# Talk:Rabeprazole

Just an FYI: I am reworking major changes to this article. I hope to have them finished by next week. ―Biochemistry🙴❤ 02:07, 5 October 2017 (UTC)

Done! Let me know what you think.―Biochemistry🙴❤ 23:55, 9 October 2017 (UTC)
While the article is in OK form, it relies on the review from 1999 so is not really ready for GA review.  The MHRA label is from 2013 and would be better to use more.  I looked at pubmed and PMID 22928894 appears to be the most recent review on this drug from 2012, and isn't cited.  It should pass GA fine once the refs are updated and sources checked against them. Jytdog (talk) 02:29, 10 October 2017 (UTC)
Thank you for searching for that review; I'll have to take a look at it. Do you recommend trying to remove and replace the older information then, or just citing on top of it? ―Biochemistry🙴❤ 03:29, 13 October 2017 (UTC)
Generally see what the newer says the same or different; if the same just replace with the newer ref (to save  someone from doing the same exercise later) and if different, change the content and cite the newer. generally older refs should just fall away...  Thanks for your work on this! Jytdog (talk) 07:17, 13 October 2017 (UTC)
You're welcome! My edits are complete. Thank you again for the advice! ―Biochemistry🙴❤ 00:54, 17 October 2017 (UTC)
Looks great, except for the huge picture of the bottle of Aciphex which is just going to draw the ire of all the generics people and doesn't add a lot of value.  i would take that out... Jytdog (talk) 03:43, 17 October 2017 (UTC)

This review is transcluded from Talk:Rabeprazole/GA1. The edit link for this section can be used to add comments to the review.
Reviewer: Tom (LT) (talk · contribs) 10:11, 28 November 2017 (UTC)

I will take up this review, about one of my favourite drugs. Give me some time to familiarise myself with the page, and I'll respond in 2-3 days. --Tom (LT) (talk) 10:11, 28 November 2017 (UTC)


### Assessment
### Comments
@Biochemistry&Love great work on this article, it's really easy to read and I think you've done a great job writing it up. I have a few comments at the moment and will expand a greater list when I have some more time to go through the text and references with a more fine-toothed comb.
"History" section is very short. Doesn't actually state who developed it or how
Expanded from an original NDA filed in the USA.―Biochemistry🙴❤ 04:49, 3 December 2017 (UTC)
"Legal" lists only UK and US which form a small proportion of the world's population. I think it would be more representative to (if possible) add its legal status in the EU, China and India. --Tom (LT) (talk) 06:24, 1 December 2017 (UTC)
Much agreed! Added EU, India, and Japan. I haven't found China yet.―Biochemistry🙴❤ 20:44, 2 December 2017 (UTC)
Still thinking about some of the wording, especially these two sentences "but it is unclear if these effects were due to rabeprazole or extenuating circumstances", and "Theoretical side effects"... wondering if these are straying into WP:PEACOCK territory  See below --Tom (LT) (talk) 21:40, 2 December 2017 (UTC)
No image problems
Will check copyright  Nil issues --Tom (LT) (talk) 21:40, 2 December 2017 (UTC)
Will update review in 1-2 days. --Tom (LT) (talk) 06:24, 1 December 2017 (UTC)
References check is the only thing that is pending. --Tom (LT) (talk) 21:40, 2 December 2017 (UTC)
Done, nil issues identified --Tom (LT) (talk) 22:55, 14 December 2017 (UTC)


#### Wording
As stated above this article is really easy to read and I think does a great job of communicating its subject matter. Some fairly small changes to increase the readability:--Tom (LT) (talk) 21:39, 2 December 2017 (UTC)

Lead
"Rabeprazole is an antiulcer drug of the proton pump inhibitor class. It is used to suppress gastric acid production for a number of medical uses" -> "Rabeprazole is a proton pump inhibitor used to suppress gastric acid production for a number of medical uses" for accuracy
Done! ―Biochemistry🙴❤ 04:51, 3 December 2017 (UTC)
Suggest breakup the lead into 2-3 paragraphs and include information about what its indications are
Done! ―Biochemistry🙴❤ 05:05, 3 December 2017 (UTC)
Medical uses
"hypersecretory (too much secretion) " -> "conditions with excess acid secretion"
Reworded. Done!―Biochemistry🙴❤ 12:27, 3 December 2017 (UTC)
Suggest wikilink the medical conditions to respective articles
Done! ―Biochemistry🙴❤ 12:27, 3 December 2017 (UTC)
Reword "In general, the safest possible route is to avoid using rabeprazole while breast feeding" to avoid WP:HOWTO
Reworded. Let me know if this is sufficient. ―Biochemistry🙴❤ 12:27, 3 December 2017 (UTC)
Suggest wikilink "area under the curve"
Done! ―Biochemistry🙴❤ 12:27, 3 December 2017 (UTC)
"Renal or hepatic dysfunction" -> Suggest change to "Kidney or liver dysfunction" for ease of understanding
Done! ―Biochemistry🙴❤ 12:27, 3 December 2017 (UTC)
"but not to the degree that dangerous accumulation of the drug in the plasma would be expected to occur" -> "but not to a degree of dangerous accumulation"
Done! ―Biochemistry🙴❤ 12:27, 3 December 2017 (UTC)
Adverse effects
"However, the most common side effects " -> remove "However"
Done! ―Biochemistry🙴❤ 12:31, 3 December 2017 (UTC)
"Rare side effects include rashes, flu-like symptoms, and infections" would be good to know what type of infections
Clarified: C dif infx. ―Biochemistry🙴❤ 12:36, 3 December 2017 (UTC)
 Question:   source " "ACIPHEX". Eisai Inc. " needs to be fixed up. The source you've provided isn't verifiable... will need some more information --Tom (LT) (talk) 11:30, 7 December 2017 (UTC)
Eep, good point! I've clarified that this is the package insert & added a link.―Biochemistry🙴❤ 05:13, 9 December 2017 (UTC)
"liver injury (hepatotoxicity) have been reported in the literature" -> (a) "liver injury", removing hepatotoxicity; and (b) remove "in the literature"
I've clarified that hepatotoxicity is the technical definition. Removed "in the literature." Let me know if this is sufficient. ―Biochemistry🙴❤ 12:31, 3 December 2017 (UTC)
loos great --Tom (LT) (talk) 11:30, 7 December 2017 (UTC)
"coma, and death" if these are a result of an already mentioned side-effect, then I suggest reword to "which are potentially fatal" to clarify which side-effects cause this; I am certain death is not an idiopathic side-effect
Per the PI, I believe these are listed as idiopathic ADRs. See Postmarketing Experience (sect. 6.2). ―Biochemistry🙴❤ 12:37, 3 December 2017 (UTC)
I see, how interesting and somewhat concerning. --Tom (LT) (talk) 11:30, 7 December 2017 (UTC)
Fairly so--though I think it's debatable if such effects are even due to the drug product. Post-marketing experience often encapsulates more than that which can be directly attributable to the drug; however, there are definitely some easily attributable risks in there (e.g. the inc. C. diff risk has clear biological plausibility). ―Biochemistry🙴❤ 05:17, 9 December 2017 (UTC)
"Rabeprazole is associated with elevated serum gastrin levels, which are thought to be dependent upon the degree of CYP2C19 metabolism the drug undergoes. Notably, rabeprazole is not as significantly metabolized by this enzyme compared to other medications in the same class, like omeprazole.[1]" might belong better in a different section
Elevated serum gastrin is an ADR. I've clarified the wording to emphasize the comparison between rabeprazole and omeprazole on this ADR. ―Biochemistry🙴❤ 23:23, 3 December 2017 (UTC)
Thanks, much better --Tom (LT) (talk) 11:30, 7 December 2017 (UTC)
"but it is unclear if these effects were due to rabeprazole or extenuating circumstances" and "Theoretical side effects": I am somewhat concerened here about WP:PEACOCK / overly promotional language. If this could be reworded that would be great
Let me know what you think of the new changes.―Biochemistry🙴❤ 23:32, 3 December 2017 (UTC)
Thanks, looks much better. --Tom (LT) (talk) 11:30, 7 December 2017 (UTC)
Acid suppressive drugs are associated with a slight increase in the risk of gastric cancer [1]
This is related to the hypergastrinemia side effect, mentioned under the ADRs. The meta-analysis you've cited doesn't specifically address rabeprazole, though a couple of the studies analyzed included rabeprazole (only one by name). I'm not sure I feel comfortable declaring that acid suppressants increase gastric cancer based on that study, though I can certainly see the biological plausibility for such a claim. I'm just not sure that the evidence is conclusive yet--for any acid suppressant. How do you feel about the qualifier, "may be associated," instead?―Biochemistry🙴❤ 23:51, 3 December 2017 (UTC)
Happy with this wording. Evidence presented in metaanalysis for PPIs and rabeprazole in particular is not large enough to say definitively, as you state. --Tom (LT) (talk) 11:30, 7 December 2017 (UTC)
Edited! Thanks for the suggestion re: the clinical significance of this ADR. ―Biochemistry🙴❤ 05:20, 9 December 2017 (UTC)
Pharmacology
This whole section is more easy to read than I'd have expected given the subject matter - well done
Thank you kindly! (: ―Biochemistry🙴❤ 23:51, 3 December 2017 (UTC)
Update
 Question:   One more issue: "Conditions that involve excess gastric acid production (e.g. Zollinger-Ellison syndrome), conditions that are worsened by gastric acid (e.g. ulcerations of the gastrointestinal tract), and conditions whose pathophysiology are driven by gastric acid (e.g. symptomatic gastroesophageal reflux disease) are responsive to rabeprazole treatment" Sorry for addition at the last minute. Something not quite right here. Is Z-E syndrome really "Responsive to rabeprazole treatment"? is GERD's pathophysiology really "driven" by gastric acid? I think it might be most correct to remove the last bit and maybe reword "driven" somehow. --Tom (LT) (talk) 11:30, 7 December 2017 (UTC)
Rabeprazole is FDA-approved for the treatment of Z-E, so I'd argue that it is responsive to it. Given that rabeprazole is also FDA-approved for the treatment of GERD, and rabeprazole's primary MoA as an acid-suppressant, I'd also feel comfortable noting that GERD is driven by acid (though there are, of course, other factors that contribute to GERD and cause it, such as increases in abdominal pressure secondary to obesity, allowing the acid to insult the LES). I've reworded this bit under Medical uses to better reflect the role of gastric acid in GERD. Let me know what you think.―Biochemistry🙴❤ 05:36, 9 December 2017 (UTC)
Thank you, as you state GERD is more to do with the problem of reflux of gastric acid. I also fail to see how suppressing acid in ZE helps the underlying tumour [2]. If possible I would be most happy if we could compromise and reword this to something like "Rabeprazole is used in the management of..." and then remove the "are responsive to rabeprazole treatment". --Tom (LT) (talk) 21:25, 9 December 2017 (UTC)
I apologize for the delay; I didn't realize there was anything left besides the refs. I accept your proposed compromise. I've edited the lead section per your suggestion. ―Biochemistry🙴❤ 20:55, 13 December 2017 (UTC)
Thanks for your prompt replies too :). So, only three issues remaining - need some more information on that source, and the cancer bit inserted. --Tom (LT) (talk) 11:30, 7 December 2017 (UTC)

My pleasure! Let me know if there's anything I've missed! (: ―Biochemistry🙴❤ 05:37, 9 December 2017 (UTC)
No further issues identified. Have boldly made one small edit, and have promoted to GA - well done! --Tom (LT) (talk) 22:55, 14 December 2017 (UTC)
Thank you for your diligent review! (: ―Biochemistry🙴❤ 03:56, 18 December 2017 (UTC)