bizarre side-effects from Aciphex - pharm Steve, anyone?

[GardeniaGirl]

I've been taking Aciphex for about 2 weeks now and it has totally eliminated the constant nausea I was having for the past few months.

But, I started getting some mild insomnia.

I take methotrexate and it makes me very depressed. So far my psych has not been able to find anything to help with this.

Ever since starting the aciphex, my mood has been much, much better - almost moving above normal into slightly hypomanic.

Also, severe bloating in my stomach.

I started doing some reading on it last night and found that insomnia is listed as a side effect and I found a few patient reviews describing a slightly elevated mood.

I think I will go manic and not sleep at all if I keep taking it, plus the bloating is extremely uncomfortable, so I didn't take it today and my stomach already feels much better.

What baffles me is how an acid reflux drug could cause mood problems.

Some patients on the reviews I read reported becoming depressed while taking it. For me, it is going the opposite direction..,

anyone have any ideas?

I may experiment with taking it every other day or every three days because so far my psychiatrist has found NOTHING to help with the mood problems from methotrexate.

[Pharmacist.steve]

Could the "bloating" be poor digestion because the med has reduced your acid level in your stomach to a point you can't digest your food?. The tabs are enteric coated .. so to dissolve in the intestines .. so cutting it in half might not be a good idea ... but trying it every other day .. to see what happens. The loss of sleep could be pushing you farther down the "manic path".. if dosing everyother day helps the bloating but not the insomnia ... I would think that it would be better to treat the insomnia.

[GardeniaGirl]

thanks steve - I am going to cut back to every 3 days for now.

I already take Ambien which puts me out for a good 7-8 hours every night -

with Aciphex, I was tossing and turning most nights.

I didn't link it to the Aciphex until I started reading patient reviews.

I would have never thought that a drug for stomach acid could have those sorts of effects.

Thanks - GG

[BrokenBladder]

GG~~

I'm sorry that you're having trouble with this med. I don't have any personal experence with it, but I've had some reactions to other meds. Hang in there and hopefully it will work itself out.

Tale care amd keep us posted!!

[mrsdoubtfyre]

impair digestion of protein. When the undigested protein gets into the intestine, then bacteria ferment it and gas is produced--hence the bloating.

This is a trade-off, because the gas then pushes up and creates more reflux.

You can try using a simethicone product, like Gas-X to help move the gas along.
However over time your ability to absorb amino acids will fall, and then your ability to make proteins for your body will go down. Use of a whey product may be helpful when this occurs.

There is a warning about slow metabolizers for this drug:
Metabolism: Rabeprazole is extensively metabolized. The thioether and sulphone are the primary metabolites measured in human plasma. These metabolites were not observed to have significant antisecretory activity. In vitro studies have demonstrated that rabeprazole is metabolized in the liver primarily by cytochromes P450 3A (CYP3A) to a sulphone metabolite and cytochrome P450 2C19 (CYP2C19) to desmethyl rabeprazole. The thioether metabolite is formed non-enzymatically by reduction of rabeprazole. CYP2C19 exhibits a known genetic polymorphism due to its deficiency in some sub-populations (e.g. 3 to 5% of Caucasians and 17 to 20% of Asians). Rabeprazole metabolism is slow in these sub-populations, therefore, they are referred to as poor metabolizers of the drug.
from http://www.rxlist.com/cgi/generic/aciphex_cp.htm

You are taking folic acid with that methotrexate, aren't you? This is very important. Low folic acid is present in depression. And methotrexate blocks folic acid use in the body. Some people cannot use folic acid properly due to genetic errors --called polymorphisms-- and in this case using folinic acid is more useful. Source Naturals now makes it OTC. So check that out.
www.iherb.com carries it.

[Kathi49]

GG,

I really have no idea about Aciphex other than I tried once and it didn't agree with me. I tend to go with what Steve is saying though....it makes sense to me. And your post struck me because a friend of mine said just last week that the military hospital he goes to stopped prescribing it totally....for anyone. But before I say too much more, and honestly I don't why, I am going to call him back. I may have misunderstood what he was saying. I just can't imagine a hospital pharmacy pulling it for everyone. But that is what he said. I think what really happened is that they stopped prescribing it for him because it wasn't working well anymore. Maybe he just THINKS they stopped prescribing for it everyone. I am :confused: ! Anyway, he has been switched to Nexium. I wish I would have asked more about Aciphex but the conversation really centered around Nexium. I know, it sounds bizzare, that's why I need to call him back to clarify if I heard him right. :eek: :)

[mrsdoubtfyre]

Methotrexate is very hard on the stomach. I have seen patients reach a point when oral is too irritating. They move on to injectable with better results.

Also the military setting would probably have a fixed formulary in place.
Drugs are purchased according to price and deals offered by the companies.
Typically only one drug in each expensive class is chosen.

Aciphex may have been outbid by another company like Nexium.

For example an HMO I used to work for had this progression:
Prilosec (when it was solo out there)
Prevacid (cheaper than Prilosec Rx)
then Aciphex
then Protonix
then OTC prilosec!
This was over several years--about 5. Nexium never made the list, and I finally moved on so I don't know if it ever did.

Now Prevacid is the most expensive of the list!

[Kathi49]

Interesting Mrs. D. I didn't know Prevacid was the most expensive on the LIST. But I do know Nexium is terribly expensive. Thank goodness for insurance. Looking at your list is sort of how it they were given to me in succession. Some caused diarrhea others caused headaches or other strange SE's. But the Nexium hasn't bothered me at all.