The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed that rabeprazole tablets should be restricted for use in patients that cannot have annimal-derived products.

Crushing is not recommended as stomach acid can destroy the active drug

For people with no swallowing difficulties:

• 1st Line: Lansoprazole capsules/Omeprazole capsules
• 2nd line: Pantoprazole tablets (Suitable for patients that cannot have animal-derived products) 
• 2nd line: Rabeprazole tablets (Suitable for patients that cannot have animal-derived products)
• 3rd line: Esomeprazole capsules – not for new initiation

For patients who cannot swallow tablets/have swallowing difficulties:

• 1st Line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules/omeprazole capsules (opened, and granules dispersed in water/yoghurt/apple puree)
• 3rd line: esomeprazole granule sachets

For patients with enteral feeding tubes:

• 1st line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules
• 3rd line: esomeprazole granule sachets (do not use if tube is less than 6F)