Does vonoprazan interact with sucralfate and oxetacaine?

Drug Interaction Between Vonoprazan, Sucralfate, and Oxetacaine

There is no documented direct pharmacokinetic or pharmacodynamic interaction between vonoprazan and sucralfate or oxetacaine, but these medications should be administered at least 2 hours apart to avoid potential absorption interference.

Mechanism and Rationale for Separation

Sucralfate requires separation from acid-suppressive agents like vonoprazan because it needs adequate spacing to prevent absorption interference. 1, 2

• The American Gastroenterological Association recommends that sucralfate should be administered at least 2 hours apart from drugs that decrease gastric acidity (including PPIs and potassium-competitive acid blockers like vonoprazan) to avoid interaction 1
• The American College of Clinical Pharmacy similarly recommends this 2-hour separation between sucralfate and acid-suppressive medications 2

Vonoprazan Pharmacology Relevant to Interactions

Vonoprazan is metabolized primarily by CYP3A4 and to a lesser extent by CYP2B6, CYP2C19, CYP2D6, and SULT2A1 3

• Food has minimal effect on vonoprazan's intestinal absorption, suggesting that physical interactions in the GI tract are less likely to significantly impact its bioavailability 3
• Vonoprazan reaches maximum plasma concentration at 1.5-2.0 hours after oral administration 3
• The drug is highly concentrated in gastric parietal cells due to its basic properties (pKa 9.6) and acid-resistant characteristics 3

Oxetacaine Considerations

Oxetacaine is a topical anesthetic often combined with antacids in products like Mucaine gel 2

• Oxetacaine-containing products provide only short-term symptomatic relief through local anesthetic action 2
• When oxetacaine is formulated with antacids (as in Mucaine gel), the same 2-hour separation rule applies as with sucralfate 2

Practical Administration Guidelines

Administer vonoprazan first, then wait at least 2 hours before giving sucralfate or oxetacaine-containing antacid products. 1, 2

• Vonoprazan can be taken without regard to meals, providing flexibility in timing 3
• If using both sucralfate and oxetacaine/antacid combinations, coordinate timing to maintain the 2-hour separation from vonoprazan 2
• There are no contraindications to using these medications together when properly spaced 2

Clinical Context

Vonoprazan provides more potent and durable acid suppression compared to standard PPIs, maintaining intragastric pH >4 for 83% of a 24-hour period by day 7 of treatment 3

• This superior acid control may reduce the need for additional agents like sucralfate in many acid-related conditions 4
• Vonoprazan is generally well tolerated with adverse events (mostly constipation or diarrhea) occurring at frequencies of 8-17% 3
• Meta-analysis shows vonoprazan may significantly decrease diarrhea and loose stools compared to PPIs 5