ONRAB-LS is a combination medication that contains Rabeprazole (20 mg) and Levosulpiride (75 mg SR). This combination is primarily used to treat gastrointestinal conditions, particularly related to acid reflux and motility disorders.

Uses of ONRAB-LS

1. Gastroesophageal Reflux Disease (GERD): Rabeprazole, a proton pump inhibitor (PPI), reduces the production of stomach acid, which helps relieve symptoms like heartburn, acid regurgitation, and irritation of the esophagus caused by acid reflux.
2. Dyspepsia and Peptic Ulcers: Rabeprazole helps heal and prevent ulcers in the stomach and intestines by lowering stomach acid, which can irritate and worsen these conditions.
3. Irritable Bowel Syndrome (IBS): Levosulpiride, a prokinetic agent, improves gastrointestinal motility, which can help alleviate symptoms of irritable bowel syndrome such as bloating, nausea, and abdominal discomfort.
4. Functional Dyspepsia: The combination can be used to treat indigestion, especially when it is related to delayed gastric emptying or low gastrointestinal motility, which is addressed by Levosulpiride.
5. Nausea and Vomiting: Levosulpiride has antiemetic (anti-nausea) effects and is often used for treating nausea and vomiting associated with motility disorders or functional dyspepsia.

Mechanism of Action

• Rabeprazole: It works by irreversibly inhibiting the proton pumps in the stomach lining that produce gastric acid, thereby lowering acid levels and allowing healing of the esophageal lining and stomach ulcers.
• Levosulpiride: It works as a dopamine antagonist, particularly on D2 receptors, to enhance the movement of the stomach and intestines (gastroprokinetic effect), improving symptoms of bloating, gas, and delayed gastric emptying.

Side Effects of ONRAB-LS

1. Common Side Effects:
   • Rabeprazole:
     • Headache
     • Diarrhea or constipation
     • Abdominal pain
     • Nausea
     • Flatulence (excessive gas)
     • Dizziness
   • Levosulpiride:
     • Drowsiness or sedation
     • Fatigue
     • Restlessness
     • Diarrhea or constipation
     • Weight gain (especially with long-term use)
2. Serious Side Effects (Less Common):
   • Rabeprazole:
     • Long-term use of PPIs like Rabeprazole can lead to:
       • Vitamin B12 deficiency
       • Magnesium deficiency
       • Increased risk of fractures, particularly of the hip, wrist, or spine
       • Increased risk of gastrointestinal infections (due to reduced stomach acid)
   • Levosulpiride:
     • Extrapyramidal symptoms (movement disorders like tremors, dystonia, and restlessness)
     • Hyperprolactinemia (elevated levels of prolactin, which can cause breast enlargement, menstrual irregularities in women, and sexual dysfunction in men)
     • Tardive dyskinesia (involuntary movements, which can occur with prolonged use)
     • Galactorrhea (milk production not associated with breastfeeding)
3. Rare Side Effects:
   • Allergic reactions (rash, itching, swelling of the face, tongue, throat, or difficulty breathing)
   • Severe skin reactions (rare, but may include conditions like Stevens-Johnson syndrome)

Precautions and Warnings

• Kidney or Liver Disease: Rabeprazole can affect kidney function, and Levosulpiride is processed in the liver, so dose adjustments may be needed for individuals with impaired liver or kidney function.
• Pregnancy and Breastfeeding: Both Rabeprazole and Levosulpiride should be used cautiously in pregnant or breastfeeding women, as the safety profile is not fully established.
• Long-term Use: Chronic use of Rabeprazole (PPIs) should be monitored, as it can lead to nutrient deficiencies and bone health issues.

Drug Interactions

• Rabeprazole may reduce the effectiveness of drugs that need a highly acidic stomach for absorption (like ketoconazole).
• Levosulpiride may interact with other medications affecting the central nervous system, such as antidepressants or antipsychotics, increasing the risk of sedation or movement disorders.

Always consult a healthcare professional before starting or adjusting the dose of ONRAB-LS, especially if you have underlying health conditions or are on other medications.