Can Voquezna Triple Pak (vonoprazan, amoxicillin, clarithromycin) cause acute and extreme anxiety in patients with H. pylori infection?

Anxiety as a Side Effect of Voquezna Triple Pak

Clarithromycin in Voquezna Triple Pak can cause anxiety as a side effect, though it is not specifically listed among the most common adverse reactions for the combination therapy.

Medication Components and Mechanism

Voquezna Triple Pak contains:

• Vonoprazan (acid suppressor)
• Amoxicillin (antibiotic)
• Clarithromycin (antibiotic)

This combination is used to treat H. pylori infection, which is a common cause of peptic ulcers and gastritis.

Evidence for Anxiety as a Side Effect

While the FDA label for Voquezna Triple Pak 1 does not specifically list anxiety among the most common adverse reactions, it does mention anxiety in the "Other adverse reactions" section. The FDA label states that anxiety has been reported in patients receiving vonoprazan-containing regimens for H. pylori treatment.

The adverse reactions listed for Voquezna Triple Pak include:

• Diarrhea (4.0%)
• Dysgeusia (taste disturbance) (3.8%)
• Abdominal pain (2.3%)
• Vulvovaginal candidiasis (2.0%)

Clarithromycin and Anxiety

Although not explicitly mentioned in the provided evidence, clarithromycin (one component of the Triple Pak) has been associated with neuropsychiatric side effects including anxiety in clinical practice. Macrolide antibiotics like clarithromycin can cross the blood-brain barrier and potentially affect the central nervous system.

Management Recommendations

If a patient experiences acute and extreme anxiety while taking Voquezna Triple Pak:

1. Evaluate the severity of symptoms:

   • If symptoms are severe or include suicidal ideation, discontinue treatment immediately and seek urgent medical attention
   • For moderate symptoms, consider whether benefits outweigh risks

2. Consider alternative regimens:

   • Vonoprazan-amoxicillin dual therapy without clarithromycin may be an effective alternative 2
   • Studies show dual therapy can achieve similar eradication rates (92.9% vs 91.9% for triple therapy) 2

3. If treatment must continue:

   • Take medication with food to potentially reduce side effects
   • Avoid caffeine and other stimulants that may worsen anxiety
   • Consider temporary supportive medication for anxiety if appropriate

Clinical Considerations

• The neuropsychiatric effects of clarithromycin typically resolve after discontinuation of the medication
• The risk of treatment failure must be weighed against the severity of anxiety symptoms
• H. pylori eradication is important for preventing long-term complications such as peptic ulcer disease and gastric cancer

Key Takeaways

1. Anxiety can occur as a side effect of Voquezna Triple Pak, most likely due to the clarithromycin component
2. If severe anxiety occurs, consider switching to vonoprazan-amoxicillin dual therapy, which has shown comparable efficacy 2
3. Document the adverse reaction to guide future antibiotic choices
4. Ensure adequate follow-up to confirm H. pylori eradication after completion of therapy

If anxiety symptoms are severe enough to impact quality of life or medication adherence, the benefits of continuing treatment should be carefully weighed against the risks of discontinuation or switching to an alternative regimen.