Fexuprazan Clinical Guidelines

Pharmacokinetic and Pharmacodynamic Properties

• The drug is not metabolized by CYP2C19, eliminating the genetic polymorphism variability seen with PPIs 1
• Based on pharmacodynamic studies, fexuprazan 40 mg provides intragastric acid inhibition similar to standard PPI doses rather than more potent suppression 1, 2

Safety and Efficacy

• Like all potent acid suppressors, P-CABs including fexuprazan may be associated with increased risks of enteric infections, though this risk appears comparable to PPIs 1
• Fexuprazan should generally not be used as first-line therapy for acid-related conditions where clinical superiority over PPIs has not been demonstrated 1, 2

Clinical Positioning and Common Pitfalls

• Fexuprazan may be considered in selected patients with documented acid-related reflux who fail twice-daily PPI therapy 2
• Do not prescribe fexuprazan as first-line therapy when standard PPIs would be more cost-effective, particularly for mild erosive esophagitis or non-erosive reflux disease 1, 2
• Avoid assuming that more potent acid inhibition automatically translates to superior clinical outcomes across all foregut disorders 2
• Do not overlook the need to demonstrate superiority over both standard-dose and double-dose PPIs before selecting fexuprazan, given the substantial cost differential 2