracture, hypomagnesemia, B12-deficiency, CDI and acid-rebound risk.
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FDA category B. Use during pregnancy when indicated.
Compatible with breastfeeding.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Rabeprazole is evaluated for the following indications with varying evidence strength: Gastroesophageal reflux disease (evidence tier A), Peptic ulcer disease (evidence tier A), PPI for NSAID gastric prophylaxis in low-risk patients (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Rabeprazole (≥ 1 in 100): Headache, Diarrhea or constipation, Nausea, Abdominal pain, Flatulence, Skin rash. See the Safety section for uncommon and serious reactions.
FDA category B. FDA category B. Use during pregnancy when indicated.
Compatible with breastfeeding.
Rabeprazole is contraindicated in: Rabeprazole or other PPI hypersensitivity; Concomitant rilpivirine; Pregnancy – with caution. Full list in the Safety section.