Recommended Dosage of Vonoprazan
The recommended dose of vonoprazan is 20 mg once daily for treatment of erosive esophagitis, 10 mg once daily for maintenance of healed erosive esophagitis, and 20 mg twice daily when used as part of Helicobacter pylori eradication regimens. 1, 2, 3
Dosing for Specific Conditions
Gastroesophageal Reflux Disease (GERD)
- Erosive Esophagitis (Treatment): 20 mg once daily for up to 8 weeks 2, 4
- Maintenance of Healed Erosive Esophagitis: 10 mg once daily 2, 4
- Non-erosive Reflux Disease: 10 mg once daily 1, 2
Helicobacter Pylori Eradication
- 20 mg twice daily in combination with antibiotics (typically amoxicillin and clarithromycin) for 14 days 1
- This higher dosing frequency is important for H. pylori eradication, particularly for clarithromycin-resistant strains 1
Peptic Ulcer Disease
- 20 mg once daily for treatment of gastric or duodenal ulcers 1, 3
- 10 mg once daily for secondary prevention of low-dose aspirin or NSAID-induced peptic ulcers 3
Dosing Considerations
Timing of Administration
- Can be taken without regard to meals (food has minimal effect on absorption) 2, 3
- Unlike PPIs, vonoprazan does not require premeal dosing due to its acid-stable properties 1
- Steady state concentrations are achieved by day 3-4 of treatment 2
Dosing in Special Populations
Renal Impairment:
- No dose adjustment needed for mild to moderate renal impairment
- For severe renal impairment (eGFR 15 to <30 mL/min/1.73 m²), consider dose reduction as systemic exposure may be 2.4 times greater 2
Hepatic Impairment:
- No dose adjustment needed for mild hepatic impairment
- For moderate to severe hepatic impairment (Child-Pugh Class B or C), consider dose reduction as systemic exposure may be 2.4-2.6 times greater 2
Elderly Patients:
- No dose adjustment required based on age alone 2
Clinical Efficacy Considerations
- Vonoprazan 20 mg provides more potent and consistent acid suppression than standard-dose PPIs 1, 4
- Particularly effective for severe erosive esophagitis (LA Grade C/D), with superior healing rates compared to lansoprazole 1, 4
- For milder forms of GERD (LA Grade A/B), efficacy is similar to PPIs 1, 5
Common Pitfalls and Caveats
- Despite its efficacy, vonoprazan is generally not recommended as first-line therapy for most acid-related disorders due to higher cost and limited long-term safety data compared to PPIs 1
- Exception: First-line use is appropriate for H. pylori eradication regimens, where vonoprazan shows superior eradication rates, especially for clarithromycin-resistant strains 1
- Vonoprazan increases serum gastrin levels, which may cause false-positive results in diagnostic investigations for neuroendocrine tumors 2
- The drug has not shown significant benefit over PPIs in patients with non-erosive reflux disease or functional heartburn 1, 6
By following these dosing recommendations and considering the specific clinical context, vonoprazan can be effectively used to manage acid-related disorders, particularly in cases where PPIs have failed or in patients with severe disease.