Vonoprazan Clinical Use Guidelines

Introduction to Vonoprazan

The American Gastroenterological Association recommends vonoprazan, a potassium-competitive acid blocker (P-CAB), for PPI-refractory GERD, Helicobacter pylori eradication, and peptic ulcer disease, but not as first-line therapy for uncomplicated non-erosive GERD 1, 2

Vonoprazan has several advantages over PPIs, including being acid-stable, not requiring premeal dosing, having a rapid onset of action, a longer half-life, and achieving maximal acid suppression in 1 day 1, 2
The American College of Gastroenterology notes that vonoprazan is not a prodrug and is not metabolized by CYP2C19, eliminating genetic polymorphism-related variability in response 1

The American Gastroenterological Association recommends vonoprazan for severe erosive esophagitis (LA grade C/D) that has failed PPI therapy, with a strong evidence base 1, 2
Vonoprazan is also recommended for Helicobacter pylori eradication therapy, achieving >90% eradication rates, according to the Infectious Diseases Society of America 1
The American College of Gastroenterology suggests vonoprazan as first-line therapy for peptic ulcer disease, with a high level of evidence 1, 2

The standard dose of vonoprazan is 20 mg once daily, which can be taken at any time relative to meals, as recommended by the American Gastroenterological Association 1

The American College of Gastroenterology recommends starting with standard-dose PPI once daily for initial GERD presentation, with vonoprazan considered for PPI-refractory disease 1, 3, 4
Vonoprazan can be used as part of triple or quadruple therapy for H. pylori eradication, with a high success rate, according to the Infectious Diseases Society of America 1

The American Gastroenterological Association advises against discontinuing PPIs inappropriately, particularly in patients with complicated GERD, to prevent rebound acid hypersecretion 5, 6
Vonoprazan has a similar safety profile to PPIs, with no significant adverse events reported in clinical studies, as noted by the American College of Gastroenterology 1, 2