Gastroenterology Book

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Potassium Competitive Acid Blocker

Aka: Potassium Competitive Acid Blocker, PCAB, Vonoprazan, Voquezna, Takecab
  1. Mechanism
    1. Potassium Competitive Acid Blocker (PCAB) blocks both active and resting proton pumps
      1. Activity onset within hours regardless of timing with meals
    2. Contrast with Proton Pump Inhibitors
      1. Block only active proton pumps
      2. Full action is delayed up to 7 days
      3. Best taken 30 to 60 minutes before a meal
  2. Preparations
    1. Vonoprazan Fumarate (Takecab)
      1. High Dose: 20 mg orally twice daily
        1. Helicobacter Pylori Management
      2. Moderate Dose: 20 mg orally daily
        1. Gastric Ulcer or Duodenal Ulcer
        2. Gastroesophageal Reflux (GERD)
      3. Low Dose: 10 mg orally daily
        1. Reflux Esophagitis prevention
        2. Aspirin or NSAID induced peptic ulcer prevention
  3. Preparations: Helicobacter Pylori Management
    1. Background
      1. Lower efficacy than quadruple therapy
      2. At $800 in 2022, the cost is four fold higher than standard quadruple therapy
    2. Voquezna Dual Pak (Vonoprazan, Amoxicillin)
    3. Voquezna Triple Pak (Vonoprazan, Amoxicillin, Clarithromycin)
  4. References
    1. Echizen (2016) Clin Pharmacokinet 55(4):409-18 +PMID: 26369775 [PubMed]

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