Hyperacidity and associated conditions:

Erratic food habits, spicy foods, increased stress and tension and sleep pattern disturbances are the triggering factors for many major diseases including GI disorders like hyperacidity, nausea and vomiting, dyspepsia, gastro-esophageal reflux disorders, gastric and duodenal ulcers and irritable bowel syndrome. Further NSAIDs, antibiotics and other chronic drug therapies affect acid secretion and disturb gastro-intestinal motility. This has resulted into increased need for drugs that normalize acid secretion.

Proton pump inhibitors (PPIs) are indicated in the management of acid-related diseases (ARDs) and in association with Helicobacter pylori (H. pylori) eradication therapy when needed. PPIs represent the most important recent advance in the treatment of ARDs. With efficacy profiles superior to those of histamine H2-receptor antagonists (H2RA), and antacids, PPIs are now considered the drugs of choice in managing patients with ARDs.

Rabeprazole:

Rabeprazole is a potent proton pump inhibitor that suppresses gastric acid secretion by specific inhibition of the gastric H+K+-ATPase enzyme system at the secretory surface of the gastric parietal cell and is used in the treatment of hyperacidity and ulcers. It has a faster onset of action and lower potential for drug interaction compared to omeprazole and other PPIs. Importantly it provides 24 hour uninterrupted acid control, is free from reflex hyperacidity and provides once a day dosage convenience.

Rabeprazole reduces hyperacidity, prevents and heals ulcers and is important partner in H. pylori combination treatment. It is also recommended along with chronic drug therapies like NSAIDs, antibiotics and chemotherapeutic drugs to prevent GI ulcerations.

Rabeprazole + antiemetic- Prokinetic: The need for combination:

Gastro esophageal reflux disease (GERD), reflux esophagitis, peptic ulcer, gastric ulcer and other gastric acid related disorders have a pathogenesis related to both – reduced gastric motility and release of excessive gastric acid. Acid secretion is controlled with Rabeprazole whereas prokinetic agents are known to enhance gastrointestinal motility and prevent gastric reflux protecting against GERD. Thus a combination therapy of a prokinetic agent and a gastric acid lowering compound is rational and has shown more effectiveness than mono-therapy of proton pump inhibitors.

Levosulpiride: An effective prokinetic – antiemetic

Levosulpiride is a substituted benzamide reported to be a selective antagonist of dopamine D2 receptors activity on both central and peripheral levels. It is an atypical neuroleptic and a prokinetic agent. Levosulpiride is also claimed to have mood elevating properties.

It was shown to be effective in the treatment of dyspepsia (functional or organic dyspepsia, diabetic gastroparesis and reflux oesophagitis), in the prevention and treatment of iatrogenic emesis resulting from pharmacological agents and the treatment of severe non-iatrogenic nausea and vomiting.

The results of trials in diabetic patients show the importance of gastric emptying in the maintenance of glycemic control and the usefulness of chronic administration of levosulpiride in diabetic subjects with gastroparesis.

Rabeprazole + Levosulpiride: A synergistic combination

Rabeprazole is an effective PPI that controls acid secretion whereas levosulpiride is an effective prokinetic – antiemetic. Their combination has synergistic action in conditions associated with hyperacidity and reflux disorders. Extended form of Levosulpiride ensures sustained protection even with once a day dosage.

Dosage: 1 capsule daily

Indications:

• Hyperacidity and heartburn
• GERD, nausea and vomiting
• Dyspepsia and gastroparesis
• Chronic NSAIDs, anticancer, anti-TB and other drug therapies

Contra-indications: Hypersensitivity to any of the drug in combination