Based on the experience of the clinical studies it can be concluded that Pariet ® is usually well tolerated by patients. . Side effects are generally mild to moderate and are transient in nature
Before the drug Pariet ® in testosterone cypionate dosage clinical trials include the following side effects: headache, abdominal pain, diarrhea, flatulence, constipation, dry mouth, dizziness, rash, peripheral edema .
Adverse reactions are systematized with respect to each of the organ systems using the following classification of frequency of occurrence:
very frequent (≥1 / 10)
Common (≥ / 100, <1/10)
Uncommon (≥ / 1000, <1/100)
Rare (≥10000 <1/1000)
Very rare (<1/10000), including isolated cases.
Violations of the immune system:
rarely, acute systemic allergic reactions, blood disorders and lymphatic system: rarely, thrombocytopenia, neutropenia, leukopenia, Violations of the Metabolism and nutrition: rare-hypomagnesemia,Violations of the hepatobiliary system: elevated liver enzymes, rarely, hepatitis, jaundice, hepatic encephalopathy; Violations of the kidney and urinary tract: rarely, interstitial nephritis; Disorders of the skin and subcutaneous tissue disorders: rarely, bullous rash, urticaria, very rarely, erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome. Violations of the musculoskeletal system: rarely – myalgia, arthralgia, Violations of the reproductive system: very rarely, gynecomastia;
Changes of other laboratory parameters were observed during the reception of rabeprazole sodium.
According posmarketingovyh observations while taking proton pump inhibitors (PPIs) may increase the risk of fractures (see. “Special Instructions” section).
information intentional or accidental overdose is minimal. Cases of severe overdose rabeprazole was not observed. Treatment specific antidote for the drug Pariet ® is unknown. Rabeprazole well bound to testosterone cypionate dosage plasma proteins, and therefore poorly displayed during dialysis. In case of overdose should be carried out is symptomatic and supportive treatment.
Interaction with other drugs
450 cytochrome system
sodium rabeprazole, as well as other proton pump inhibitors (PPI), is metabolized with the cytochrome P450 (CYP450) in the liver. In in vitro studies on human liver microsomes it showed that sodium rabeprazole metabolized isozymes CYP2C19 and CYP3A4.
Studies in healthy volunteers have shown that sodium rabeprazole has pharmacokinetic or clinically significant interactions with drugs that are metabolized by P450 cytochrome system – warfarin, phenytoin, theophylline and diazepam (regardless of whether patients metabolize diazepam strongly or weakly).
study of combination therapy with the antibacterial agents were conducted. This four-way crossover study involved 16 healthy volunteers who received 20 mg rabeprazole, amoxicillin 1000 mg, clarithromycin 500 mg, or a combination of these three drugs (RAK – rabeprazole, amoxicillin, clarithromycin). Indicators AUC and C max; clarithromycin and amoxicillin were similar when compared to monotherapy with the combination therapy.
Indicators AUC and C max; for rabeprazole increased by 11% and 34%, respectively, and for 14-hydroxy-clarithromycin (the active metabolite of clarithromycin) AUC and C max; increased 42% and 46%, respectively, for the combination therapy versus monotherapy. This increase in impact indicators for rabeprazole and clarithromycin were not considered clinically significant.
Interactions due to the inhibition of gastric acid secretion
of sodium rabeprazole provides a stable and long-lasting inhibition of gastric acid secretion. Thus, there may be interaction with substances whose absorption depends on pH. When concomitantly with rabeprazole sodium absorption of ketoconazole reduced by 30% and increases absorption of digoxin by 22%. Therefore, some patients should be carried out surveillance for a decision on the need to adjust the dose while taking rabeprazole sodium with ketoconazole, digoxin or other drugs, for which absorption depends on pH.
In simultaneous reception of atazanavir 300 mg / ritonavir 100 mg with omeprazole (40 mg 1 time per day) or atazanavir 400 mg with lansoprazole (60 mg 1 time per day) in healthy volunteers was observed a significant reduction in testosterone cypionate dosage atazanavir exposure. Atazanavir absorption depends on pH. Although simultaneous with rabeprazole was not studied, similar results are also expected for other proton pump inhibitors.Thus, it is not recommended concomitant use of atazanavir with proton pump inhibitors, including rabeprazole.
In clinical studies, antacid agents used in conjunction with rabeprazole sodium. Clinically relevant interaction of rabeprazole sodium with aluminum hydroxide gel or magnesium hydroxide were observed.
In a clinical study in the course of receiving rabeprazole sodium depleted fat food clinically significant interactions were observed. Receiving rabeprazole sodium simultaneously with fat rich food may slow the absorption of rabeprazole to 4 hours or more, but the C max; and AUC are not changed.
Experiments in vitro c using human liver microsomes showed that cyclosporin inhibits metabolism rabeprazole IC50 with 62 micromoles, ie at a concentration 50 times C.. Max; in healthy volunteers after 20 days of 20 mg of rabeprazole. The degree of inhibition is similar to that of omeprazole for equivalent concentrations.
According to reports of adverse events, according to the published pharmacokinetic studies and retrospective analysis suggests that simultaneous reception of IPP and methotrexate (particularly in high dosage) may lead to increased concentrations of methotrexate and / or its metabolite gidroksimetotreksata and increase half-life. However, special studies of drug interactions with methotrexate IPP was conducted.
A patient on therapy with rabeprazole sodium does not preclude the presence of gastric malignancy.
The tablets of the drug Pariet ® can not chew or crush. The tablets should be swallowed whole. It was found that neither the time of day nor food intake does not affect the activity of sodium rabeprazole.
In a special study in patients with mild or moderate hepatic impairment has not been found significant differences between the frequency of side effects Pariet drug ® from that of matched age and sex of healthy individuals but despite this, it is advisable to be careful at the first appointment of the drug Pariet ® in patients with severely impaired hepatic function. AUC rabeprazole sodium in patients with severe hepatic impairment is approximately two times higher than in healthy patients.
Patients with impaired renal or hepatic function dose adjustment Pariet ® is required.
the treatment of proton pump inhibitors for at least 3 months in rare cases, cases of symptomatic or asymptomatic hypomagnesemia were observed. In most cases these messages received within a year after therapy. Serious adverse events were tetany, arrhythmias and seizures. Most patients required treatment for hypomagnesemia, including magnesium replacement and discontinuation of proton pump inhibitors. Patients who are receiving long-term treatment or who take proton pump inhibitors with drugs such as digoxin or drugs that may cause hypomagnesemia (eg diuretics), health care providers should monitor the magnesium concentration prior to treatment with proton pump inhibitors in the treatment period.
Patients should not be taken concurrently with the drug Pariet ® other means of reducing the acidity, such as blockers of H 2 receptor antagonists or proton pump inhibitors.
, according to observational studies suggests that therapy with proton pump inhibitors (PPIs) may lead to increased risk of osteoporosis-related fractures of the hip, wrist or spine. The risk of fracture was increased in patients receiving high doses of PPIs long-term (one year or more).
Concomitant use with methotrexate rabeprazole
According to the literature, simultaneous IPP with methotrexate (particularly in high dosage) may lead to increased concentrations of methotrexate and / or its metabolite gidroksimetotreksata and increase half-life, which can lead to the manifestation of toxicity of methotrexate. If necessary, use of high doses of methotrexate, may be considered a temporary cessation of PPI therapy.
Therapy PPIs can lead to increased risks of gastrointestinal infections such as Clostridium difficile.
Effect on driving and working with machinery
Based on the features testosterone cypionate dosage of the pharmacodynamics of rabeprazole and profile of adverse effects, it is unlikely that Pariet ® affects the ability to drive and operate machinery. However, in case of drowsiness should avoid these activities.
Running low dose t3 clen cycle trying to lose bodyfat isn’t a real hot idea imo.