II. Indications
- Erosive Esophagitis
III. Mechanism
- Potassium Competitive Acid Blocker (PCAB)
- Similar mechanism as Proton Pump Inhibitors (PPIs)
- In addition to blocking active proton pumps (as with PPIs), PCABs also block resting proton pumps
IV. Dosing
- Healing of Erosive Esophagitis and GERD Relief
- Vonoprazin 20 mg orally daily for 8 weeks
- Decrease dose to 10 mg orally daily if GFR <30 ml/min
- Maintenance of Healed Erosive Esophagitis and GERD Relief
- Vonoprazin 10 mg orally daily for up to 6 months
-
Helicobacter Pylori
- Packaged with Antibiotics (Amoxicillin and Clarithromycin)
- However, no evidence for greater efficacy for PCABs than the much lower cost Proton Pump Inhibitors
V. Efficacy
- Vonoprazin 20 mg is similar to Lansoprazole (Prevacid) 30 mg for erosive Esophagitis healing at 4 weeks
- Vonoprazin is $650/month at the time of release in 2024
VI. Adverse Effects
- Diarrhea
- Nausea
- Longterm adverse effects are similar to Proton Pump Inhibitors
- Increased Fracture risk
- Clostridioides difficile
VII. Safety
- Unknown safety in pregnancy
- Unknown safety in Lactation
VIII. Drug Interactions
-
CYP3A4 Inducers
- Decrease Vonoprazin efficacy
IX. Resources
X. References
- (2024) Presc Lett 31(1): 5