What is the maximum dose of rabeprazole (proton pump inhibitor)?

Maximum Dose of Rabeprazole

The maximum dose of rabeprazole is 120 mg daily, which has been safely used in patients with Zollinger-Ellison syndrome. 1, 2

Standard Dosing Guidelines

Rabeprazole dosing varies by indication:

• Standard therapeutic doses:

  • 20 mg once daily for most acid-related disorders 3, 4
  • 10-20 mg once daily for maintenance therapy 3

• Higher doses for specific conditions:

  • 20 mg twice daily (40 mg total) for H. pylori eradication as part of triple therapy 5, 4
  • 60 mg once daily as starting dose for Zollinger-Ellison syndrome and hypersecretory states 3, 2
  • Up to 120 mg daily for Zollinger-Ellison syndrome with dose titration based on acid output 1, 2

Dosing Considerations

Administration Timing

• Rabeprazole should be taken 30 minutes before meals for optimal acid suppression 6
• For twice-daily dosing, administer 30 minutes before morning and evening meals 5

Special Populations

• Renal impairment: No dosage adjustment required 4
• Hepatic impairment: No dosage adjustment needed for mild to moderate hepatic impairment 4

Efficacy and Safety

Rabeprazole demonstrates dose-dependent inhibition of acid secretion with a rapid onset of action 3, 7. It has several advantages:

• More rapid onset of action compared to omeprazole 3
• Less susceptible to CYP2C19 genetic polymorphisms due to non-enzymatic metabolism 7
• Similar efficacy to other PPIs at equivalent doses 3, 4

Safety at High Doses

• Even at doses up to 120 mg daily, rabeprazole has been well-tolerated in clinical studies 1, 2
• FDA labeling notes that patients with Zollinger-Ellison syndrome have been safely treated with up to 120 mg once daily 1

Common Adverse Effects

• Headache
• Diarrhea
• Nausea
• Abdominal pain
• Rhinitis
• Pharyngitis 4, 8

Clinical Pearls

• For most acid-related disorders, 20 mg once daily is sufficient 3, 4
• Higher doses (40-120 mg daily) should be reserved for hypersecretory conditions 1, 2
• No specific antidote exists for rabeprazole overdose; treatment should be symptomatic and supportive 1
• Rabeprazole is extensively protein-bound and not readily dialyzable in case of overdose 1

While rabeprazole is generally well-tolerated even at higher doses, clinicians should use the lowest effective dose for the shortest duration needed to minimize potential long-term risks associated with PPI therapy.