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vonoprazan (Voquezna)

Indications: - in combination with amoxicillin & clarithromycin or with amoxicillin only for treatment of Helicobacter pylori infection (FDA approved May 2022) - treatment of grade C/D esophagitis (erosive esophagitis) [9] - twice daily proton pump inhibitor not effective [6,11] - treatment of non-erosive esophagitis [10] * 10 day dual course (vonoprazan-amoxicillin) reportedly non-inferior to 14 day course of BMTL regimen [3] Contraindications: - gastroesophageal reflux disease (GERD) in the absence of esophagitis Dosage: - H pylori: 20 mg BID in combination with amoxicillin 1000 mg TID or tetracycline 500 mg TID for 10 days - esophagitis: start 20 mg PO QD, maintenance 10-20 mg PO QD Pharmacokinetics: - longer half-life than proton pump inhibitors - does not require administration 30-60 minutes before eating for maximal effect Adverse effects: - dysgeusia, diarrhea, abdominal pain, headache, nasopharyngitis, hypertension, vulvovaginal candidiasis Mechanism of action: - K+ channel competitive blocker Notes: - listed as vonoprazan fumarate in PubChem - Cost 2024 $750/month

General

gastrointestinal agent

Database Correlations

PUBCHEM correlations

References

  1. Hamza Z Two New Regimens Win FDA Approval for H. Pylori Infection. Dual and triple vonoprazan-based treatments offer physicians another set of options. MedPage Today May 4, 2022 https://www.medpagetoday.com/gastroenterology/generalgastroenterology/98547
  2. Yan TL, Wang JH, He XJ, et al. Ten-Day Vonoprazan-Amoxicillin Dual Therapy vs Standard 14-Day Bismuth-Based Quadruple Therapy for First-Line Helicobacter pylori Eradication: A Multicenter Randomized Clinical Trial. Am J Gastroenterol. 2023 Dec 11 PMID: 37975609 https://journals.lww.com/ajg/fulltext/9900/ten_day_vonoprazan_amoxicillin_dual_therapy_vs.935.aspx
  3. Yan TL, Wang JH, He XJ, et al. Ten-Day Vonoprazan-Amoxicillin Dual Therapy vs Standard 14-Day Bismuth-Based Quadruple Therapy for First-Line Helicobacter pylori Eradication: A Multicenter Randomized Clinical Trial. Am J Gastroenterol. 2023 Dec 11 PMID: 37975609 https://journals.lww.com/ajg/fulltext/9900/ten_day_vonoprazan_amoxicillin_dual_therapy_vs.935.aspx
  4. Zhuang Q, Chen S, Zhou X, et al. Comparative Efficacy of P-CAB vs Proton Pump Inhibitors for Grade C/D Esophagitis: A Systematic Review and Network Meta-analysis. Am J Gastroenterol. 2024 Mar 22. PMID: 38345252
  5. Laine L et al. Vonoprazan versus lansoprazole for healing and maintenance of healing of erosive esophagitis: A randomized trial. Gastroenterology 2023 Jan; 164:61 PMID: 36228734 Free article. Clinical Trial. https://www.gastrojournal.org/article/S0016-5085(22)01163-5/fulltext
  6. Laine L et al. Vonoprazan is efficacious for treatment of heartburn in nonerosive reflux disease: A randomized trial. Clin Gastroenterol Hepatol 2024 May 13; [e-pub]. PMID: 38750866 https://www.cghjournal.org/article/S1542-3565(24)00443-9/pdf
  7. Katzka DA, Kahrilas PJ. Potassium-competitive acid blocker suppression of gastric acid in erosive esophagitis: Is stronger and longer better? Gastroenterology 2023 Jan; 164:14. PMID: 36341738 https://www.gastrojournal.org/article/S0016-5085(22)01244-6/fulltext
  8. Park A. Phathom Pharmaceuticals aims to 'kick some acid' with first Voquezna campaign. Fierce Pharma 2024 Mar 26 https://www.fiercepharma.com/marketing/phathom-pharmaceuticals-aims-kick-some-acid-1st-voquezna-campaign
  9. Zhuang Q, Chen S, Zhou X, et al. Comparative Efficacy of P-CAB vs Proton Pump Inhibitors for Grade C/D Esophagitis: A Systematic Review and Network Meta-analysis. Am J Gastroenterol. 2024 May 1;119(5):803-813. PMID: 38345252
  10. Brookds M FDA OKs Voquezna for Heartburn Relief in Nonerosive Gastroesophageal Reflux Disease. Medscape. July 18, 2024 https://www.medscape.com/viewarticle/fda-oks-voquezna-heartburn-relief-nonerosive-2024a1000dal
  11. Patel A, Laine L, Moayyedi P, Wu J AGA Clinical practice update on integrating potassium-competitive acid blockers into clinical practice: Expert review. Gastroenterology 2024 Nov; 167:1228 PMID: 39269391 https://www.gastrojournal.org/article/S0016-5085(24)05226-0/fulltext

Component-of

amoxicillin/clarithromycin/vonoprazan amoxicillin/vonoprazan