Voquezna Maintenance Dosing
For maintenance therapy after healing erosive esophagitis, use Voquezna (vonoprazan) 10 mg once daily for up to 6 months. 1
Standard Maintenance Dose
The FDA-approved maintenance dose is vonoprazan 10 mg once daily for maintaining healed erosive esophagitis and relief of associated heartburn 1. This applies to all grades of healed erosive esophagitis and can be continued for up to 6 months.
Key Dosing Considerations
Normal Renal and Hepatic Function
- 10 mg once daily is the standard maintenance dose
- Can be taken with or without food
- Swallow tablets whole; do not crush or chew 1
Renal Impairment
For maintenance therapy, no dose adjustment is needed regardless of renal function 1. The standard 10 mg once daily dose applies to patients with:
- eGFR ≥30 mL/min
- eGFR <30 mL/min
This differs from the healing phase, where dose reduction is required for severe renal impairment.
Hepatic Impairment
For maintenance therapy, no dose adjustment is needed regardless of hepatic function 1. The standard 10 mg once daily dose applies to patients with:
- Child-Pugh Class A
- Child-Pugh Class B
- Child-Pugh Class C
Again, this differs from the healing phase where dose reduction is recommended for moderate-to-severe hepatic impairment.
Clinical Evidence Supporting Maintenance Dosing
The 10 mg maintenance dose demonstrates robust efficacy. In the pivotal US/European trial, vonoprazan 10 mg maintained healing in 81% of patients with LA grade A/B erosive esophagitis at 24 weeks, compared to 77% with lansoprazole 15 mg 2. For more severe disease (LA grade C/D), maintenance rates were even higher at 97-99% 2.
Important clinical context: While vonoprazan 20 mg showed slightly higher maintenance rates (82% at 24 weeks), the FDA-approved maintenance dose remains 10 mg once daily 1, 3. The 20 mg dose is reserved for the initial 8-week healing phase.
Missed Dose Instructions
If a maintenance dose is missed 1:
- Take as soon as possible within 12 hours of the missed dose
- If >12 hours have passed, skip the missed dose and resume regular schedule
- Do not double the next dose
Duration of Maintenance Therapy
The FDA label specifies maintenance therapy for up to 6 months 1. However, long-term safety data extending to 5 years show no increased risk of malignant changes or gastric neuroendocrine tumors, though parietal cell hyperplasia and elevated gastrin levels are more common with vonoprazan than PPIs 4, 5.
Common Pitfalls to Avoid
- Do not use 20 mg for maintenance: The healing dose (20 mg) should not be continued for maintenance therapy; step down to 10 mg after healing is confirmed
- Do not adjust dose for renal/hepatic impairment during maintenance: Unlike the healing phase, the 10 mg maintenance dose remains unchanged regardless of organ function
- Do not use as first-line for mild disease: Current AGA guidelines recommend reserving vonoprazan for patients who fail twice-daily PPI therapy, particularly for milder LA grade A/B erosive esophagitis, due to cost considerations and limited long-term safety data 2