Can vonoprazan (Voquezna) be used in a patient with stage 4 chronic kidney disease (eGFR 15–29 mL/min/1.73 m²)?

Can You Take Voquezna with Stage 4 CKD?

Yes, vonoprazan (Voquezna) can be used in stage 4 CKD, but requires dose reduction to 10 mg once daily for healing erosive esophagitis, while maintenance therapy and heartburn relief use standard dosing. 1

Dose Adjustments by Indication

Healing of Erosive Esophagitis

• Reduce dose to 10 mg once daily when eGFR is less than 30 mL/min/1.73 m² (stage 4 CKD) 1
• Standard 20 mg once daily dosing applies only when eGFR is 30 mL/min or greater 1

Maintenance Therapy and Heartburn Relief

• No dose adjustment required for maintenance of healed erosive esophagitis or relief of heartburn associated with non-erosive GERD, regardless of renal function 1
• Use the same dosing as patients with normal renal function 1

H. pylori Treatment

• Use is not recommended in stage 4 CKD (eGFR <30 mL/min/1.73 m²) for triple therapy regimens 1
• This restriction likely relates to the concomitant antibiotics (amoxicillin and clarithromycin) rather than vonoprazan itself 1

Clinical Monitoring Considerations

Renal Function Surveillance

• Monitor renal function every 3-6 months in stage 4 CKD patients, as recommended for this population 2
• Reassess dosing if eGFR changes significantly, particularly if it improves above 30 mL/min/1.73 m² or declines to stage 5 1

Safety Monitoring

• Watch for acute tubulointerstitial nephritis, which has been reported with vonoprazan and requires discontinuation if suspected 1
• Monitor for signs of Clostridioides difficile-associated diarrhea, as acid suppression may increase risk 1
• Use the shortest duration appropriate to the condition being treated 1

Important Caveats

Drug Interactions in CKD

• Stage 4 CKD patients are at higher risk for drug-drug interactions due to altered pharmacokinetics 3, 4
• Vonoprazan is contraindicated with rilpivirine-containing products regardless of renal function 1

Long-term Considerations

• Prolonged acid suppression can lead to vitamin B12 deficiency and hypomagnesemia, which may be more problematic in advanced CKD 1
• Consider periodic monitoring of vitamin B12 and magnesium levels in patients requiring long-term therapy 1

Practical Implementation

• Swallow tablets whole; do not crush or chew 1
• Can be taken with or without food 1
• If a dose is missed for healing/maintenance indications, take within 12 hours; otherwise skip and resume regular schedule 1