How to Take Vonoprazan
Vonoprazan should be taken once daily at a dose of 20 mg for treatment of erosive esophagitis and 10 mg for maintenance therapy, with tablets swallowed whole with or without food. 1
Dosing Recommendations
- For healing of erosive esophagitis: 20 mg once daily for up to 8 weeks 1, 2
- For maintenance of healed erosive esophagitis: 10 mg once daily 3, 4
- For H. pylori eradication: 20 mg twice daily in combination with antibiotics for 14 days 2
- For non-erosive gastroesophageal reflux disease (NERD): 10 mg once daily 3, 5
Administration Instructions
- Swallow vonoprazan tablets whole; do not chew or crush the tablet 1
- Can be taken with or without food (food has minimal effect on absorption) 1, 6
- Take at a consistent time each day for optimal effect 1, 6
Missed Dose Instructions
- For erosive esophagitis treatment or NERD: If a dose is missed, take vonoprazan as soon as possible within 12 hours after the missed dose. If more than 12 hours have passed, skip the missed dose and take the next dose at the regularly scheduled time 1
- For H. pylori treatment: If a dose is missed, take vonoprazan as soon as possible within 4 hours after the missed dose. If more than 4 hours have passed, skip the missed dose and take the next dose at the regularly scheduled time 1, 2
Dosage Adjustments for Special Populations
Renal Impairment
- For patients with eGFR ≥30 mL/minute: Standard dosing 1
- For patients with eGFR <30 mL/minute: 10 mg once daily for erosive esophagitis; not recommended for H. pylori treatment 1
Hepatic Impairment
- Child-Pugh Class A: Standard dosing 1
- Child-Pugh Class B or C: 10 mg once daily for erosive esophagitis; not recommended for H. pylori treatment 1
Duration of Treatment
- For healing of erosive esophagitis: Up to 8 weeks 2, 7
- For H. pylori eradication: 14 days is the standard duration in the US 2
- For maintenance therapy: Long-term use should be limited to the shortest duration appropriate to the condition being treated due to potential risks with prolonged acid suppression 1, 3
Important Precautions
- Missed doses should be taken according to the specific timing guidelines for each indication 1
- Long-term use may be associated with risks including bone fracture, vitamin B12 deficiency, and hypomagnesemia 1
- Monitor for signs of acute tubulointerstitial nephritis, which has been reported with vonoprazan 1
- Consider periodic monitoring of magnesium levels in patients on prolonged therapy 1
Vonoprazan has shown superior efficacy compared to lansoprazole for healing and maintenance of healing of erosive esophagitis, particularly in more severe cases (LA Grade C/D) 4, 3, making proper administration important for optimal outcomes.