What is the next step for a patient with inadequate response to 40mg pantoprazole (Proton Pump Inhibitor - PPI) for gastroesophageal reflux disease (GERD), considering a trial of vonoprazan (Voquezna)?

From the Guidelines

If pantoprazole 40mg is not controlling your symptoms, you should consult your healthcare provider about increasing the dose to twice a day or switching to a more effective acid suppressive agent, such as Voquezna (vonoprazan), as suggested by the AGA clinical practice update 1. When considering the next step for a patient with inadequate response to 40mg pantoprazole for gastroesophageal reflux disease (GERD), it is essential to assess compliance and consider increasing the dose to twice a day or switching to a more effective acid suppressive agent, such as Voquezna (vonoprazan) 1.

Key Considerations

• The AGA clinical practice update recommends increasing the dose to twice a day or switching to a more effective acid suppressive agent once a day if there is an inadequate response to single-dose PPI therapy 1.
• Voquezna (vonoprazan) is a potassium-competitive acid blocker (P-CAB) that works faster and provides more consistent acid suppression throughout the day, making it a potential alternative for patients who do not respond to PPIs 1.
• Before switching to Voquezna, the doctor may also consider adding another medication or investigating other causes for the patient's persistent symptoms 1.

Potential Benefits and Risks

• Voquezna has been shown to be noninferior to lansoprazole for gastric ulcer healing and duodenal ulcers, and may be useful in PPI treatment failures of ulcers 1.
• However, the use of Voquezna should be tailored to individual patients, considering their risk factors and clinical considerations, and further data are needed to support its routine use as first-line prophylactic therapy 1.

Next Steps

• Consult with a healthcare provider to determine the best course of action, which may include increasing the pantoprazole dose, switching to Voquezna, or adding another medication 1.
• The healthcare provider will evaluate the patient's symptoms, medical history, and possibly perform tests to determine the most appropriate treatment plan 1.

From the FDA Drug Label

VOQUEZNA is used in adults: for 8 weeks to heal acid-related damage to the lining of the esophagus (called erosive esophagitis) and for relief of heartburn related to erosive esophagitis. VOQUEZNA may cause serious side effects, including: A type of kidney problem (acute tubulointerstitial nephritis). The most common side effects of VOQUEZNA for treatment of erosive esophagitis and/or relief of heartburn related to gastroesophageal reflux disease include: stomach inflammation diarrhea stomach bloating stomach pain nausea indigestion constipation high blood pressure urinary tract infection

For a patient with inadequate response to 40mg pantoprazole (Proton Pump Inhibitor - PPI) for gastroesophageal reflux disease (GERD), considering a trial of vonoprazan (Voquezna), the next step would be to:

• Consult the healthcare provider to discuss the potential benefits and risks of switching to vonoprazan.
• Assess the patient's overall health and medical history to determine the best course of treatment.
• Monitor the patient's response to vonoprazan and adjust the treatment plan as needed. There is no direct information in the provided drug labels that supports a specific next step for a patient with inadequate response to pantoprazole. 2 2

From the Research

Next Steps for Inadequate Response to Pantoprazole

For a patient with an inadequate response to 40mg pantoprazole for gastroesophageal reflux disease (GERD), considering a trial of vonoprazan (Voquezna) may be a viable option. The following points summarize the potential next steps:

• Vonoprazan Efficacy: Studies have shown that vonoprazan is superior to proton pump inhibitors (PPIs) in terms of efficacy, safety, and cost-effectiveness in reflux disorders and H. pylori eradication 3.
• Comparison to PPIs: Vonoprazan has been compared to PPIs in the treatment of peptic ulcers resulting from endoscopic submucosal dissection, with results showing comparable efficacy and safety 4.
• Pantoprazole Limitations: Pantoprazole, a PPI, has been shown to be effective in treating GERD, but some patients may not respond adequately to the standard 40mg dose 5, 6.
• Potential Benefits of Vonoprazan: Vonoprazan may offer benefits over PPIs, including higher efficacy and lower risk of drug interactions, making it a potential alternative for patients with inadequate response to pantoprazole 3.
• Considerations for Switching to Vonoprazan: When considering switching to vonoprazan, factors such as the patient's medical history, current medications, and potential side effects should be taken into account 3, 4.