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Voquezna
vonoprazan
Adult Dosing .
Dosage forms: TAB: 10 mg, 20 mg
erosive esophagitis
- [initial tx]
- Dose: 20 mg PO qd x8wk; Info: do not cut/crush/chew tab
- [maintenance tx]
- Dose: 10 mg PO qd for up to 6mo; Info: do not cut/crush/chew tab
GERD, non-erosive symptomatic
- [10 mg PO qd x4wk]
- Info: do not cut/crush/chew tab
H. pylori infection
- [triple tx]
- Dose: 20 mg PO bid x14 days; Info: give w/ amoxicillin 1 g PO bid and clarithromycin 500 mg PO bid; do not cut/crush/chew tab; search 'H. pylori Tx' for epocrates H. pylori Tx Regimens decision tool
- [dual tx]
- Dose: 20 mg PO bid x14 days; Info: give w/ amoxicillin 1 g PO tid; dosing may vary; do not cut/crush/chew tab; search 'H. pylori Tx' for epocrates H. pylori Tx Regimens decision tool
renal dosing
- [erosive esophagitis initial tx]
- eGFR <30: 10 mg qd
- HD/PD: not defined
- [H. pylori infection]
- eGFR <30: avoid use
- HD/PD: not defined
- [all other indications]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [erosive esophagitis initial tx]
- Child-Pugh Class B or C: 10 mg qd
- [H. pylori infection]
- Child-Pugh Class B or C: avoid use
- [all other indications]
- hepatic impairment: no adjustment
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- eGFR <30 (H. pylori infection use)
- hepatic impairment, Child-Pugh Class B-C (H. pylori infection use)
- avoid: breastfeeding during tx and x2 days after D/C
- caution: eGFR <30 (erosive esophagitis initial tx use)
- caution: hepatic impairment, Child-Pugh Class B-C (erosive esophagitis initial tx use)
- caution: long-term use
- caution: high-dose use
- caution: hypomagnesemia
- caution: hypocalcemia risk
Drug Interactions .
Overview
vonoprazan
PPI
- CYP3A4 substrate
- CYP2C19 inhibitor, weak
- CYP3A4 inhibitor, weak
- gastric pH modulator
- hypomagnesemia
Contraindicated
- cisapride
- rilpivirine
Avoid/Use Alternative
- alprazolam
- amphetamine
- apalutamide
- atazanavir
- bosentan
- bosutinib
- butalbital
- carbamazepine
- cefpodoxime
- cefuroxime axetil
- cenobamate
- clopidogrel
- codeine
- colchicine
- dabrafenib
- dacomitinib
- dasatinib
- dexlansoprazole
- dextroamphetamine
- efavirenz
- eliglustat
- encorafenib
- enzalutamide
- erlotinib
- esomeprazole
- etravirine
- fexinidazole
- fosphenytoin
- gefitinib
- hydrocodone
- infigratinib
- ivosidenib
- ketoconazole
- lansoprazole
- ledipasvir
- levoketoconazole
- lopinavir/ritonavir
- lorlatinib
- lumacaftor/ivacaftor
- mavacamten
- mefenamic acid
- meperidine
- mesalamine
- methadone
- methamphetamine
- methylphenidate
- mitapivat
- mitotane
- modafinil
- nafcillin
- nelfinavir
- neratinib
- nilotinib
- nirogacestat
- omeprazole
- oxycodone
- pacritinib
- pantoprazole
- pazopanib
- pentobarbital
- pexidartinib
- phenobarbital
- phenytoin
- pimozide
- posaconazole
- pralsetinib
- primidone
- propafenone
- rabeprazole
- repotrectinib
- rifabutin
- rifampin
- rifapentine
- risedronate
- selpercatinib
- simvastatin
- sotorasib
- sparsentan
- St. John's wort
- triazolam
- velpatasvir
Monitor/Modify Tx
- abemaciclib
- acalabrutinib
- alfentanil
- amiodarone
- amphotericin
- avanafil
- avapritinib
- belumosudil
- brigatinib
- bumetanide
- capivasertib
- carboplatin
- cetuximab
- chlorothiazide
- chlorthalidone
- cilostazol
- cisplatin
- citalopram
- clozapine
- cyclosporine
- cysteamine
- diazepam
- digoxin
- disopyramide
- docetaxel
- dofetilide
- domperidone
- entrectinib
- erythromycin
- ethacrynic acid
- everolimus
- fedratinib
- felodipine
- fentanyl
- finerenone
- flibanserin
- foscarnet
- furosemide
- gentamicin
- gepirone
- glipizide
- hydrochlorothiazide
- ibrutinib
- indapamide
- itraconazole
- ivabradine
- ixabepilone
- lemborexant
- levothyroxine
- lomitapide
- lonafarnib
- lovastatin
- lumateperone
- lurasidone
- lurbinectedin
- metolazone
- midazolam
- mobocertinib
- necitumumab
- nifedipine
- nimodipine
- nisoldipine
- octreotide
- oliceridine
- panitumumab
- patiromer
- pemigatinib
- peppermint
- quinidine (antiarrhythmic)
- red yeast rice
- ribociclib
- romidepsin
- selumetinib
- sirolimus
- sirolimus albumin-bound
- sodium polystyrene sulfonate
- spironolactone
- sufentanil
- tacrolimus
- tadalafil
- temsirolimus
- tobramycin
- tolvaptan
- torsemide
- ubrogepant
- vardenafil
- venetoclax
- vinblastine
- vincristine
- vinorelbine
- warfarin
- zanubrutinib
Caution Advised
- abrocitinib
- armodafinil
- artemether/lumefantrine
- belzutifan
- bexarotene
- cariprazine
- carisoprodol
- clobazam
- cobimetinib
- conivaptan
- cyclophosphamide
- danshen
- daridorexant
- darolutamide
- dexamethasone
- dicloxacillin
- dihydroergotamine
- echinacea
- elafibranor
- elagolix
- enasidenib
- eplerenone
- ergotamine
- eslicarbazepine acetate
- felbamate
- ferrous fumarate
- ferrous gluconate
- ferrous sulfate
- fosamprenavir
- fosinopril
- garlic
- ginkgo
- ginseng, Asian
- glycerol phenylbutyrate
- griseofulvin
- levodopa
- meropenem
- methylergonovine
- mycophenolate mofetil
- nevirapine
- olutasidenib
- omaveloxolone
- oxcarbazepine
- palovarotene
- perampanel
- pioglitazone
- prednisone
- proguanil
- ritonavir
- roflumilast
- roflumilast topical
- rufinamide
- sarilumab
- sirolimus topical
- somatropin
- stiripentol
- suzetrigine
- tazemetostat
- tecovirimat
- telotristat ethyl
- tocilizumab
- topiramate
- tovorafenib
- vaborbactam
- vamorolone
- vemurafenib
- verapamil
- vorasidenib
Adverse Reactions .
Serious Reactions
- hypersensitivity rxn
- anaphylaxis
- toxic epidermal necrolysis
- Stevens-Johnson syndrome
- erythema multiforme
- tubulointerstitial nephritis
- hepatic failure
- C. difficile-assoc. diarrhea
- fractures
- thrombocytopenia
- hypomagnesemia (long-term use)
Common Reactions
- URI
- gastritis
- abdominal pain
- dyspepsia
- HTN
- UTI
- diarrhea
- abdominal distension
- nausea
- constipation
- vitamin B12 deficiency (long-term use)
- fundic gland polyps (long-term use)
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; consider Mg at baseline, then periodically if long-term tx or hypocalcemia risk; consider Ca at baseline, then periodically if hypocalcemia risk
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; inadequate human data available; no known risk of teratogenicity based on animal data at up to 27x MRHD
Pregnancy Reporting
report pregnancy to Phathom Pharmaceuticals Adverse Event Line at 1-888-775-7428
Lactation
Clinical Summary
avoid breastfeeding during tx and x2 days after D/C; no human data available, though theoretical risk of infant hepatic dysfxn based on animal data at 0.2-22x MRHD; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver; CYP450: 2B6, 2C9, 2C19, 2D6, 3A4/5 substrate
Excretion: urine 67% (8% unchanged), feces 31% (1.4% unchanged); Half-life: 6.8-7.9h
Subclass: H. pylori ; Potassium-Competitive Acid Blockers
Mechanism of Action
inhibits gastric parietal cell hydrogen-potassium ATPase in a potassium competitive manner (potassium-competitive acid blocker)
Formulary .
No Formulary Selected
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