Rabeprazole (Aciphex) Risks, Warnings, and Complications

GASTRIC MALIGNANCY: Tell your doctor if you do not get relief from GERD symptoms or your symptoms come back. You may have something more serious, such as a gastric malignancy (stomach cancer). Your doctor may order diagnostic testing, including an endoscopy.

DRUG INTERACTIONS WITH ANTICOAGULANTS: Taking rabeprazole and anticoagulants (blood thinners) such as warfarin together can lead to an increased risk of bleeding. Tell your doctor if you are on a blood thinner. Your provider may recommend checking INR more frequently.

ACUTE TUBULOINTERSTITIAL NEPHRITIS: Rabeprazole and other proton pump inhibitors can lead to a kidney condition called acute tubulointerstitial nephritis (TIN). This can happen at any time during treatment. Tell your doctor without delay if you develop any urinary symptoms, such as increased or decreased urination, blood in urine, tiredness, nausea, or loss of appetite.

CLOSTRIDIUM DIFFICILE ASSOCIATED DIARRHEA: Proton pump inhibitors, including rabeprazole, can increase the risk of Clostridium difficile-associated diarrhea (a type of severe watery diarrhea). This risk is especially high in hospitalized patients. Take the lowest dose of PPI therapy for the shortest time possible to treat your condition. Call your doctor immediately if you develop severe watery stools with or without fever and severe stomach pain.

BONE FRACTURES: Rabeprazole is associated with an increased risk of osteoporotic bone fractures in the hip, wrist, or spine. This risk is highest in people who receive high doses, multiple daily doses, and long-term treatment with PPIs (for a year or more). Use the lowest dose of rabeprazole for the shortest duration possible. Talk with your doctor if you are at risk of an osteoporosis-related bone fracture.

SEVERE ALLERGIC REACTIONS: There are reports of severe allergic reactions after taking proton pump inhibitors. Stop taking rabeprazole and call your doctor immediately or seek emergency medical care if you develop a skin rash, hives, itching, blistering, peeling, or bleeding.

CUTANEOUS AND SYSTEMIC LUPUS ERYTHEMATOSUS: People taking PPIs including rabeprazole can develop autoimmune conditions such as cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE). These conditions can be new in onset or a worsening of existing autoimmune diseases. CLE is more commonly reported than SLE. It can occur within weeks or years of starting proton pump inhibitors and in people of all ages including infants and elderly individuals. Tell your doctor if you develop a sun-sensitive rash on your cheeks or arms, joint pain, or flu-like symptoms. Do not take PPIs for longer than prescribed. Most patients who develop lupus improve in 4-12 weeks after PPI therapy is discontinued.

VITAMIN B12 DEFICIENCY: Treatment with rabeprazole and other PPIs daily for long periods of time can lead to decreased absorption of cyanocobalamin (vitamin B12). Tell your doctor if you have symptoms such as tiredness, weakness, headache, loss of appetite, indigestion, palpitations, or shortness of breath.

HYPOMAGNESEMIA: Taking PPIs for a long time (at least 3 months and usually more than a year) can lead to hypomagnesemia (low magnesium). This can cause serious complications including involuntary muscle contractions, irregular heartbeat, and seizures. Low magnesium can lead to other changes in mineral metabolism, such as hypocalcemia (low calcium) and/or hypokalemia (low potassium). Your doctor may recommend discontinuing rabeprazole and prescribe magnesium replacement if this happens.

Doctors may want to monitor patients taking other drugs such as digoxin or diuretics (water pills) (which can also cause hypomagnesemia) before starting rabeprazole and periodically during treatment.

DRUG INTERACTION WITH METHOTREXATE: Taking PPIs and high-dose methotrexate together can raise serum methotrexate levels and lead to toxicity. Methotrexate is an immunosuppressant drug that is prescribed for treatment of psoriasis, rheumatoid arthritis, and certain types of cancers. If you are on high-dose methotrexate, your doctor may recommend temporarily discontinuing rabeprazole.

FUNDIC GLAND POLYPS: Taking rabeprazole and other PPIs is linked to an increased risk of fundic gland polyps (small growths in the stomach). This risk is higher when you take PPIs for more than a year. Fundic gland polyps usually do not cause any symptoms and are found incidentally on endoscopy. You should take PPIs or the shortest duration possible to treat your condition.