What is AcipHex and Who is it for?

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AcipHex® (rabeprazole sodium) is a delayed-release medication that reduces the amount of acid your stomach produces, to treat both common and uncommon gastrointestinal conditions.

AcipHex belongs to a class of drugs known as proton pump inhibitors (PPIs), used for many years and in a variety of chemical makeups to reduce the production of stomach acid. It’s effective for most people who use it, and it’s even available through a virtual visit with a medical clinician online from LifeMD.

What is a Proton Pump Inhibitor (PPI)?

Proton pump inhibitors are a class of medication that prevent the gastric proton pump in your stomach from producing too much gastric acid. PPIs typically take one to four days to begin working.

PPIs are not long-term solutions for most conditions, and they can cause side effects and health risks when used habitually.

AcipHex is generally intended for short-term treatment — typically between four and eight weeks of use – but as a prescription medication, it’s been proven effective over years of research.

AcipHex comes in a light-yellow tablet labeled “ACIPHEX 20” in red lettering, for 20 mg doses.

Who Needs AcipHex: Common Uses

AcipHex is prescribed to treat conditions or symptoms caused by an excess of stomach acid and chronic acid reflux, or heartburn. These conditions include:

  • Ulcers in the stomach lining or intestines

  • Gastroesophageal reflux disease (GERD)

  • Erosive Esophagitis

  • Zollinger-Ellison Syndrome

  • Heartburn

  • Coughing

  • Barrett’s Esophagus

When used in combination with other medications, AcipHex can also treat conditions like Helicobacter pylori infections – or H. pylori — in which this aggressive bacteria infects the digestive system, attacking the stomach and small intestines and affecting stomach acid production.

In this setting, AcipHex is typically prescribed alongside antibiotics like amoxicillin or nitroimidazole to cure H. pylori infections, and research suggests rabeprazole, the active ingredient in AcipHex, may have greater antibacterial properties than other proton pump inhibitors.

AcipHex (rabeprazole sodium) delayed-release tablets (20 mg) are approved by the FDA for the treatment of GERD, duodenal ulcers, H. pylori infections, and pathological hypersecretory conditions such as Zollinger-Ellison Syndrome. The FDA has also approved smaller 5 mg and 10 mg AcipHex doses for children between the ages of 1 and 11.

A woman holds her hands between her breastbone. She is presumably suffer from symptoms of heartburn, acid reflux, or GERD.

How AcipHex Works

AcipHex, like other proton pump inhibitors, works by decreasing the amount of acid in your stomach to reduce the uncomfortable symptoms of acid reflux.

Stomach acid is critical in breaking down the food you eat into functional building blocks that your body can use for energy and normal physiology. It’s what turns your chewed, clumpy food into a softer slurry that your digestive tract can then break down further.

Stomach acid is necessary for normal digestion, but in some people, stomach acid can rise up into the esophagus – where it’s not intended to be – and lead to a burning sensation and pain. This is called acid reflux and is a symptom of conditions like GERD.

Over time, repeat exposure to stomach acid can damage the lining of your esophagus and the sphincter muscle that keeps acid where it’s supposed to be – in the stomach – leading to worse symptoms and other complications when left untreated.

AcipHex works by blocking the hydrogen/potassium adenosine triphosphatase enzyme system (or the H+/K+ ATPase), more commonly called the gastric proton pump. As the last step in the stomach acid secretion process, inhibiting the proton pump is a highly effective approach to reducing acid content in the stomach; some proton pump inhibitors can reduce gastric acid nearly completely.

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Can AcipHex be purchased over the counter?

AcipHex is not an over-the-counter (OTC) medication. It’s only available with a prescription.

If you’re experiencing abdominal pain, vomiting, nausea, or bloating that you suspect might be caused by excess stomach acid, an over-the-counter proton pump inhibitor may be able to help.

But a full diagnosis from a medical provider can help you learn more about your symptoms and whether you may have a condition like GERD. At LifeMD, affiliated and board-certified online doctors and healthcare professionals can also make a diagnosis virtually in many cases.

Is there an OTC alternative to AcipHex?

Rabeprazole is typically used for more serious digestive issues caused by stomach acid — such as duodenal ulcers (sores in the small intestine) and GERD. Other treatment options exist if your condition is less severe.

The U.S. Food and Drug Administration recommends using OTC PPIs for a maximum of 14 days and only three times per year. Before consulting your primary health care provider, consider these over-the-counter options for acid reflux relief.

  • Lansoprazole (Prevacid®)
  • Esomeprazole (Nexium®)
  • Omeprazole magnesium (Prilosec®)
  • Omeprazole with sodium bicarbonate (Zegerid®)

Which is Better: Proton Pump Inhibitors or H2 Blockers?

For many years, H2 blockers (or H2 receptor agonists, H2RAs) were the treatment of choice for common acid reflux conditions.

These work by blocking histamine in the stomach lining, which results in decreased stomach acid production.

Common H2 blockers include:

  • Cimetidine (Tagamet®)

  • Nizatadine (Axid®, Tazac®)

  • Famotadine (Fluxid®, Pepcid®)

But since the ‘90s, proton pump inhibitors have become the primary tool for doctors treating severe acid reflux.

Because AcipHex works at the last stage of stomach acid release, it’s generally more effective than other approaches to acid reflux treatment, like H2 receptor antagonists.

Proton pump inhibitors have proven more effective at alleviating the symptoms of acid reflux and healing the ulcers that can cause it.

And because they’ve been shown to be so safe, some are even approved for use over-the-counter.

Your Many Options for Treating Acid Reflux

AcipHex isn't the only option when it comes to treating acid reflux and conditions related to stomach acid and the esophageal system. Proton pump inhibitors, particularly prescription versions like AcipHex, are considered the most effective. Options include:

Proton Pump Inhibitors

  • Omeprazole (Prilosec®)
  • Lansoprazole (Prevacid®)
  • Pantoprazole (Protonix®)
  • Dexlansoprazole (Kapidex®)
  • Esomeprazole (Nexium®)
  • Rabeprazole (AcipHex®)
  • Dexrabeprazole (Dexilant®)

H2 Antagonists

  • Ranitidine (Zantac®)
  • Famotidine (Pepcid®)
  • Nizatidine (Axid®)
  • Cimetidine (Tagamet®)


  • Aluminum Hydroxide (Amphojel®, AlternaGEL®)
  • Magnesium Hydroxide (Phillips' Milk of Magnesia®, Maalox®)
  • Calcium Carbonate (Tums®, Caltrate®)
  • Sodium Bicarbonate (Alka-Seltzer®, Baking Soda®)
  • Magaldrate (Riopan®)
  • Alginic Acid (Gaviscon®, Gelusil®)
  • Dihydroxyaluminum Sodium Carbonate (Basaljel®)
  • Trisilicate (Gaviscon®)
  • Oxethazaine (Paxar®)
  • Simethicone (Gas-X®, Mylanta®)

How to Take AcipHex

AcipHex can treat the symptoms and causes of a variety of gastric conditions, all of which are related to stomach acid and your gastrointestinal system’s pathophysiology.

Taken correctly, AcipHex may be a good choice for those dealing with stomach or esophagus pain.

How do you know if AcipHex is right for you? A doctor will help to diagnose and evaluate your symptoms before prescribing AcipHex, if appropriate.

AcipHex is available in 20 mg doses and is typically taken once daily. It should not be used by patients under the age of 12, though lower doses of rabeprazole can be used by younger patients, as indicated by your healthcare provider.

If you’ve been experiencing severe stomach pain and believe AcipHex could help, reach out to your doctor to discuss a prescription. Do not use rabeprazole without the guidance of a medical professional as it may interact with other medications or cause complications if you have another medical condition.

Read the label

Your doctor will have explained how to use AcipHex, but the label on your prescription bottle can give you more details about taking AcipHex.

This prescription label will include:

  • The medication dosage: How much AcipHex should you be taking, and how often?

  • The duration of use: How long should you be taking AcipHex?

  • When the drug should be taken: After or before meals? In the mornings or in the evenings?

  • The number of refills allowed: How many times can you return to the pharmacy for new medication after you’ve run out?

Understanding your doctor's instructions and the directions on the prescription label is essential as your dosage instructions may differ depending on which condition you’re treating.

Follow your doctor’s instructions

Make a note of any additional information your doctor provides during or after your consultation.

For example, if you’re treating duodenal ulcers with AcipHex, your doctor may advise you to take the medicine after you’ve eaten; if you’re treating GERD with AcipHex, taking AcipHex with or without food may be just fine.

A hand holds a glass under a faucet of running water while the glass fills up with water.

How to take AcipHex

AcipHex tablets should be taken whole with a glass of water once daily.

As AcipHex is a unique delayed-release formulation, you shouldn’t break, chew, or crush your tablet. Breaking these tablets can expose you to a more immediate effect from the drug, greater potency, and can increase the chances of side effects.

You’ll typically be prescribed 20 mg of AcipHex once daily if you have the following:

  • Erosive or ulcerative GERD (take it with or without food)

  • Duodenal ulcers (take it once in the morning, after breakfast)

  • Symptoms associated with GERD

Conditions like Zollinger-Ellison Syndrome may require higher doses — 60 mg to 100 mg daily — depending on your doctor’s diagnosis.

To treat H. pylori infections, your doctor may prescribe a combination of AcipHex, amoxicillin, and/or clarithromycin over a 7-day course of treatment.

Are There Potential Side Effects With AcipHex?

Even though the use of proton pump inhibitors has increased worldwide — over 50 million Americans use them regularly — and they’re considered safe for most individuals, taking these medications carries some risks, particularly when used continuously for long periods of time.

Potential (mild) side effects of AcipHex

AcipHex is unlikely to cause side effects when used correctly. Most people who experience side effects while taking AcipHex will feel mild discomfort. Some potential mild side effects include:

  • Stomach and throat pain

  • Headaches

  • Nausea and vomiting

  • Digestive disturbances, such as diarrhea and constipation

  • Gut infections

Potential (serious) side effects of AcipHex

The most serious side effects associated with AcipHex are those that indicate an allergic reaction to the medication. Seek medical attention immediately for any of the following symptoms:

  • Hives

  • Breathing difficulties — this may include swelling of the tongue, lips, throat, or face

Some other severe side effects that can occur on AcipHex and will require emergency medical attention include:

  • Blood or watery diarrhea

  • Severe stomach pains

  • Seizures

  • Tremors, muscle cramps, and jitters

  • Uncontrolled bleeding

  • Bloody stools

  • Infrequent urination or bloody urine

  • Sudden pain, especially in the wrists, hips, or back

  • Signs of low magnesium, including muscle spasms and irregular heartbeats.

  • Signs of worsening lupus or lupus erythematosus, including skin rash that affects the cheeks, nose, or arms, and that worsens when exposed to sunlight

Drug Interactions: What Medications Should I Not Be Taking with AcipHex?

Before your doctor prescribes AcipHex, you’ll need to disclose any medications you’re already taking. Several drugs and drug classes can interact with rabeprazole, including:

  • Blood thinners, such as warfarin

  • Diuretics

  • Immunosuppressants, such as methotrexate and cyclosporin

  • Antifungal medications, such as ketoconazole and pasaconazole

  • Protease inhibitors, like atazanavir

AcipHex Contraindications: Are There Any Conditions That Prevent Me from Using AcipHex or a Proton Pump Inhibitor?

AcipHex (and some other proton pump inhibitors) are not appropriate for people with certain medical conditions. Of course, that includes anyone with a known hypersensitivity to rabeprazole (the main ingredient in AcipHex) or any of the other ingredients in the AcipHex formula.

The FDA also cautions individuals with the following conditions to speak to their physician and ensure that AcipHex is safe for them to use:

  • Gastric cancer (stomach cancer)

  • Acute interstitial nephritis (inflammation of the kidneys that impairs their function)

  • Vitamin B12 deficiency

  • Low levels of calcium or magnesium

  • Bone fractures or osteoporosis

  • Liver disease

What Should I Do If I Miss a Dose of AcipHex?

If you’ve missed your prescribed dose of AcipHex, take it as soon as you remember or skip that planned dose if it’s nearly time to take the next dose.

Never take extra medication to make up for the missed dose, and always take AcipHex as instructed — for example, with or without food per your doctor’s directions.

Emergency or Accidental Overdose: What to Do

Taking an extra dose or two of rabeprazole won’t necessarily cause severe effects, but if someone collapses or experiences breathing difficulties, it may indicate an allergic reaction or accidental overdose.

In the event of an emergency that could be linked to the use of a proton pump inhibitor, call 911 immediately.

What Are the Risks Associated with Long-Term Use of AcipHex?

If you have a condition that requires long-term management of stomach acid, such as erosive esophagitis, AcipHex may not be the best option for you. Your doctor can help make this decision based on your situation.

Rabeprazole is typically prescribed for short-term treatment and several risks have been linked to prolonged use of the drug, including:

  • Developing a B12 deficiency: Higher doses of rabeprazole and long-term use can prevent the absorption of vitamin B12 in the body.

  • Fundic gland polyps: These are stomach growths that are usually non-cancerous.

  • Weakened bones and bone fractures: PPIs can decrease bone mass and increase the risk of osteoporosis when used continuously.

  • Cancer: According to research, the use of PPIs may increase the risk of gastric cancer.

So, Should I Take AcipHex?

If you’re wondering whether you should be taking AcipHex instead of over-the-counter alternatives, here are some factors to consider:

  • AcipHex provides up to 24 hours of symptomatic relief.

  • It can be taken with meals or on an empty stomach.

  • It may be less expensive than OTC and other prescription options, and because of its potency, AcipHex is likely to work better than other OTC substitutes.

Other things to keep in mind:

  • AcipHex is a prescription drug, so you'll need an appointment with your doctor before you can obtain it.

  • AcipHex can interfere with some other medications.

  • It should not be taken long-term. Prolonged use can result in low magnesium and B12 levels, and weakened bones, among other things.

LifeMD is a telehealth partner of choice for AcipHex, helping eligible patients get a diagnosis and determine the right course of treatment completely online.

Through a virtual telehealth visit, a board-certified doctor or nurse practitioner can help you determine what’s causing your discomfort, prescribe the right medications, and have your prescription sent to your nearest pharmacy.

It’s fast and easy — and you can stay in touch with your prescribing physician by messaging them in your LifeMD patient portal at any time.

Learn more about your condition and treatment options with a LifeMD virtual visit today.

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This article is intended for informational purposes only and should not be considered medical advice. Consult a healthcare professional or call a doctor in the case of a medical emergency.

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