Pariet: Advanced Acid Control for Lasting GERD Relief

Pariet

Product dosage: 20mg
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Pariet (rabeprazole sodium) is a proton pump inhibitor (PPI) prescribed for the management of acid-related gastrointestinal disorders. It functions by selectively and irreversibly inhibiting the H+/K+ ATPase enzyme system—the proton pump—at the secretory surface of gastric parietal cells. This action results in a profound and sustained suppression of both basal and stimulated gastric acid secretion, regardless of the stimulus. By elevating gastric pH, Pariet facilitates the healing of erosive and ulcerative lesions and provides long-term symptomatic control, offering a targeted therapeutic approach for patients suffering from persistent acid reflux and its complications.

Features

• Active Pharmaceutical Ingredient: Rabeprazole sodium.
• Pharmacological Class: Proton pump inhibitor (substituted benzimidazole).
• Available Strengths: 10 mg and 20 mg enteric-coated tablets.
• Mechanism of Action: Irreversible inhibition of the H+/K+ ATPase proton pump in gastric parietal cells.
• Administration: Oral, once or twice daily.
• Formulation: Delayed-release tablets designed to bypass gastric acid degradation for optimal intestinal absorption.
• Onset of Action: Significant acid suppression can occur within one hour.
• Duration of Action: Provides up to 24 hours of antisecretory effect following a single dose due to its long-lasting inhibition of proton pumps.
• Bioavailability: Approximately 52% and is not significantly affected by food intake, though administration before a meal is recommended.
• Metabolism: Primarily hepatic, via non-enzymatic reduction and cytochrome P450 (CYP) system (CYP2C19 and CYP3A4).

Benefits

• Achieves rapid and profound suppression of gastric acid production, providing prompt relief from heartburn and acid regurgitation symptoms.
• Promotes high healing rates for erosive esophagitis, often within a standard 4 to 8-week treatment course.
• Offers effective maintenance therapy for healed esophagitis, preventing relapse and the need for repeated acute treatment cycles.
• Provides superior acid control compared to H2-receptor antagonists, particularly for nocturnal acid breakthrough.
• Can be used in combination with antibiotics for the eradication of Helicobacter pylori (H. pylori), a primary cause of peptic ulcer disease.
• Reduces the risk of NSAID-associated gastric ulcers in patients at high risk requiring continuous NSAID therapy.

Common use

Pariet is indicated for the short-term treatment and maintenance of healing in a range of acid-related conditions. Its primary use is in the management of Gastroesophageal Reflux Disease (GERD), including the treatment of symptomatic GERD and the healing and maintenance of healing of erosive or ulcerative esophagitis. It is also approved for the treatment of duodenal ulcers and gastric ulcers. Furthermore, Pariet is a key component in combination regimens for the eradication of H. pylori infection to reduce the risk of duodenal ulcer recurrence. It is also used in the treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome.

Dosage and direction

The dosage of Pariet must be individualized based on the condition being treated and patient response. The tablet should be swallowed whole with a glass of water; it must not be chewed, crushed, or split, as this will damage the enteric coating and degrade the drug. It is typically administered once daily, preferably in the morning before a meal.

• Healing of Erosive Esophagitis or Symptomatic GERD: 20 mg once daily for 4 to 8 weeks. For patients not fully healed after 8 weeks, an additional 8-week course may be considered.
• Maintenance of Healing of Erosive Esophagitis: 20 mg once daily.
• Treatment of Duodenal Ulcers: 20 mg once daily after breakfast for 4 weeks.
• H. pylori Eradication (Dual or Triple Therapy): 20 mg twice daily with meals for 7 days, in combination with prescribed antibiotics (e.g., amoxicillin, clarithromycin).
• Pathological Hypersecretory Conditions: The starting dose is 60 mg once daily. The dosage may be titrated upwards, and doses as high as 100 mg once daily or 60 mg twice daily have been administered. Dosing should be continued for as long as clinically indicated.

Precautions

• Symptomatic Response: A positive response to therapy with Pariet does not preclude the presence of gastric malignancy. All patients with persistent or concerning symptoms should undergo appropriate diagnostic evaluation to rule out malignancy.
• Bone Fracture: Long-term and multiple daily dose PPI therapy may be associated with an increased risk of osteoporosis-related fractures of the hip, wrist, or spine. Use the lowest effective dose and duration for the condition being treated.
• Hypomagnesemia: Symptomatic and asymptomatic hypomagnesemia has been reported rarely with prolonged PPI use (typically >1 year). Monitoring magnesium levels before initiation and periodically during long-term therapy should be considered, especially in patients expected to be on prolonged treatment or taking digoxin or drugs that may cause hypomagnesemia.
• Vitamin B12 Deficiency: Long-term use (e.g., longer than 3 years) may lead to malabsorption of vitamin B12 due to hypochlorhydria. Monitor patients with pre-existing B12 deficiency or those with risk factors for deficiency.
• Acute Interstitial Nephritis: Has been observed in patients taking PPIs and may occur at any time during therapy. Discontinue Pariet if this condition develops.
• Clostridium difficile-Associated Diarrhea (CDAD): PPI use may increase the risk of developing CDAD, especially in hospitalized patients. Consider this diagnosis in patients with diarrhea that does not improve.
• Cutaneous and Systemic Lupus Erythematosus: PPIs have been reported to cause new or worsening of existing lupus. Discontinue Pariet if signs or symptoms occur.

Contraindications

Pariet is contraindicated in patients with known hypersensitivity to rabeprazole, any substituted benzimidazole, or to any of the excipients in the formulation. Concomitant use with rilpivirine-containing products is also contraindicated due to the potential for decreased rilpivirine absorption and loss of virologic response.

Possible side effect

Like all medicines, Pariet can cause side effects, although not everybody gets them. Most are mild to moderate in severity.

• Very Common (≥1/10): Headache.
• Common (≥1/100 to <1/10): Diarrhea, nausea, vomiting, abdominal pain, flatulence, constipation, dry mouth, dizziness, insomnia, somnolence, cough, pharyngitis, rhinitis, back pain, weakness, flu-like syndrome.
• Uncommon (≥1/1,000 to <1/100): Anorexia, gastritis, stomatitis, chest pain, leg cramps, myalgia, urinary tract infection, increased hepatic enzymes, rash, pruritus, sweating.
• Rare (≥1/10,000 to <1/1,000): Leukopenia, thrombocytopenia, hypersensitivity reactions (e.g., facial edema, urticaria), visual disturbance, confusion, depression, vertigo, hepatitis, jaundice, hepatic failure, arthralgia, interstitial nephritis, fever, blurred vision, taste perversion.
• Very Rare (<1/10,000): Agranulocytosis, pancytopenia, anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell’s syndrome), erythema multiforme, hyponatremia, hypomagnesemia, muscle spasms, gynecomastia.

Drug interaction

Rabeprazole is metabolized by the CYP450 system and can interact with other drugs that use this pathway.

• Drugs Dependent on Gastric pH for Absorption: The increased intragastric pH during Pariet therapy can alter the absorption of drugs with pH-dependent bioavailability. Absorption may be decreased (e.g., ketoconazole, itraconazole, erlotinib, nilotinib, dasatinib) or increased (e.g., digoxin). Monitor patients accordingly.
• Warfarin: Concomitant administration may lead to increased INR and prothrombin time. Monitoring of INR is recommended, especially during initiation and withdrawal of Pariet.
• Methotrexate: PPIs may increase serum levels of methotrexate and/or its metabolite, potentially increasing toxicity. Consider temporary withdrawal of the PPI during high-dose methotrexate therapy.
• CYP2C19 Substrates: Rabeprazole can inhibit CYP2C19. The systemic exposure to drugs metabolized by this enzyme (e.g., phenytoin, diazepam, clopidogrel, citalopram) may be increased.
• Clopidogrel: The antiplatelet activity of clopidogrel may be reduced when used concomitantly with PPIs that inhibit CYP2C19 (like omeprazole and esomeprazole). The clinical relevance of this interaction with rabeprazole is less clear, but caution is advised. Avoid concomitant use unless absolutely necessary.
• Tacrolimus: A potential interaction may exist, potentially increasing tacrolimus levels. Monitor tacrolimus concentrations.

Missed dose

If a dose is missed, it should be taken as soon as remembered on that day. If it is almost time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed. Do not take a double dose to make up for a forgotten one.

Overdose

Experience with rabeprazole overdose is limited. Doses up to 80 mg have been administered without reported adverse effects. There is no known antidote for rabeprazole. It is not removed by hemodialysis. Overdose should be managed through supportive care and monitoring of the patient’s clinical status. Treatment should be symptomatic and supportive.

Storage

Store at room temperature (15°C to 30°C or 59°F to 86°F) in a dry place, protected from light and moisture. Keep the medication in its original container, tightly closed, and out of the reach of children and pets. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided may not cover all possible uses, directions, precautions, drug interactions, or adverse effects.

Reviews

• Clinical Efficacy (Gastroenterologist): “In my practice, rabeprazole has proven to be a highly effective and reliable proton pump inhibitor. Its rapid onset of action is particularly beneficial for patients seeking prompt symptomatic relief. I find its efficacy in healing severe erosive esophagitis to be on par with other agents in its class, and its tolerability profile is generally excellent, leading to high patient adherence.”
• Patient Experience (Long-term GERD sufferer): “After years of struggling with persistent heartburn that disrupted my sleep and diet, my doctor prescribed Pariet 20mg. The difference was noticeable within a few days. I can now eat a wider variety of foods without fear of severe reflux. The once-daily dosing is convenient. I experienced some mild headaches initially, but they subsided after the first week.”
• Pharmacological Profile (Clinical Pharmacist): “Rabeprazole offers a favorable pharmacokinetic profile. Its primarily non-enzymatic metabolism reduces its potential for significant CYP450-mediated drug interactions compared to some other PPIs like omeprazole. This makes it a prudent choice for elderly patients or those on complex polypharmacy regimens, though a thorough medication review is always necessary.”