Razo D

Therapeutic indications

Razo D is a fixed combination of medication containing Domperidone and Rabeprazole. It is used in the management of stomach acidity, acid reflux, heartburn, nausea, and vomiting. Razo D is used for control, treatment, and prevention of the following conditions:

• Gastric ulcer
• Gastroesophageal reflux disease (GERD)
• Nausea
• Vomiting
• Heartburn
• Erosive esophagitis
• Zollinger Ellison syndrome
• Diabetic or idiopathic gastroparesis
• Helicobacter pylori infection when used with Amoxicillin or Clarithromycin
• Parkinson’s disease
• Duodenal ulcer
• Peptic ulcer
• Bloating
• Dyspepsia
• Belching
• Acid reflux
• Gastrin-secreting tumor
• A hernia
• Indigestion
• Difficulty swallowing
• A persistent cough

Do I need a Prescription?

Razo D can be bought from pharmacies close to you and from online drug stores. A doctor’s prescription is mandatory.

Dosage

The dosage for Razo D depends on the condition being treated, the severity, the age and weight and the individual response to the medication.  The recommended dosage for Razo D:

• One tablet is taken once a day.
• Severe cases, take a tablet two times a day

Razo D should not be used for a period longer than two weeks unless instructed by your doctor.

Chemical composition

Razo D has two active ingredients, these are:

• 20 mg Rabeprazole. A proton pump inhibitor(PPI)
• 30 mg of Domperidone. A dopamine antagonist or antiemetic

Mechanism of Action (MOA)

Rabeprazole a PPI works by inhibiting the production of hydrogen ions in the final step of acid secretion in the stomach. It binds irreversibly to the hydrogen ion/potassium ion ATPase enzyme, a proton pump in the gastric parietal cells and as a result prevents the secretion of hydrogen ions. The hydrogen ions normally combine with chloride ions in the stomach to form hydrochloric acid. When the acid levels reduce, it allows for healing caused by the acid and prevents the occurrence of more damage to the stomach, duodenum, and esophagus due to acid production.

Domperidone is a blocker of peripheral dopamine-receptors. It works by increasing peristalsis in the esophagus that improves gastroduodenal coordination, lowering pressure on the esophageal sphincter, peristalsis and gastric motility. This, in turn, facilitates gastric emptying relieving conditions symptoms.

Facts on Razo D

• Razo D is well absorbed from the gastrointestinal wall with a bioavailability of approximately 52%.
• Razo D is transported mainly 97% by plasma protein binding
• Peak plasma concentrations occur within three and a half hours after administration.
• 90% of Razo D is excreted from the body through urine with an elimination half-life of 1 to 2 hours.
• It takes about an hour for the effects of Razo D to be felt. The effects are however delayed when taken after a meal.
• The effects of Razo D can last up to 24 hours.

Contraindications

Razo D use is not recommended in a number of medical conditions. Its use might worsen the condition or predispose you to side effects of the medication that is fatal. Inform your doctor before you use Razo D of all medical conditions you have or have has previously. You are not to use Razo D if you have the following conditions:

• Allergy to the active ingredients.
• Intestinal blockage
• Imbalance of electrolytes such as magnesium, potassium, and calcium
• Severe renal impairment
• Severe liver disease
• Congestive heart failure
• Osteoporosis
• Alcoholism
• Pregnant and planning to conceive. Should only be used when the benefits outweigh the risks. Animal studies have shown harm to the fetus
• Should be used if the benefits outweigh the risks. The effect on the nursing baby is not known.
• Gastrointestinal hemorrhage
• Atrophic gastritis
• Interstitial nephritis
• Vitamin B 12 deficiency
• Intestinal perforation
• Lupus
• Breast cancer
• Gastric cancer
• Diarrhea

Side effects

Apart from the intended effects, Razo D can also cause some side effects. The side effects do not occur in every individual. They depend on the dosage, duration of use and reaction to the drug. The side effects can be common and less serious and can go away as you keep taking the medication or they can be rare and very serious.  Report to your doctor any side effects you might experience especially if they do not go away to seek medical advice. The following are the common side effects of Razo D:

• Diarrhea
• A headache
• Flu-like symptoms
• Anxiety
• Constipation
• Nutrient malabsorption
• Dizziness
• Joint pain
• Itching
• Drowsiness
• Galactorrhea
• Skin rash
• Constipation
• Dizziness
• Fatigue
• Backache
• Abdominal pain
• Cough
• Arthralgia
• Myalgia
• Dry mouth
• Sensitivity to light
• Aggression
• Sleep disturbances
• Irregular periods
• Flatulence
• Chest pain

Serious side effects include:

• Convulsions
• Arrhythmias
• Cardiac arrest
• Hypokalemia
• Dysrhythmias
• Gynecomastia
• Fractures due to osteoporosis
• Confusion
• Depression
• Agitation
• Hallucination
• Hepatitis
• Increases in the liver enzymes
• Yellowing of skin and eyes
• Hepatic encephalopathy
• Candidiasis
• Blood disorders
• Peripheral edema
• Angina
• Malaise
• Low levels of potassium and magnesium
• Stevens-Johnsons syndrome
• Alopecia
• Muscular weakness
• Changes in sexual urge
• Disturbance of taste
• Toxic epidermal necrolysis
• Eczema
• Visual disturbances
• Hyperlipidemia

The use of Razo D should be discontinued in case you have an allergic reaction to the medication. Signs of an allergic reaction include:

• Difficulty breathing
• Swelling of the tongue, lips, face, and throat
• Itching
• Rashes on the skin

If you accidentally take an overdose of Razo D, immediately inform your doctor or rush to the emergency center of the nearest hospital. Carry the medication package with you. Taking an overdose can result in side effects of the medication. The signs of an overdose include swelling of lips, throat, face, and throat, seizures, skin turning grey or blue, bad cough, fever, itching and tightness in the chest.

Drug interactions

When two medication or more are taken concurrently, drug interactions can occur. Inform your doctor about all medication you are currently using and those you have used recently both prescription drugs and over the counter drugs, any dietary supplements and herbal products.

Drug interactions may affect the working of the drug making it less effective or it may lead to the occurrence of side effects. Razo D interacts with the following medications and products:

• Atropine
• Ketoconazole and erythromycin inhibit the metabolism of Razo D increasing its activity.
• Phenytoin
• Amiodarone
• Warfarin
• Clarithromycin
• Nelfinavir
• Bromocriptine
• Drugs of controlling irregular heartbeat
• Antidepressants such as phenelzine, isocarboxazid
• Mood medications like mesoridazine, thioridazine
• Narcotic painkillers such as morphine, codeine
• Atazanavir
• Iron pills
• Should be used at least one hour before taking Razo D as it lowers its effectiveness
• Media that is iodinated
• Amlodipine
• Gatifloxacin
• Aloe Vera
• Estradiol
• Amiodarone
• Amprenavir
• Saquinavir and methotrexate. Concurrent use lowers their plasma concentrations.
• Diuretics
• Avoid using caffeinated drinks, cola drinks,tea, chocolate, and high energy drinks.
• Using concurrently increases dizzies and can also increase damage to the stomach.
• Drugs that prolong QT interval
• Potent CYP3A4 inhibitors

What to Do If You Skip a Dose

Take the missed dose as soon as you realize it. But if it is close to the time of your next dose, you can miss it and continue with the normal schedule. However, do not double your dose to make up for the missed dose. Frequent missing of doses makes your medications to be less effective in treating your condition. To avoid dose missing, set a reminder or have a family member remind you when it is time for your next dose.

Precautions

Before using Razo D, you need to consider a number of precautions. The precautions include:

• Allergic reaction:  Do not use Razo D if you have an allergic reaction to the active ingredients, other PPI and dopamine antagonists.
• Report to your doctor any medications you are using or have been using to avoid drug interactions.
• Educate your doctor about any medical conditions you have or your medical history to prevent the occurrence of side effects that might be fatal
• Liver disease: You should use Razo D cautiously. In case of severe cases, dose adjustment is recommended.
• Kidney disease: Use Razo D cautiously and dose adjustment is recommended in case of severe renal impairment.
• Pregnancy or planning to conceive: Razo D has been shown to cause fetal harm in animals, thus should only be used when the benefits outweigh the risks.
• Razo D is secreted into breast milk but its effects on the nursing baby are not well known. Thus it should only be used when the benefits outweigh the risks.
• Taking of alcohol is not recommended while using Razo D. it increases of dizziness and drowsiness
• Razo D should be stored at room temperature away from moisture and heat.
• Razo D might affect the absorption of magnesium, thus the levels should be clearly monitored. Your doctor might also prescribe magnesium supplement together with Razo D.
• Razo D also interferes with the absorption of calcium. When used for prolonged durations, it leads to weak bones and development of osteoporosis that might lead to bone fractures of the spine and wrist. Razo D can, therefore, be prescribed together with calcium and vitamin D supplements.
• Razo D causes dizziness and drowsiness. If you become dizzy and drowsy do not engage in activities that require mental alertness such as driving or operation of heavy machinery as it could be dangerous.
• Always check for the expiry date of the medication. Do not take expired medication as its effectiveness can be reduced or it could cause toxicity.
• Do not use Razo D together with steroids.
• Avoid exposure to sunlight as Razo D can make you more sensitive to sunlight. Use sunscreen to avoid sunburns.
• Do not take other PPIs while using Razo D as it already contains a proton pump inhibitor.
• Razo D should not be administered in individuals with CYP3A4 deficiency as it will not be well metabolized and can cause serious side effects.

Alternative Brands and Manufacturing Companies of the Drug

Razo D is manufactured by Dr.Reddys Laboratories Ltd. Razo D are manufactured as 20 mg capsules.

Substitutes of the drug

Substitute drugs with the same composition and strength include:

• Veloz D capsule – Torrent Pharmaceuticals Ltd
• Cyra-D capsule – -Systopic Laboratories Pvt Ltd
• Rabemac-DSR capsule – Macleods Pharmaceuticals Pvt Ltd
• Rekool D capsule SR – Alembic Pharmaceuticals Ltd
• Rabeking- DSR capsule – Mankind Pharma Ltd
• Rablet D capsule – Lupin Ltd
• Hapii-D capsule SR – Zydus Cadila
• Esoga-RD capsule SR – Abbott
• Raberite D capsule – MHS Pharmaceuticals
• Above 5 D capsule – Pfizer Limited
• Acera D capsule – IPCA Laboratories Ltd
• APD tablet – Vanguard Therapeutics Pvt Ltd
• B-Joy Plus caps – Concertina Pharma
• Ecorab D capsule SR – Indiabulls Pharmaceutical Ltd
• RabopeP-DSR capsule – Seagull Pharmaceuticals Pvt Ltd
• Rabitop D capsule SR – Aristo Pharmaceuticals Pvt Ltd

References

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