Co-Administration of Voquenza (Peramivir) and Vonoprazan
There is no evidence of clinically significant drug-drug interactions between peramivir (Voquenza) and vonoprazan, and co-administration appears safe based on their distinct pharmacokinetic profiles and lack of shared metabolic pathways.
Pharmacokinetic Rationale for Safety
Vonoprazan Metabolism and Transport
- Vonoprazan is metabolized primarily by CYP3A4, CYP2B6, and CYP2C19, and is a substrate of P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) transporters 1, 2.
- Vonoprazan acts as a mild inhibitor of P-gp and BCRP, which can increase exposure to drugs that are substrates of these transporters 1.
- Vonoprazan is not significantly affected by CYP2C19 polymorphisms, providing consistent pharmacokinetics across patient populations 2.
Peramivir Characteristics
- Peramivir is a neuraminidase inhibitor used for influenza treatment that does not undergo significant hepatic metabolism and is primarily eliminated unchanged through renal excretion 3.
- Peramivir is not a substrate, inhibitor, or inducer of major CYP enzymes, making metabolic drug interactions unlikely 3.
Absence of Interaction Mechanisms
- Since peramivir does not interact with CYP enzymes or P-gp/BCRP transporters, and vonoprazan's effects are limited to these pathways, no pharmacokinetic interaction is expected between these two agents.
- The reviewed drug interaction tables for vonoprazan-containing regimens do not list antiviral agents like peramivir as problematic co-medications 3.
Clinical Monitoring Considerations
Standard Safety Monitoring
- Monitor for vonoprazan's typical adverse effects including mild gastrointestinal symptoms, which occur at similar rates to proton pump inhibitors 1, 4.
- Be aware that vonoprazan elevates serum gastrin levels higher than PPIs, though this is not clinically significant in short-term use 1, 4.
Peramivir-Specific Considerations
- Continue standard monitoring for peramivir adverse effects, primarily gastrointestinal symptoms and potential respiratory effects in patients with underlying airway disease 3.
- No dose adjustments are needed for either medication when used together.
Common Pitfalls to Avoid
- Do not confuse vonoprazan with traditional PPIs - vonoprazan is a potassium-competitive acid blocker (P-CAB) with different pharmacology, though it shares similar safety concerns related to acid suppression 1, 2.
- Avoid assuming all acid suppressants have the same drug interaction profile - vonoprazan's interactions differ from PPIs due to its distinct mechanism and metabolism 1.
- Do not discontinue necessary acid suppression therapy during influenza treatment, as there is no contraindication to concurrent use 1, 4.