Anreb Plus
Generic Name
Rabeprazole Sodium + Itopride Hydrochloride
Manufacturer
Beximco Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| anreb plus 100 mg tablet | ৳ 12.00 | ৳ 120.00 |
Description
Overview of the medicine
Anreb Plus 100 mg Tablet is a combination medicine containing Rabeprazole (a proton pump inhibitor) and Itopride (a prokinetic agent). It is used to treat gastroesophageal reflux disease (GERD), dyspepsia, and other conditions involving excessive acid production and impaired gastric motility.
Uses & Indications
Dosage
Adults
One tablet once daily, preferably before breakfast or as directed by the physician.
Elderly
No specific dose adjustment is generally required, but caution should be exercised in patients with significant renal or hepatic impairment.
Renal_impairment
Use with caution. Dose adjustment may be necessary based on the severity of impairment. Consult a physician.
Hepatic_impairment
Use with caution. Dose adjustment may be necessary based on the severity of impairment. Consult a physician.
How to Take
Take the tablet whole with a glass of water. Do not crush, chew, or break it. It should be taken before meals, typically 30 minutes before breakfast.
Mechanism of Action
Rabeprazole inhibits the H+/K+-ATPase enzyme system (the proton pump) at the secretory surface of the gastric parietal cell, blocking the final step of acid production. Itopride acts as a dopamine D2 receptor antagonist and inhibits acetylcholinesterase, leading to increased acetylcholine levels, thereby enhancing gastrointestinal motility.
Pharmacokinetics
Onset
Rabeprazole's acid-suppressing effect begins within an hour. Itopride's prokinetic effects can be observed within 30-60 minutes.
Excretion
Both Rabeprazole and Itopride metabolites are primarily excreted through the kidneys (urine).
Half life
Rabeprazole has a plasma half-life of 1-2 hours. Itopride has a terminal elimination half-life of approximately 6-8 hours.
Absorption
Rabeprazole is rapidly absorbed after oral administration, with peak plasma concentrations occurring within 2-5 hours. Itopride is rapidly and extensively absorbed, with peak concentrations reached in about 30-45 minutes.
Metabolism
Rabeprazole is primarily metabolized in the liver via CYP2C19 and CYP3A4 enzymes. Itopride is extensively metabolized in the liver mainly by flavin-containing monooxygenase 3 (FMO-3).
Side Effects
Contraindications
- Hypersensitivity to Rabeprazole, Itopride, or any component of the formulation.
- Patients with gastrointestinal hemorrhage, mechanical obstruction, or perforation.
- Children under 12 years of age.
Drug Interactions
Warfarin
Increased INR and prothrombin time have been reported with concomitant use of PPIs and warfarin; monitor closely.
Methotrexate
Concomitant use with PPIs may increase and prolong serum levels of methotrexate and/or its metabolite.
Anticholinergics
The prokinetic effect of Itopride may be reduced by anticholinergic drugs.
Other dopamine agonists
Exercise caution when combining Itopride with other dopamine agonists.
Digoxin, Ketoconazole, Itraconazole
Rabeprazole may alter the absorption of pH-dependent drugs by significantly reducing gastric acidity.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
In case of an overdose, symptomatic and supportive treatment should be initiated. There is no specific antidote. Monitor vital signs and provide general supportive care.
Pregnancy & Lactation
Pregnancy Category C. Use in pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether Rabeprazole or Itopride is excreted in human milk; therefore, caution should be exercised when administered to a nursing mother. Consult your doctor.
Side Effects
Contraindications
- Hypersensitivity to Rabeprazole, Itopride, or any component of the formulation.
- Patients with gastrointestinal hemorrhage, mechanical obstruction, or perforation.
- Children under 12 years of age.
Drug Interactions
Warfarin
Increased INR and prothrombin time have been reported with concomitant use of PPIs and warfarin; monitor closely.
Methotrexate
Concomitant use with PPIs may increase and prolong serum levels of methotrexate and/or its metabolite.
Anticholinergics
The prokinetic effect of Itopride may be reduced by anticholinergic drugs.
Other dopamine agonists
Exercise caution when combining Itopride with other dopamine agonists.
Digoxin, Ketoconazole, Itraconazole
Rabeprazole may alter the absorption of pH-dependent drugs by significantly reducing gastric acidity.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
In case of an overdose, symptomatic and supportive treatment should be initiated. There is no specific antidote. Monitor vital signs and provide general supportive care.
Pregnancy & Lactation
Pregnancy Category C. Use in pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether Rabeprazole or Itopride is excreted in human milk; therefore, caution should be exercised when administered to a nursing mother. Consult your doctor.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24-36 months from manufacturing date
Availability
Pharmacies nationwide
Approval Status
Approved (DGDA, Bangladesh)
Patent Status
Off-patent (generic available)
Clinical Trials
Clinical trials have demonstrated the efficacy of Rabeprazole in acid suppression and Itopride in improving gastric motility, supporting their combined use for GERD with dysmotility.
Lab Monitoring
- For long-term use, periodic monitoring of liver function tests and magnesium levels may be considered.
Doctor Notes
- Advise patients to take this medication 30 minutes before the first meal of the day for optimal effect.
- Monitor for signs of hypomagnesemia, C. difficile infection, and bone health in patients on long-term PPI therapy.
- Counsel patients on lifestyle modifications to manage GERD symptoms effectively.
Patient Guidelines
- Take the medicine exactly as prescribed by your doctor.
- Do not stop taking the medicine suddenly without consulting your doctor.
- Report any unusual or severe side effects to your doctor immediately.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose.
Driving Precautions
This medicine may cause dizziness or drowsiness in some individuals. If you experience these symptoms, avoid driving or operating heavy machinery.
Lifestyle Advice
- Avoid spicy, fatty, and acidic foods.
- Eat smaller, more frequent meals.
- Avoid lying down immediately after eating; try to wait at least 2-3 hours.
- Elevate the head of your bed if you experience nighttime reflux.
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