Rabeprazole Sodium

Combination Therapy with Clarithromycin and Amoxicillin Clinical Impact: Concomitant administration of clarithromycin with other drugs can lead to serious adverse reactions, including potentially fatal arrhythmias, and are contraindicated. Amoxicillin also has drug interactions. See Drug Interactions in prescribing information for amoxicillin.

Combination Therapy with Clarithromycin and Amoxicillin Clinical Impact: Concomitant administration of clarithromycin with other drugs can lead to serious adverse reactions, including potentially fatal arrhythmias, and are contraindicated. Intervention: See Contraindications and Warnings and Precautions in prescribing information for clarithromycin.

Concomitant use with rabeprazole is contraindicated due to decreased exposure of rilpivirine, which may reduce antiviral effect and promote drug resistance.

Decreased exposure of some antiretroviral drugs (e.g., rilpivirine, atazanavir, and nelfinavir) when used concomitantly with rabeprazole may reduce antiviral effect and promote the development of drug resistance. See prescribing information Atazanavir: See prescribing information for atazanavir for dosing information Nelfinavir: Avoid concomitant use with Rabeprazole Sodium delayed-release tablets.

Concomitant use may elevate and prolong serum levels of methotrexate and its metabolite hydroxymethotrexate, possibly leading to methotrexate toxicities.

• Decreased exposure of some antiretroviral drugs (e.g., rilpivirine, atazanavir, and nelfinavir) when used concomitantly with rabeprazole may reduce antiviral effect and promote the development of drug resistance. Nelfinavir : Avoid concomitant use with rabeprazole sodium delayed-release tablets. See prescribing information for nelfinavir.

Increased exposure of saquinavir when used concomitantly with rabeprazole may increase toxicity.

Concomitant use may increase INR and prothrombin time, leading to abnormal bleeding and potentially death.

Rabeprazole inhibits cyclosporine metabolism in vitro with potential for increased cyclosporine levels.

Rabeprazole may decrease absorption of dasatinib due to increased gastric pH.

Potential for increased exposure of digoxin; monitor digoxin concentrations and adjust dose if needed.

Rabeprazole may decrease absorption of erlotinib due to increased gastric pH.

May interfere with absorption of iron salts where gastric pH is important for bioavailability.

Rabeprazole may decrease absorption of itraconazole due to increased gastric pH.

Approximately 30% decrease in ketoconazole bioavailability due to increased gastric pH. Patients may need monitoring.

Rabeprazole may reduce absorption of mycophenolate due to increased gastric pH.

Rabeprazole may decrease absorption of mycophenolate mofetil due to increased gastric pH.

Rabeprazole may decrease absorption of nilotinib due to increased gastric pH.

Studies in healthy subjects have shown that rabeprazole does not have clinically significant interactions with other drugs metabolized by the CYP450 system, such as warfarin and theophylline given as single oral doses, diazepam as a single intravenous dose, and phenytoin given as a single intravenous dose (with supplemental oral dosing).

This degree of inhibition is similar to that by omeprazole at equivalent concentrations.

Table 2 includes drugs with clinically important drug interactions and interaction with diagnostics when administered concomitantly with rabeprazole sodium delayed-release tablets and instructions for preventing or managing them. Table 2: Clinically Relevant Interactions Affecting Drugs Co-Administered with Rabeprazole Sodium Delayed-Release Tablets and Interactions with Diagnostics Antiretrovirals Clinical Impact: The effect of PPI on antiretroviral drugs is variable. • Decreased exposure of some antiretroviral drugs (e.g., rilpivirine, atazanavir, and nelfinavir) when used concomitantly with rabeprazole may reduce antiviral effect and promote the development of drug resistance.