Usage
Dexrabeprazole + Domperidone is prescribed for the treatment of gastroesophageal reflux disease (GERD), including symptoms like heartburn and acid reflux. It’s also used to treat peptic ulcers, dyspepsia (indigestion), and Zollinger-Ellison syndrome (a condition characterized by excessive stomach acid production). Additionally, it aids in managing nausea and vomiting associated with these conditions. This combination medication belongs to two pharmacological classifications: proton pump inhibitors (PPIs) and prokinetic agents. Dexrabeprazole, the PPI, decreases stomach acid production, while Domperidone, the prokinetic agent, promotes gastric motility.
Alternate Names
No internationally recognized alternate names exist for this specific combination. However, it is sometimes referred to as Rabeprazole + Domperidone, substituting Dexrabeprazole with its parent compound. Brand names may vary regionally. Some examples are Dexorab, Diorob-DX and Dom R Capsules.
How It Works
Pharmacodynamics: Dexrabeprazole irreversibly inhibits H+/K+ ATPase, the proton pump in gastric parietal cells, thus reducing gastric acid secretion. Domperidone is a dopamine D2 receptor antagonist. It also blocks dopamine receptors in the chemoreceptor trigger zone, leading to antiemetic effects. In the gut, it increases acetylcholine concentrations at the myenteric plexus and thereby increases esophageal and gastric motility and lower esophageal sphincter pressure, and facilitates gastric emptying.
Pharmacokinetics: Dexrabeprazole is rapidly absorbed after oral administration and is extensively metabolized by the liver. Domperidone has limited absorption due to first pass hepatic metabolism. Both drugs are primarily metabolized by CYP3A4 enzymes. Elimination pathways involve both renal and hepatic excretion.
Dosage
Standard Dosage
Adults:
A common adult dose is one capsule containing 10mg Dexrabeprazole and 30mg Domperidone, taken once daily, approximately 30 minutes before a meal.
Children:
Use in children under 12 years is generally not recommended due to limited safety and efficacy data. For adolescents 12 years and older, the adult dose may be considered, under strict medical supervision and adjusted based on individual response.
Special Cases:
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Elderly Patients: Caution advised due to potential increased sensitivity to side effects. Dosage adjustments might be necessary, especially in those with renal or hepatic impairment.
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Patients with Renal Impairment: For patients with severe renal dysfunction, dose adjustments may be needed. Close monitoring is required.
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Patients with Hepatic Dysfunction: For patients with severe hepatic dysfunction, this combination is generally not recommended.
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Patients with Comorbid Conditions: Caution advised in patients with cardiovascular diseases, especially those with prolonged QT interval.
Clinical Use Cases
The dosages for the listed clinical scenarios generally align with the standard adult dosage, with potential adjustments as needed:
- Intubation
- Surgical Procedures
- Mechanical Ventilation
- Intensive Care Unit (ICU) Use
- Emergency Situations
Dosage Adjustments
Dose adjustments are based on individual patient factors, including renal or hepatic function, coexisting medical conditions, and drug interactions. Therapeutic drug monitoring might be helpful to adjust the dosage in specific cases.
Side Effects
Common Side Effects
- Headache
- Diarrhea
- Nausea
- Abdominal pain
- Dry mouth
- Flatulence
- Dizziness
Rare but Serious Side Effects
- Cardiac arrhythmias, including QT prolongation
- Extrapyramidal symptoms (movement disorders)
- Severe allergic reactions
Long-Term Effects
- Potential for vitamin B12 deficiency and hypomagnesemia with prolonged use.
- Increased risk of bone fractures (osteoporosis)
Adverse Drug Reactions (ADR)
- Angioedema
- Anaphylaxis
- Stevens-Johnson syndrome
- Toxic epidermal necrolysis
Contraindications
- Hypersensitivity to either Dexrabeprazole or Domperidone
- Gastrointestinal bleeding or perforation
- Prolactinoma (pituitary tumor)
- Pheochromocytoma
- QT prolongation or ventricular arrhythmia
- Concurrent use of drugs that prolong the QT interval
- Moderate to severe hepatic impairment
Drug Interactions
- Ketoconazole, fluconazole, voriconazole (antifungals)
- Warfarin (anticoagulant)
- Digoxin (cardiac glycoside)
- Metoclopramide (prokinetic)
- Antiarrhythmics that prolong QT interval
Pregnancy and Breastfeeding
Data regarding safety during pregnancy are limited. Use only if clearly needed and the potential benefits outweigh the risks. Domperidone is excreted in breast milk, thus breastfeeding while using this combination is generally not recommended. Discuss potential alternatives with your doctor.
Drug Profile Summary
- Mechanism of Action: Dexrabeprazole: inhibits proton pumps, reducing gastric acid secretion. Domperidone: dopamine antagonist; enhances gastrointestinal motility and has antiemetic action.
- Side Effects: Common: headache, diarrhea, nausea, abdominal pain. Serious: cardiac arrhythmias, extrapyramidal symptoms.
- Contraindications: Hypersensitivity, GI bleeding, Prolactinoma, long QT syndrome, severe hepatic impairment, concurrent use with QT prolonging drugs.
- Drug Interactions: Antifungals (azoles), warfarin, digoxin, QT prolonging drugs.
- Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks during pregnancy. Breastfeeding not recommended.
- Dosage: Adults: 10mg/30mg once daily before meals. Adjustments necessary for renal/hepatic impairment. Pediatric use restricted.
- Monitoring Parameters: Electrolytes, ECG, liver function tests, complete blood count.
Popular Combinations
This drug is often prescribed alone. Co-administration with antacids may reduce Dexrabeprazole absorption, while concomitant use with other prokinetics (like metoclopramide) can increase the risk of side effects.
Precautions
- Monitor for electrolyte imbalances, particularly magnesium, potassium, and calcium.
- Evaluate cardiac function, especially QT interval, before and during treatment.
- Assess liver and kidney function.
- Caution with driving or operating machinery due to potential dizziness.
- Avoid alcohol due to potential interaction.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Dexrabeprazole + Domperidone?
A: The common adult dose is one capsule of 10mg Dexrabeprazole + 30mg Domperidone once daily, 30 minutes before a meal. Adjustments may be necessary. Pediatric use limited to specific cases, under strict medical supervision.
Q2: What are the major contraindications to using this combination?
A: Contraindications include hypersensitivity, gastrointestinal bleeding, prolactinoma, long QT syndrome or concurrent use of QT-prolonging drugs, and severe liver impairment.
Q3: Can this combination be used during pregnancy?
A: Use cautiously during pregnancy only if the potential benefit justifies the potential risk to the fetus. Consult with a specialist.
Q4: Is it safe to breastfeed while taking this medication?
A: Breastfeeding is generally not recommended due to the excretion of Domperidone in breast milk. Discuss safe alternatives with your physician.
Q5: What are the potential long-term side effects?
A: Long-term use may lead to vitamin B12 deficiency, hypomagnesemia, and an increased risk of bone fractures. Regular monitoring is recommended.
Q6: What are the most significant drug interactions?
A: Interactions can occur with antifungals (azoles), warfarin, digoxin, and drugs that prolong the QT interval. Concomitant use should be carefully evaluated.
Q7: What precautions should be taken with elderly patients?
A: Elderly patients may be more susceptible to side effects, requiring careful monitoring and potential dose adjustment, especially with pre-existing renal or hepatic issues.
Q8: What should patients do if they miss a dose?
A: If a dose is missed, take it as soon as remembered, unless it’s close to the next scheduled dose. Do not double the dose. Maintain regular dosing intervals.
Q9: Are there any dietary restrictions with this medication?
A: High-fat meals may affect the drug’s efficacy. Consuming alcohol is not recommended.
Q10: What should a patient do if they experience side effects?
A: Patients experiencing side effects, especially severe ones, should contact their healthcare professional immediately.
