Rebamipide is a gastroprotective agent with a unique mechanism of action, distinct from proton pump inhibitors (PPIs) and H2-receptor antagonists. It is a quinolinone derivative that promotes gastric mucosal defense and healing by increasing prostaglandin synthesis, scavenging free radicals, and stimulating mucus secretion. It is a cornerstone in the management of gastritis and gastric ulcers in the Indian context, where dietary and lifestyle factors are prevalent.
Adult: 100 mg orally three times daily (after meals).
Note: Administer after meals to improve tolerability and potentially enhance mucosal contact. Tablet should be swallowed whole with a glass of water. Do not crush or chew.
Rebamipide enhances the natural defense mechanisms of the gastric mucosa. It does not inhibit gastric acid secretion. Its primary actions include: 1) Induction of endogenous prostaglandins (PGE2 and PGI2) synthesis in the gastric mucosa, which promotes mucus and bicarbonate secretion and mucosal blood flow. 2) Scavenging of hydroxyl radicals, providing antioxidant protection against reactive oxygen species (ROS) generated during inflammation or by NSAIDs. 3) Upregulation of growth factors like EGF and TGF-α, promoting epithelial cell proliferation and repair. 4) Inhibition of neutrophil activation and adhesion, reducing inflammatory cytokine release (e.g., IL-8).
Pregnancy: Category N (Not classified by US FDA). Animal studies have not shown teratogenicity, but adequate human data is lacking. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Not recommended unless clearly needed.
Driving: Rebamipide may cause dizziness in some patients. Patients should be cautioned about operating machinery or driving if they experience dizziness.
| Warfarin | Theoretical risk of increased anticoagulant effect due to protein binding displacement. Monitor INR closely. | Moderate |
| NSAIDs (e.g., Diclofenac, Ibuprofen) | Rebamipide is used to protect against NSAID-induced gastropathy. No significant PK interaction. | Minor |
| Proton Pump Inhibitors (e.g., Omeprazole, Pantoprazole) | Additive or synergistic mucosal healing effect. No significant PK interaction. | Minor |
| Antacids/Aluminum hydroxide | May decrease the absorption of rebamipide. Administer rebamipide at least 2 hours before or after antacids. | Moderate |
| Sucralfate | May interfere with absorption of rebamipide. Administer rebamipide at least 2 hours before sucralfate. | Moderate |