What is the recommended dose of Fexuprazan (Potassium-competitive acid blocker) for treating gastroesophageal reflux disease (GERD) and peptic ulcer disease?

Recommended Dosage of Fexuprazan for GERD and Peptic Ulcer Disease

Fexuprazan 40 mg once daily is the recommended dose for treating gastroesophageal reflux disease (GERD), while specific dosing for peptic ulcer disease may vary based on clinical presentation. 1, 2

Fexuprazan Overview

Fexuprazan is a potassium-competitive acid blocker (P-CAB) with several pharmacological advantages over traditional proton pump inhibitors (PPIs):

• Acid-stable formulation that doesn't require enteric coating 1
• Not a prodrug, allowing for immediate activity without conversion 1
• Longer half-life (6-9 hours vs 1-2 hours for PPIs) 1
• Can be taken regardless of meal timing 1
• Reaches maximal acid suppression within 1 day (vs 3-5 days for PPIs) 1
• Not affected by CYP2C19 genetic polymorphisms 1

Dosing for GERD

• Standard dose: 40 mg once daily for treatment of erosive esophagitis and GERD symptoms 2, 3
• For laryngopharyngeal reflux disease (a form of extraesophageal GERD), 40 mg once daily has shown efficacy comparable to esomeprazole 40 mg 3
• May be particularly effective for PPI-resistant GERD patients 4, 5

Dosing for Gastritis and Peptic Ulcer Disease

• For acute or chronic gastritis with erosions: 20 mg once daily or 10 mg twice daily 6
• The American Gastroenterological Association (AGA) notes that P-CABs should generally not be used as first-line therapy for peptic ulcer disease unless PPI therapy has failed 1

Clinical Considerations

When to Use Fexuprazan

• Second-line therapy: Consider fexuprazan after failure of twice-daily PPI therapy in patients with documented acid-related reflux 1
• Particularly effective for:
  • Erosive esophagitis patients who failed PPI therapy 1, 4
  • Patients with severe GERD symptoms 3

When to Avoid as First-line

• Non-erosive GERD or uninvestigated heartburn symptoms 1
• Mild erosive esophagitis (LA grade A/B) 1
• First-line peptic ulcer disease treatment 1

Advantages in Specific Populations

• Patients with severe symptoms may experience faster symptom improvement with fexuprazan compared to PPIs 3
• Resolution rates are higher in patients with erosive GERD (83%) compared to non-erosive GERD (28%) 4

Important Considerations and Cautions

• Cost considerations: P-CABs like fexuprazan are typically more expensive than PPIs, which may impact cost-effectiveness as first-line therapy 1
• Safety profile appears comparable to PPIs in short-term studies, but long-term safety data are more limited 1, 2
• Serum gastrin levels may be elevated to higher levels with P-CABs compared to PPIs 1
• Factors associated with poor response to P-CABs include co-existing functional dyspepsia and sleep disturbances 5

While fexuprazan shows promise as an effective acid-suppressing medication with potential advantages over PPIs, current guidelines recommend reserving it for patients who have failed standard PPI therapy, particularly for those with documented acid-related disorders and more severe presentations 1.