Consumer medicine information

Rabeprazole Sandoz

Rabeprazole sodium

BRAND INFORMATION

Brand name

Rabeprazole Sandoz

Active ingredient

Rabeprazole sodium

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Rabeprazole Sandoz.

WHAT IS IN THIS LEAFLET

This leaflet answers some common questions about Rabeprazole Sandoz.

It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you taking this medicine against the benefits they expect it will have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine. You may need to read it again.

WHAT RABEPRAZOLE SANDOZ IS USED FOR

This medicine contains the active ingredient rabeprazole sodium. Rabeprazole belongs to a group of medicines called proton pump inhibitors (PPIs). It works by decreasing the amount of acid the stomach makes, to give relief from the symptoms and allow healing to take place. Your food will still be digested in the normal way.

Gastro-oesophageal reflux disease (GORD)
This can be caused by food and acid from the stomach flowing the wrong way (reflux) back up the food pipe, also known as the oesophagus.

Reflux can cause a burning sensation in the chest rising up to the throat, also known as heartburn.

Rabeprazole sodium is also used to help stop reflux oesophagitis from coming back or relapsing.

Gastric and duodenal ulcers
Depending on the position of the ulcer it is called a gastric or duodenal ulcer. A gastric ulcer occurs in the stomach. A duodenal ulcer occurs in the duodenum which is the tube leading out of the stomach. These ulcers can be caused by too much acid being made in the stomach.

Most people who have a peptic ulcer also have a bacteria called Helicobacter pylori in their stomach. Your doctor may also prescribe a course of antibiotics (clarithromycin and amoxycillin) for you. When this medicine is taken with antibiotics, the combination therapy will kill the Helicobacter pylori and let your ulcer heal.

Chronic Gastritis
The presence of the bacteria Helicobacter pylori may cause the stomach to become inflamed, resulting in pain, nausea and vomiting; all of which are signs of chronic gastritis.

When this medicine is taken with antibiotics, it will help kill Helicobacter pylori and allow the stomach to heal.

Your doctor may have prescribed Rabeprazole Sandoz for another reason. Ask your doctor if you have any questions about why this medicine has been prescribed for you.

This medicine is not addictive.

This medicine is available only with a doctor's prescription.

BEFORE YOU TAKE RABEPRAZOLE SANDOZ

When you must not take it

Do not take this medicine if you have an allergy to:

  • rabeprazole sodium
  • any of the ingredients listed at the end of this leaflet
  • other proton pump inhibitors (omeprazole, esomeprazole, lansoprazole, pantoprazole)

Symptoms of an allergic reaction may include:

  • shortness of breath, wheezing or difficulty breathing
  • swelling of the face, lips, tongue or other parts of the body
  • rash, itching or hives on the skin.

Do not take this medicine if:

  • the expiry date (month and year) printed on the pack has passed. If you take Rabeprazole Sandoz after the expiry date it may not work
  • the packaging is torn or shows signs of tampering.

Rabeprazole Sandoz should not be given to children under 18 years of age. Safety and effectiveness of Rabeprazole Sandoz in children has not been established.

Before you start to take it

You must tell your doctor if:

  • you are pregnant or intend to become pregnant
  • you are breastfeeding or intend to breastfeed. It is not known if Rabeprazole Sandoz passes into breast milk
  • you have or have ever had liver disease.

If you have not told your doctor about any of the above, tell him/her before you start taking Rabeprazole Sandoz.

Taking other medicines

Tell your doctor or pharmacist if you are taking any other medicines, including medicines you can buy without a prescription from a pharmacy, supermarket or health food shop.

Do not take Rabeprazole Sandoz and tell you doctor or pharmacist if you are taking any of the following:

  • atazanavir, a medicine used (with other antiretrovirals) to treat HIV-1 infection.
  • clopidogrel, an antiplatelet medicine.

You should not take Rabeprazole Sandoz while taking these medicines.

Also tell your doctor or pharmacist if you are taking any of the following:

  • ciclosporin, a medicine used to treat several conditions including prevention of graft rejection following kidney, liver or heart transplantation; severe, active rheumatoid arthritis; severe skin diseases; kidney disease where other treatments have failed.
  • methotrexate, a medicine used to treat some kinds of cancer. It is also to treat psoriasis (skin disease) and rheumatoid arthritis.
  • digoxin, a medicine used to treat heart problems
  • ketoconazole, a medicine used to treat fungal infections
  • mycophenolate mofetil, a medicine used to prevent organ rejection following kidney, liver or heart transplants
  • clarithromycin, a medicine used to treat infections.

These medicines may be affected by Rabeprazole Sandoz or may affect how well it works. Your doctor of pharmacist can tell you what to do if you are taking any other medicines.

If you have not told your doctor or pharmacist about any of the above, tell them before you start taking Rabeprazole Sandoz.

Your doctor will advise you whether or not to take Rabeprazole Sandoz or if you need to have your dose adjusted.

HOW TO TAKE RABEPRAZOLE SANDOZ

Follow the directions given to you by your doctor or pharmacist. They may differ from the information contained in this leaflet.

If you do not understand the instructions, ask your doctor or pharmacist for help.

How much to take

Adults

The usual dose is one tablet, to be taken once daily, at the same time each day.

The dose of Rabeprazole Sandoz tablets is usually 20mg, but may vary from 10mg to 40mg per day depending on what condition you are being treated for and how severe it is.

For treating Helicobacter pylori infections in combination with antibiotics (clarithromycin and amoxycillin), the dose is one 20mg tablet twice each day, morning and evening, for 7 days.

Children

Rabeprazole Sandoz should not be given to children under 18 years of age. Safety and effectiveness of Rabeprazole Sandoz in children has not been established.

Ask your doctor or pharmacist if you are unsure of the correct dose for you. They will tell you exactly how much to take.

How to take it

  • Rabeprazole Sandoz should be swallowed whole with a glass of water or other liquid
  • Do NOT crush or chew the tablets. They have a special coating which protects them from the acid in your stomach. If the coating is broken by chewing, the tablets may not work.
  • It does not matter if you take Rabeprazole Sandoz with food or on an empty stomach.

Ask your doctor or pharmacist for help if you do not understand the instructions provided with this medicine.

If you forget to take it

If you forget to take your tablet take it as soon as you remember, and then continue to take it as you would normally.

However, if it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to.

Do not take a double dose to make up for the dose that you missed.

If you are not sure what to do, check with your doctor or pharmacist.

If you have trouble remembering to take your medicine, ask your pharmacist for some hints.

If you have taken too much (overdose)

Immediately telephone your doctor or the Poisons Information Centre (telephone Australia 13 11 26 or New Zealand 0800 POISON or 0800 764 766) for advice, or go to Accident and Emergency at the nearest hospital. Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

WHILE YOU ARE TAKING RABEPRAZOLE SANDOZ

Things you must do

  • Use Rabeprazole Sandoz exactly as your doctor has prescribed
  • Always swallow Rabeprazole Sandoz tablets whole
  • Tell your doctor if you become pregnant while you are taking Rabeprazole Sandoz.

Tel your doctor or pharmacist that you are taking Rabeprazole Sandoz if you are about to start taking a new medicine.

Things you must not do

  • Do not take Rabeprazole Sandoz to treat any other complaint unless your doctor tells you to
  • Do not give this medicine to anyone else, even if they have the same symptoms as you
  • Do not crush or chew the tablets
  • Do not give this medicine to children.

Tell your doctor if you need to have a specific blood test (Chromogranin A) while you are taking Rabeprazole Sandoz It may affect the results of this test.

SIDE EFFECTS

Rabeprazole Sandoz is usually well tolerated but tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Rabeprazole Sandoz.

All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical attention if you get some of the side effects.

Do not be alarmed by the following lists of side effects. You may not experience any of them.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor or pharmacist if you notice any of the following and they worry you:

  • headache
  • dizziness
  • diarrhoea
  • nausea
  • abdominal pain
  • wind
  • vomiting
  • constipation
  • indigestion
  • belching
  • runny or blocked nose
  • sore throat and discomfort when swallowing
  • cough
  • pain (including chest, back or joint pain)
  • muscle weakness, physical weakness or lack of energy
  • rash
  • rash or itchy rash accompanied by skin eruption or blisters
  • flu-like symptoms
  • sleeplessness (insomnia)
  • dry mouth
  • leg cramps
  • swelling of the arms or legs
  • nervousness
  • sleepiness (somnolence)
  • loss of appetite for food (anorexia)
  • weight gain
  • sweating

These side effects are usually mild.

Tell your doctor as soon as possible if you notice any of the following:

  • painful and/or frequent urination (common symptoms of a urinary tract infection)
  • vision or taste disturbance
  • depression
  • feeling dizzy, faint, lightheaded or weak (hypotension)
  • shortness of breath
  • signs of frequent infections such as fever, severe chills, sore throat or mouth ulcers.

These are serious side effects. You may need urgent medical attention. Serious side effects are rare.

Tell your doctor immediately and do not take your next dose of Rabeprazole Sandoz if you experience:

  • signs of allergy such as skin rash, reddening, blisters or itching, swelling of the face, lips or other parts of the body, shortness of breath or wheezing.
  • Pass black (blood-stained) stools

If you experience symptoms such as severe (watery or bloody) diarrhoea, fever, abdominal pain or tenderness, you may have Clostridium difficile colitis (bowel inflammation).

Other problems are more likely to arise from the ulcer itself rather than the treatment.

For this reason contact your doctor immediately if you notice any of the following:

  • pain or indigestion
  • you begin to vomit blood or food
  • you pass black (blood stained) motions.

Under rare circumstances supervised by the doctor, proton pump inhibitors (PPIs) might be used for long periods of time.

Low magnesium can occur in some people who take a proton pump inhibitor. Symptoms of low magnesium can include: seizures, dizziness, spasms, cramps or muscle weakness.

Withdrawal of long term PPI therapy may lead to worsening of acid-related symptoms.

People who take proton pump inhibitor medicines at high doses for a long period of time (1 year or longer) may have an increased risk of fractures of the hip, wrist, or spine.

Proton pump inhibitors may reduce the amount of acid in your stomach. Stomach acid is needed to absorb vitamin B-12 properly. Talk with your doctor or pharmacist about the possibility of vitamin B-12 deficiency if you have been taking a proton pump inhibitor for a long time (i.e. more than 3 years).

Other side effects not listed above may also occur in some people. Tell your doctor if you notice anything making you feel unwell when you are taking, or soon after you have finished taking Rabeprazole Sandoz.

Ask your doctor or pharmacist if you do not understand anything in this list.

AFTER TAKING RABEPRAZOLE SANDOZ

Storage

Keep your medicine in the original container.

If you take it out of its original container it may not keep well.

Keep your medicine in a cool dry place where the temperature is below 25°C. Do not keep Rabeprazole Sandoz in the refrigerator.

Do not store Rabeprazole Sandoz or any other medicine in the bathroom or near a sink. Do not leave it on a window sill or in the car.

Heat and dampness can destroy some medicines.

Keep your medicine where children cannot reach them. A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Disposal

If your doctor tells you to stop taking this medicine or the tablets have passed the expiry date, ask your pharmacist what to do with any medicine that is left over.

PRODUCT DESCRIPTION

What it looks like

Rabeprazole Sandoz comes in two types of tablets:

Rabeprazole Sandoz 10mg - pink, biconvex shaped enteric coated tablets.

Rabeprazole Sandoz 20mg - yellow, biconvex shaped enteric coated tablets.

Rabeprazole Sandoz 10mg tablets are supplied in blister packs of 28 enteric coated tablets.

Rabeprazole Sandoz 20mg are supplied in blister packs of 30 enteric coated tablets.

Ingredients

Active ingredients:

  • Rabeprazole Sandoz 10mg - 10mg rabeprazole sodium
  • Rabeprazole Sandoz 20mg - 20mg rabeprazole sodium

Inactive ingredients:

  • calcium hydroxide
  • mannitol
  • hyprolose
  • sodium stearyl fumarate
  • hypromellose
  • purified talc
  • hypromellose phthalate
  • dibutyl sebacate
  • iron oxide yellow (10 mg & 20 mg)
  • iron oxide red (10 mg only)
  • titanium dioxide.

This medicine does not contain lactose, sucrose, gluten, tartrazine or any other azo dyes.

Supplier

Sandoz Pty Ltd
ABN 60 075 449 553
54 Waterloo Road
Macquarie Park NSW 2113
Australia
Tel: 1800 726 369

Novartis New Zealand Limited
PO Box 99102
Newmarket, Auckland 1149
New Zealand
Tel: 0800 354 335

This leaflet was revised in July 2019.

Australian Register Numbers:

10 mg enteric coated tablet: AUST R 173081 (blister)

20 mg enteric coated tablet: AUST R 173080 (blister)

Published by MIMS September 2019

BRAND INFORMATION

Brand name

Rabeprazole Sandoz

Active ingredient

Rabeprazole sodium

Schedule

S4

 

1 Name of Medicine

Rabeprazole sodium.

6.7 Physicochemical Properties

Rabeprazole sodium solubility in water is pH dependent, being very soluble in water at pH 9 to 11, and only slightly soluble in water at pH 8. It is very soluble in methanol, freely soluble in dichloromethane and practically insoluble in hexane.
The chemical name for rabeprazole sodium is (±) 2-[{4-(3-methoxypropoxy)-3-methylpyridin-2-yl}- methylsulphinyl]-1H-benzimidazole sodium. Rabeprazole has one chiral centre and is a racemate of two enantiomers. Its empirical formula is C18H20N3NaO3S (MW: 381.43) (rabeprazole sodium).

Chemical structure.

Its structural formula is:

CAS number.

Rabeprazole.

117976-89-3.

Rabeprazole sodium.

117976-90-6.

2 Qualitative and Quantitative Composition

Each Rabeprazole Sandoz 10 mg enteric-coated tablet contains 10 mg rabeprazole sodium, equivalent to 9.42 mg rabeprazole.
Each Rabeprazole Sandoz 20 mg enteric-coated tablet contains 20 mg rabeprazole sodium equivalent to 18.85 mg rabeprazole.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Rabeprazole Sandoz 10 mg - pink, round, biconvex enteric-coated tablet.
Rabeprazole Sandoz 20 mg - yellow, round, biconvex enteric-coated tablet.

5 Pharmacological Properties

Rabeprazole (as sodium) is a substituted benzimidazole and belongs to the class of proton pump inhibitors.

5.1 Pharmacodynamic Properties

Mechanism of action.

Rabeprazole sodium suppresses gastric acid secretion by the specific inhibition of the H+/K+-ATPase enzyme (proton pump) at the secretory surface of the gastric parietal cell thereby blocking the final step of acid production. This effect is dose related and leads to inhibition of both basal and stimulated acid secretion irrespective of the stimulus. Animal studies indicate that after administration, rabeprazole rapidly disappears from both the plasma and gastric mucosa.

Antisecretory activity.

Oral administration of a 20 mg dose of rabeprazole sodium provides rapid and effective reduction of gastric acid secretion. The onset of the antisecretory effect occurs within one hour with the maximum effect occurring within two to four hours. Inhibition of basal and food stimulated acid secretion 23 hours after the first dose of rabeprazole is 69% and 82% respectively, and the duration of inhibition lasts up to 48 hours. The duration of pharmacodynamic action is much longer than the pharmacokinetic half-life (approximately one hour) would predict. This effect is probably due to the prolonged binding of rabeprazole to the parietal H+/K+-ATPase enzyme. The inhibitory effect of rabeprazole on acid secretion increases slightly with repeated once daily dosing, achieving steady-state inhibition after three days. When the drug is discontinued, secretory activity normalises over 2 to 3 days.
Helicobacter pylori is associated with duodenal and gastric ulcer disease in approximately 95% and 70% of patients respectively. H. pylori is implicated as a major contributing factor in the development of gastritis and ulcers in such patients. Recent evidence also suggests a causative link between H. pylori and gastric carcinoma. H. pylori eradication therapy is appropriate in most patients with duodenal and gastric ulcer where the latter is not caused by nonsteroidal anti-inflammatory drug (NSAID) ingestion (see Section 4.2 Dose and Method of Administration).

Serum gastrin effects.

In clinical studies, patients were treated once daily with 10 or 20 mg rabeprazole for up to 12 months duration. Serum gastrin levels increased during the first 2 to 8 weeks reflecting the inhibitory effects on acid secretion. Gastrin values returned to pretreatment levels, usually within 1 to 2 weeks after discontinuation of therapy. In a maintenance study, which was subsequently extended up to 5 years duration, serum gastrin levels were only modestly raised in most patients.

Enterochromaffin-like (ECL) cell effects.

Increased serum gastrin secondary to antisecretory agents stimulates proliferation of gastric ECL cells which, over time, may result in ECL cell hyperplasia in rats and mice and gastric carcinoids in rats, especially females (see Section 5.3 Preclinical Safety Data, Genotoxicity, Carcinogenicity; Section 4.6 Fertility, Pregnancy and Lactation, Effects on fertility).
In over 400 patients treated with rabeprazole sodium (10 or 20 mg/day) for up to one year, the incidence of ECL cell hyperplasia increased with time and dose, which is consistent with the pharmacological action of the proton pump inhibitor. No patient developed the adenomatoid, dysplastic or neoplastic changes of ECL cells in the gastric mucosa. No patient developed the carcinoid tumours observed in rats.

Clinical trials.

At the time of registration, more than 3000 patients in the US, Europe and Japan had received rabeprazole sodium in both controlled and uncontrolled clinical studies.
The efficacy of rabeprazole was assessed in nine double blind, controlled, randomised, parallel group primary efficacy trials in patients with duodenal ulcer, gastric ulcer and gastroesophageal reflux disease. Three trials were conducted in each indication, a placebo controlled study and comparative studies with either ranitidine or omeprazole. In all these studies the primary efficacy variable used was ulcer or ulcerative GORD healing rates as determined by endoscopic examination.
A further three clinical trials were conducted to establish efficacy of rabeprazole in the long-term prevention of relapse of gastroesophageal reflux disease. Two studies were placebo controlled, whilst the other was actively controlled with omeprazole. In all three studies the primary efficacy variable used was the continued absence of oesophageal erosions or ulcerations as determined by endoscopic examination.

Treatment of erosive or ulcerative gastroesophageal reflux disease (GORD).

In the placebo controlled study, 103 patients were treated for up to eight weeks either with placebo or rabeprazole sodium 10, 20 or 40 mg once daily (od). Rabeprazole sodium was significantly superior to placebo in producing endoscopic healing after four and eight weeks of treatment (p < 0.001).
Rabeprazole sodium 20 mg once daily was also significantly more effective than placebo in terms of symptom relief, providing complete resolution of heartburn frequency, daytime heartburn severity, and decreasing the amount of antacid taken per day after four and eight weeks of treatment.
Rabeprazole sodium 20 mg once daily was statistically superior to ranitidine 150 mg four times per day with respect to the percentage of patients healed at endoscopy and in symptom relief. Rabeprazole sodium was also significantly more effective than ranitidine in terms of providing complete resolution of heartburn frequency, and daytime and night-time heartburn severity; after four and eight weeks of treatment.
In an active-controlled study of 202 patients treated with rabeprazole sodium 20 mg once daily or omeprazole 20 mg once daily for up to eight weeks, rabeprazole sodium was as effective as omeprazole in producing endoscopic healing. The percentages of patients healed at endoscopy at four and eight weeks are given in Table 1.
Rabeprazole sodium 20 mg once daily was also as effective as omeprazole 20 mg once daily in reducing heartburn frequency, in improving daytime and night-time heartburn severity, and in reducing the amount of antacid taken per day.

Prevention of relapse of gastroesophageal reflux disease (GORD).

The prevention of relapse in patients with erosive or ulcerative GORD previously healed with gastric antisecretory therapy was assessed in two U.S. multicentre, double blind, placebo controlled studies of 52 weeks duration. The two studies of identical design randomised 209 and 285 patients respectively, to receive either 10 mg or 20 mg of rabeprazole sodium, or placebo once daily. In both studies rabeprazole sodium was significantly superior to placebo in prevention of relapse of GORD.
In both multicentre trials, rabeprazole sodium 10 mg once daily and 20 mg once daily were significantly more effective than placebo in preventing the recurrence of heartburn frequency (p < 0.001) as well as improving day time (p < 0.001) and night-time (p ≤ 0.003) heartburn severity.
In the actively controlled European study, 243 patients were treated with a fixed dose of either omeprazole 20 mg once daily, or rabeprazole sodium 10 mg or 20 mg once daily. Treatment with both 10 mg and 20 mg rabeprazole sodium were as effective as omeprazole 20 mg in preventing GORD relapse (p = 0.5216 and p = 0.8004 respectively). See Table 2.
Rabeprazole sodium 10 mg and 20 mg once daily were also as effective as omeprazole 20 mg once daily in reducing heartburn frequency, and improving daytime and night-time heartburn severity.

Symptomatic gastroesophageal reflux disease (GORD).

On demand treatment was assessed in a European multicentre, double blind placebo controlled randomised withdrawal study (n = 418) in endoscopically negative patients.
Following an acute open label phase, patients were randomised to receive rabeprazole sodium 10 mg or placebo taken once daily, when required, over a six month period. Efficacy of rabeprazole 10 mg on demand, in patients with complete heartburn relief at baseline was primarily evaluated by the unwillingness to continue the trial because of inadequate heartburn control. Overall, the proportion of patients discontinuing due to inadequate heartburn control was significantly higher for placebo (20%) compared to rabeprazole (6%) (p < 0.00001).
Patients were instructed to take study drug until they had experienced a full 24 hours free of heartburn, most patients in the rabeprazole group had maximum episode duration of 4 days or less. In addition, antacid use was about 2-fold higher in the placebo group than in the rabeprazole group (p = 0.0011). Treatment failure was associated with an increased antacid consumption.

Treatment of duodenal ulcers.

In a US study (n = 100) rabeprazole sodium 20 mg once daily was significantly superior to placebo in producing healing of endoscopically defined duodenal ulcers (p = 0.001) after four weeks treatment.
Patients treated for four weeks with rabeprazole sodium 20 mg once daily reported significantly less ulcer pain frequency (p < 0.001). After 7 days treatment with rabeprazole sodium 20 mg once daily, patients reported significantly less daytime (p = 0.013) and night-time (p = 0.003) ulcer pain severity than patients treated with placebo. This difference continued for the whole study period. Additionally, rabeprazole sodium 20 mg once daily was significantly more effective than placebo in reducing daily antacid use (p < 0.001).
In the ranitidine-controlled trial, 375 patients with endoscopically defined duodenal ulcers were treated with rabeprazole sodium 20 mg once daily or ranitidine 150 mg twice daily for up to four weeks. Rabeprazole sodium 20 mg once daily was significantly more effective than ranitidine 150 mg twice daily at producing complete healing of duodenal ulcers after 2 and 4 weeks (p = 0.002 and p = 0.017 respectively).
Rabeprazole sodium 20 mg once daily was also significantly more effective than ranitidine 150 mg twice daily in producing complete resolution of ulcer pain frequency (week 2, p = 0.006), in alleviating night-time ulcer pain severity (week 2, p = 0.044), and in reducing antacid consumption (p = 0.037).
In patients with endoscopically defined duodenal ulcers treated for up to four weeks, rabeprazole sodium 20 mg once daily was as effective as omeprazole 20 mg once daily in producing healing of duodenal ulcers. The percentages of patients with endoscopic healing at two and four weeks are shown in Table 3.
Rabeprazole sodium 20 mg once daily was significantly (p = 0.038) more effective than omeprazole 20 mg once daily in reducing daytime ulcer pain severity at week 4. In this trial rabeprazole sodium 20 mg once daily also proved to be as effective as omeprazole 20 mg once daily at reducing ulcer pain frequency and night-time ulcer pain.

Treatment of gastric ulcers.

Rabeprazole sodium was found to be significantly (p = 0.002) superior to placebo in producing endoscopically defined healing of gastric ulcers after 6 weeks in a placebo controlled study assessing the effectiveness of rabeprazole sodium 20 mg once daily versus placebo (p < 0.001).
The rates of endoscopic healing of gastric ulcers in patients treated with rabeprazole sodium 20 mg once daily (n = 184) and ranitidine 150 mg two times per day (n = 180) were found to be equivalent after three and six weeks of treatment.
In a European multicentre study comparing rabeprazole sodium 20 mg (n = 113) to omeprazole 20 mg (n = 114), the rates of endoscopic healing of gastric ulcers were found to be equivalent with the two treatments at three and six weeks. See Table 4.
Rabeprazole sodium was significantly superior to omeprazole in reducing ulcer pain frequency (week 6, p = 0.006), in improving daytime ulcer pain severity (week 3, p = 0.023), and in providing complete resolution of night-time ulcer pain severity (week 6, p = 0.022).

H. pylori eradication.

In a multicentre, randomised, controlled European study conducted to establish the efficacy of rabeprazole based triple therapy for H. pylori eradication in patients with peptic ulcer disease, the combination: rabeprazole sodium 20 mg twice daily with clarithromycin 500 mg twice daily and amoxycillin 1 g twice daily for a total of 7 days (n = 83), achieved an eradication rate of 94% and a healing rate for duodenal ulcers of 91%.

5.2 Pharmacokinetic Properties

Absorption.

Rabeprazole sodium tablets are enteric coated to allow rabeprazole sodium, which is acid labile, to pass through the stomach intact. Absorption is rapid, with peak plasma levels of rabeprazole sodium occurring approximately 3.5 hours after a 20 mg dose. Peak plasma concentrations (Cmax) of rabeprazole and AUC are linear over the dose range of 10 mg to 40 mg.
Absolute bioavailability of an oral 20 mg dose (compared to intravenous administration) is about 52%, largely due to presystemic metabolism. Additionally, the bioavailability does not appear to increase with repeat administration. In healthy subjects, the plasma half-life is approximately one hour (range 0.7 to 1.5 hours) and the total body clearance is estimated to be 283 ± 98 mL/min.

Distribution.

Rabeprazole sodium is approximately 97% bound to human plasma proteins. After intravenous administration the volume of distribution is 0.34 L/kg.

Metabolism.

Rabeprazole sodium is metabolised through the cytochrome P450 (CYP450) hepatic drug metabolism system (see Section 4.5 Interactions with Other Medicines and Other Forms of Interactions). In humans, the thioether (M1) and carboxylic acid (M6) are the main plasma metabolites with the sulphone (M2), desmethyl thioether (M4) and mercapturic acid conjugate (M5) minor metabolites observed at lower levels. Only the desmethyl metabolite (M3) has a small amount of antisecretory activity, but its presence in plasma is minimal.

Excretion.

Following a single 20 mg 14C-labelled oral dose of rabeprazole sodium, no unchanged drug was excreted in the urine. Approximately 90% of the dose was eliminated in urine mainly as the two metabolites: a mercapturic acid conjugate (M5) and a carboxylic acid (M6), plus two unknown metabolites also found in the species used in the toxicology studies. The remainder of the dose was recovered in faeces. Total recovery was 99.8%. This suggests low biliary excretion of the metabolites; with biotransformation and urinary excretion of water soluble metabolites as the primary route of elimination.

Renal disease.

In patients with stable, end stage, renal failure requiring maintenance haemodialysis (creatinine clearance ≤ 5 mL/min/1.73 m2), the pharmacokinetics of rabeprazole was very similar to that in healthy volunteers.

Hepatic disease.

In a single dose study of 10 patients with chronic mild to moderate compensated cirrhosis of the liver who were administered a 20 mg dose of rabeprazole sodium, AUC0-24 was approximately doubled, the elimination half-life was 2 to 3-fold higher, and total body clearance was decreased to less than half compared to values in healthy men.
In a multiple dose study of 12 patients with mild to moderate hepatic impairment administered 20 mg rabeprazole sodium once daily for eight days, AUC0-∞ and Cmax values increased approximately 30% compared to values in healthy age and gender matched subjects. These increases were not statistically significant.
No information exists on rabeprazole disposition in patients with severe hepatic impairment. Please see Section 4.2 Dose and Method of Administration for information on dosage adjustments in patients with hepatic impairment.

Geriatrics.

Elimination of rabeprazole sodium was decreased in the elderly. Following 7 days of daily dosing with 20 mg of rabeprazole sodium, the AUC approximately doubled and the Cmax increased by 60% as compared to young healthy volunteers. However, there was no evidence of rabeprazole sodium accumulation.

5.3 Preclinical Safety Data

Genotoxicity.

Rabeprazole was positive in assays for gene mutations (the Ames test, forward gene mutation tests in Chinese hamster ovary cells (CHO/ HGPRT) and mouse lymphoma cells (L5178Y/TK+/-)). Its demethylated metabolite was also positive in the Ames test. Rabeprazole was negative in assays for chromosomal damage (the in vitro Chinese hamster lung cell chromosome aberration test, the in vivo mouse micronucleus test), and in vitro and ex vivo rat hepatocyte unscheduled DNA synthesis (UDS) tests.

Carcinogenicity.

In the following section, the relative exposure levels in animals have been calculated using a human dose of 20 mg/day, the maximum recommended rabeprazole sodium dose for the treatment of GORD and active gastro-duodenal ulcers. For H. pylori eradication, the recommended dose of rabeprazole sodium is 40 mg/day (20 mg b.i.d.) for one week; this should be taken into account when reviewing exposure figures.
In an 88/104 week carcinogenicity study in CD-1 mice, rabeprazole at oral doses up to 100 mg/kg/day did not produce any increased tumour occurrence. The highest tested dose produced a systemic exposure to rabeprazole (AUC) of 1.40 microgram.hr/mL, which is 1.6 times the human exposure at the recommended dose for GORD (20 mg/day).
In a 104-week carcinogenicity study in SD rats, males were treated with oral doses of 5, 15, 30 and 60 mg/kg/day and females with 5, 15, 30, 60 and 120 mg/kg/day. Rabeprazole produced gastric enterochromaffin-like (ECL) cell hyperplasia in male and female rats and ECL cell carcinoid tumours in female rats at all doses. The lowest dose (5 mg/kg/day) produced a systemic exposure to rabeprazole (AUC) of about 0.1 microgram.hr/mL, which is about 0.1 times the human exposure at 20 mg/day. In male rats, no treatment-related tumours were observed at doses up to 60 mg/kg/day producing a rabeprazole plasma exposure (AUC) of about 0.2 microgram.hr/mL (0.2 times the human exposure at 20 mg/day).

4 Clinical Particulars

4.1 Therapeutic Indications

Rabeprazole Sandoz is indicated for:
treatment and prevention of relapse of gastroesophageal reflux disease;
symptomatic treatment of gastroesophageal reflux disease;
treatment of duodenal ulcers;
treatment of gastric ulcers.
Patients whose gastric and duodenal ulceration is not associated with ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) usually require treatment with antimicrobial agents in addition to antisecretory drugs whether on first presentation or on recurrence.
Rabeprazole Sandoz is also indicated, in combination with clarithromycin and amoxycillin, for:
eradication of Helicobacter pylori in patients with peptic ulcer disease or chronic gastritis;
healing of peptic ulcers in patients with Helicobacter pylori associated ulcers.

4.3 Contraindications

Rabeprazole Sandoz is contraindicated in patients with known hypersensitivity to rabeprazole sodium, proton pump inhibitors, or any ingredient of this product.
Rabeprazole Sandoz is contraindicated during breastfeeding.

4.4 Special Warnings and Precautions for Use

Symptomatic response to therapy with rabeprazole sodium does not preclude the presence of gastric malignancy; therefore, the possibility of malignancy should be excluded prior to commencing treatment with rabeprazole.
Patients on long-term treatment (particularly those treated for more than a year) should be kept under regular surveillance.
Patients using an on-demand regimen for symptomatic GORD should be further reviewed and/or investigated if symptoms persist beyond 6 months.
A risk of cross-hypersensitivity reactions with other proton pump inhibitors or substituted benzimidazoles cannot be excluded.

Acute interstitial nephritis.

Acute interstitial nephritis has been observed in patients taking proton pump inhibitors (PPIs) including rabeprazole sodium. Acute interstitial nephritis may occur at any point during PPI therapy and is generally attributed to an idiopathic hypersensitivity reaction. Discontinue rabeprazole sodium if acute interstitial nephritis develops.

Cyanocobalamin (vitamin B-12) deficiency.

Daily treatment with acid suppressing medicines over a long period of time (e.g. longer than 3 years) may lead to malabsorption of cyanocobalamin (vitamin B-12) caused by hypo- or achlorhydria.

Hypomagnesaemia.

Severe hypomagnesaemia, symptomatic and asymptomatic, has been reported in patients treated with PPIs like rabeprazole. Serious adverse events include hypomagnesaemia such as fatigue, tetany, seizures, delirium, convulsions, dizziness and ventricular arrhythmia can occur but may begin insidiously and be overlooked. In most patients, treatment of hypomagnesaemia required magnesium replacement and discontinuation of the PPI.
For patients expected to be on prolonged treatment or who take PPIs with medications such as digoxin or drugs that may cause hypomagnesaemia (e.g. diuretics), health care professionals should consider monitoring magnesium levels prior to initiation of PPI treatment and then periodically while treatment continues (see Section 4.8 Adverse Effects (Undesirable Effects)).

Fractures.

Observational studies suggest that proton pump inhibitor (PPI) therapy may be associated with an increased risk for osteoporosis related fractures of the hip, wrist, or spine. The risk of fracture was increased in patients who received high dose, and long-term PPI therapy (a year or longer).
Patients at risk of osteoporosis should receive care according to current clinical guidelines and they should have an adequate intake of vitamin D and calcium.

Concomitant use of rabeprazole with methotrexate.

Literature suggests that concomitant use of PPIs with methotrexate (primarily at high dose; see methotrexate prescribing information) may elevate and prolong serum levels of methotrexate and/or its metabolite, possibly leading to methotrexate toxicities. In such high dose methotrexate administration, a temporary withdrawal of the PPI may be considered in some patients.

Clostridium difficile.

Treatment with proton pump inhibitors may possibly increase the risk of gastrointestinal infections such as Salmonella, Campylobacter and Clostridium difficile.

Subacute cutaneous lupus erythematosus.

Subacute cutaneous lupus erythematosus (SCLE) has been reported with the use of PPIs. If lesions occur, especially in sun-exposed areas of the skin, and if accompanied by arthralgia, the patient should seek medical help promptly and the health care professional should consider stopping rabeprazole. The occurrence of SCLE with previous PPI treatment may increase the risk of SCLE with other PPIs.

Fundic gland polyps.

As with other PPIs, long-term use of rabeprazole is associated with an increased risk of fundic gland polyps (see Section 4.8 Adverse Effects (Undesirable Effects), Post-marketing data). Patients with large or ulcerated polyps may be at risk of gastrointestinal bleeding or small intestinal blockage. Use the lowest dose and shortest duration of PPI therapy appropriate to the condition being treated.

Use in hepatic impairment.

No dosage adjustment is necessary for patients with hepatic impairment. While no evidence of significant drug-related safety problems was observed in patients with hepatic impairment, it is advised to exercise caution when treatment with rabeprazole sodium is first initiated in patients with severe hepatic dysfunction (see Section 4.2 Dose and Method of Administration).

Use in the elderly.

See Section 4.2 Dose and Method of Administration, Dosage adjustment, Elderly.
See Section 5.2 Pharmacokinetic Properties, Excretion, Geriatrics.

Paediatric use.

See Section 4.2 Dose and Method of Administration.

Effects on laboratory tests.

PPI-induced decreases in gastric acidity may lead to increase in serum Chromogranin A (CgA) levels, which may lead to erroneous interpretation of laboratory results in investigations for neuroendocrine tumours. To avoid this interference, temporarily stop Rabeprazole Sandoz treatment at least 14 days before assessing CgA levels and consider repeating the test if initial CgA levels are high.

4.5 Interactions with Other Medicines and Other Forms of Interactions

Effect of rabeprazole sodium on other drugs - demonstrated interactions.

In vitro studies with human liver microsomes indicated that rabeprazole sodium is metabolised by isoenzymes of CYP450 (CYP2C19 and CYP3A4).
Patients may need to be monitored when the following drugs are taken together with rabeprazole sodium.

Ciclosporin.

In vitro incubations employing human liver microsomes indicated that rabeprazole inhibited ciclosporin metabolism with an IC50 of 62 micromolar, a concentration that is over 50 times higher than the Cmax in healthy volunteers following 14 days dosing with 20 mg rabeprazole sodium. Although in vitro studies may not always be predictive of an in vivo status these findings indicate that no interaction is expected between rabeprazole and ciclosporin.

Methotrexate.

Case reports, published population pharmacokinetic studies, and retrospective analyses suggest that concomitant administration of PPIs and methotrexate (primarily at high dose; see methotrexate prescribing information) may elevate and prolong serum levels of methotrexate and/or its metabolite hydroxymethotrexate. However, no formal drug interaction studies of methotrexate with PPIs have been conducted.

Digoxin.

A 22% increase in trough digoxin levels was observed in normal subjects given both drugs concomitantly.

Ketoconazole.

A 33% decrease in ketoconazole levels was observed in normal subjects given both drugs concomitantly.
Coadministration of rabeprazole sodium with ketoconazole or itraconazole may result in a significant decrease in antifungal plasma levels. Therefore individual patients may need to be monitored to determine if a dosage adjustment is necessary when ketoconazole or itraconazole are taken concomitantly with rabeprazole sodium.

Atazanavir.

Coadministration of atazanavir with other proton pump inhibitors resulted in a substantial reduction in atazanavir exposure. The absorption of atazanavir is pH dependent. Therefore, rabeprazole sodium should not be coadministered with atazanavir.

Mycophenolate mofetil.

Coadministration of proton pump inhibitors with mycophenolate mofetil in healthy and transplant patients has been reported to reduce the exposure to the active metabolite, mycophenolic acid. This is possibly due to a decrease in mycophenolate mofetil solubility at an increased gastric pH. The clinical relevance of reduced mycophenolic acid exposure on organ rejection has not been established in transplant patients receiving proton pump inhibitors and mycophenolate mofetil. Use rabeprazole sodium with caution in transplant patients receiving mycophenolate mofetil.

Clopidogrel.

Clopidogrel is metabolised to its active metabolite by CYP2C19. Inhibition of CYP2C19 by rabeprazole would be expected to result in reduced drug levels of the active metabolite of clopidogrel and a reduction in its antiplatelet activity and therefore its clinical efficacy. Concomitant use of rabeprazole with clopidogrel should be discouraged.

Effect of rabeprazole sodium on other drugs - theoretical interactions.

Rabeprazole sodium produces sustained inhibition of gastric acid secretion. An interaction with compounds whose absorption depends on gastric pH may occur due to the magnitude of acid suppression seen with rabeprazole sodium.

Effect of rabeprazole sodium on other drugs - potential interactions that have been excluded.

Studies in healthy subjects have shown that rabeprazole sodium does not have clinically significant interactions with other drugs metabolised by the CYP450 system. These studies included the drugs warfarin and theophylline (as single oral doses), phenytoin (as a single intravenous dose with supplemental oral dosing), diazepam (as a single intravenous dose) and amoxycillin (as single and multiple oral doses).
Taking rabeprazole sodium with antacids produces no clinically relevant changes in plasma rabeprazole sodium concentrations.
Plasma concentrations of rabeprazole and the active metabolite of clarithromycin are increased by 24% and 50% respectively during concomitant administration. This is considered to be useful interaction during H. pylori eradication.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

Rabeprazole at intravenous doses up to 30 mg/kg/day (plasma AUC of 8.8 microgram.hr/mL, about 10 times the human exposure at 20 mg/day) was found to have no effect on fertility and reproductive performance of male and female rats.
(Category B1)
Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human foetus having been observed. Studies in animals have not shown evidence of an increased occurrence of foetal damage.
Teratology studies have been performed in rats at intravenous doses up to 50 mg/kg/day (plasma AUC of 11.8 microgram.hr/mL, about 13 or 6.5 times the human exposure at 20 mg/day and 40 mg/day respectively), and rabbits at intravenous doses up to 30 mg/kg/day (plasma AUC of 7.3 microgram.hr/mL, about 8 or 4 times the human exposure at 20 mg/day and 40 mg/day respectively) and have revealed no evidence of impaired fertility or harm to the foetus due to rabeprazole. However, low foetoplacental transfer occurs in rats.
There are no adequate and well controlled studies in pregnant women and postmarketing experience is very limited. Rabeprazole sodium should be used in pregnancy only if the potential benefit justifies the potential risk to the foetus.
Following intravenous administration of 14C-labelled rabeprazole to lactating rats, radioactivity in milk reached levels that were about 2 to 7-fold higher than levels in the blood. Administration of rabeprazole to rats in gestation and during lactation at doses of 400 mg/kg/day (about 195 or 85 times a 20 mg or 40 mg human dose based on mg/m2) resulted in decreases in body weight gain of the pups.
It is not known whether rabeprazole sodium is excreted in human breast milk and there are no studies in lactating women. Rabeprazole sodium is however excreted in rat mammary secretions. Since many drugs are excreted in milk and because of the potential for adverse effects to nursing infants from rabeprazole sodium, a decision should be made to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

4.8 Adverse Effects (Undesirable Effects)

Throughout this section, adverse reactions are presented. Adverse reactions are adverse events that were considered to be reasonably associated with the use of rabeprazole based on the comprehensive assessment of the available adverse event information.

Clinical trials.

Rabeprazole sodium was generally well tolerated during clinical trials. The observed side effects have generally been mild or moderate and transient in nature. In the majority of cases, the incidence of the adverse events in the rabeprazole sodium treatment group was equal to or less than that observed in the placebo control treatment group.
Only headaches, diarrhoea, abdominal pain, asthenia, flatulence, rash and dry mouth have been associated with the use of rabeprazole sodium.
The adverse events, which may or may not be causally related to rabeprazole sodium, reported in clinical trials are listed below in descending order of frequency.

Common (≥ 1% and < 10%).

Nervous system.

Headache, dizziness.

Gastrointestinal.

Diarrhoea, nausea, abdominal pain, flatulence, vomiting, constipation.

Respiratory.

Rhinitis, pharyngitis, cough.

Musculoskeletal.

Nonspecific pain, back pain, myalgia.

Skin.

Rash.

Other.

Asthenia, flu-like syndrome, infection, insomnia, chest pain.

Uncommon (≥ 0.1% and < 1%).

Gastrointestinal.

Dyspepsia, eructation, dry mouth.

Respiratory.

Sinusitis, bronchitis.

Musculoskeletal.

Arthralgia, leg cramps, fracture of the hip, wrist or spine.

Urinary.

Urinary tract infection.

Other.

Fever, nervousness, somnolence, chills, peripheral oedema, rash, erythema, chest pain, pyrexia, increased hepatic enzymes.

Rare (≥ 0.01% and < 0.1%).

Gastrointestinal.

Anorexia, gastritis, weight gain, stomatitis.

Skin.

Pruritus, sweating, bullous reactions.

Special senses.

Vision or taste disturbances.

Haematologic.

Neutropenia, leucopenia, thrombocytopenia, leucocytosis.

Hepatobiliary disorders.

Hepatitis, jaundice, hepatic encephalopathy, interstitial nephritis.

Immune system disorders.

Hypersensitivity1.

Other.

Depression, erythema multiforme, toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS).
1Includes facial swelling, hypotension and dyspnoea.

Post-marketing data.

In addition to the adverse reactions reported during clinical studies and listed above, the following adverse reactions have been reported during post-marketing experience.
Erythema and rarely bullous reactions, urticarial skin eruptions and acute systemic allergic reactions, for example facial swelling, hypotension and dyspnoea have been reported in patients treated with rabeprazole sodium. These usually resolved after discontinuation of therapy.
Erythema multiforme, interstitial nephritis, gynaecomastia, myalgia and potential allergic reactions including anaphylactic reactions have been reported rarely. Blood dyscrasia including thrombocytopenia, neutropenia, leukopenia, pancytopenia, agranulocytosis and bicytopenia have been reported rarely. Hypomagnesemia has also been reported rarely.
There have also been reports of increased hepatic enzymes and serious hepatic dysfunction such as hepatitis and jaundice. Rare reports of hepatic encephalopathy have been received in patients with underlying cirrhosis. In treatment of patients with severe hepatic dysfunction the prescriber is advised to exercise caution when treatment with rabeprazole is first initiated in such patients.
There have been very rare reports of toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome and bullous rashes including subacute cutaneous lupus erythematosus.
There have been post-marketing reports of bone fractures, subacute cutaneous lupus erythematosus (SCLE), fundic gland polyps, microscopic colitis, hyponatraemia and confusion (see Section 4.4 Special Warnings and Precautions for Use).

Gastrointestinal disorders.

Frequency not known: withdrawal of longterm PPI therapy can lead to aggravation of acid-related symptoms and may result in rebound acid hypersecretion.

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at http://www.tga.gov.au/reporting-problems.

4.2 Dose and Method of Administration

Dosage.

Adults.

Treatment of active gastroesophageal reflux disease (GORD).

The recommended oral dose for this condition is one 20 mg tablet to be taken once daily for four to eight weeks.

Prevention of relapse of gastroesophageal reflux disease (GORD).

The recommended oral dose for preventing relapse of GORD, once healing is achieved, is one 10 mg tablet to be taken once daily.
If needed this dose should be increased to one 20 mg tablet to be taken once daily.

Symptomatic treatment of gastroesophageal reflux disease (GORD).

Treatment should commence at 10 mg once daily in patients without oesophagitis. If no response, the dose should be increased to 20 mg once daily for four weeks. If symptom control has not been achieved within four weeks, the patient should be further investigated.
Once symptoms have resolved, subsequent symptom control can be achieved using an on demand regimen of one 10 mg tablet to be taken once daily, when needed (see Section 4.4 Special Warnings and Precautions for Use).

Treatment of active duodenal ulcer and gastric ulcer.

The recommended oral dose for both duodenal ulcer and gastric ulcer is one 20 mg tablet to be taken once daily.
Some patients with duodenal ulcer may respond to one 10 mg tablet taken once daily.
Most patients with active duodenal ulcer heal within four weeks. However a few patients may require an additional four weeks of therapy to achieve healing. Most patients with gastric ulcer heal within six weeks. However, again a few patients may require an additional six weeks of therapy to achieve healing.

Eradication of H. pylori.

Patients with gastroduodenal ulcers or chronic gastritis due to H. pylori infection should be treated with: rabeprazole sodium 20 mg twice daily + clarithromycin 500 mg twice daily and amoxycillin 1 g twice daily for seven days.
Eradication of H. pylori with this regimen has been shown to result in the healing of duodenal or gastric ulcers without the need for continued ulcer therapy.

Method of administration.

Rabeprazole Sandoz tablets should not be chewed or crushed, but should be swallowed whole. Rabeprazole Sandoz tablets should be taken at the same time each day to facilitate treatment compliance. Rabeprazole sodium was taken with or without food in the pivotal clinical trials.

Dosage adjustment.

Renal impairment.

No dosage adjustment is necessary for patients with renal impairment.
There is no data on the use of rabeprazole in combination with antibiotic regimens in patients with renal or hepatic impairment.

Hepatic impairment.

Patients with mild to moderate hepatic impairment experience higher exposure to rabeprazole sodium at a given dose than healthy patients. Caution should be exercised in patients with severe hepatic impairment (see Section 4.4 Special Warnings and Precautions for Use).
There is no data on the use of rabeprazole in combination with antibiotic regimens in patients with renal or hepatic impairment.

Children.

Rabeprazole sodium is not recommended for use in children, as there is no experience of its use in this group.

Elderly.

No dosage adjustment is necessary in elderly patients.

4.7 Effects on Ability to Drive and Use Machines

Based on the pharmacodynamic properties and the adverse events profile, it is unlikely that rabeprazole sodium would cause an impairment of driving performance or compromise the ability to use machinery. If however, alertness is impaired due to somnolence, it is recommended that driving and operating complex machinery be avoided.

4.9 Overdose

Experience to date with deliberate or accidental overdose is limited. The maximum established exposure has not exceeded 60 mg twice daily, or 160 mg once daily. Effects are generally minimal, representative of the known adverse event profile, and reversible without further medical intervention. No specific antidote is known.
Rabeprazole sodium is extensively protein bound and is therefore not readily dialysable. As in any case of overdose, treatment should be symptomatic and general supportive measures should be used.
For information on the management of overdose, contact the Poison Information Centre on 131126 (Australia).

7 Medicine Schedule (Poisons Standard)

S4.

6 Pharmaceutical Particulars

6.1 List of Excipients

Rabeprazole Sandoz also contains the following inactive ingredients calcium hydroxide, mannitol, hyprolose, sodium stearyl fumarate, purified talc, hypromellose, hypromellose phthalate, dibutyl sebacate and titanium dioxide. The 10 mg tablet also contains iron oxide red and iron oxide yellow, and the 20 mg tablet contains iron oxide yellow.

6.2 Incompatibilities

Incompatibilities were either not assessed or not identified as part of the registration of this medicine.
For information on interactions with other medicines and other forms of interactions, see Section 4.5.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store below 25°C.

6.5 Nature and Contents of Container

Rabeprazole Sandoz 10 mg: Blister packs of 28 tablets.
Rabeprazole Sandoz 20 mg: Blister packs of 30 tablets.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of in accordance with local requirements.

Summary Table of Changes