Vonoprazan is a potassium-competitive acid blocker (PCAB) that inhibits H+, K+-ATPase-mediated gastric acid secretion. PCBs represent an alternative to proton-pump inhibitors for the treatment of acid-related disorders. Unlike proton-pump inhibitors, PCABs are not affected by CYP2C19 genetic polymorphisms and do not require acid-resistant formulations. Furthermore, vonoprazan is 350 times more potent than the proton-pump inhibitor [lansoprazole], thanks to its ability to accumulate in the gastric corpus mucosa, specifically in the parietal cells. In February 2015, vonoprazan was first marketed in Japan for the treatment of acid-related disorders and as an adjunct to Helicobacter pylori (H. pylori) eradication. In May 2022, the FDA approved the use of vonoprazan in a co-packaged product containing amoxicillin and clarithromycin for the treatment of H. pylori infection. Studies have shown that the concomitant use of vonoprazan, amoxicillin, and clarithromycin leads to an H. pylori eradication rate of approximately 90%.
Vonoprazan drug is an antiulcer drug that is used for the treatment of gastroesophageal reflux (GERD), heartburn, indigestion, gastritis, dyspepsia, etc. The potassium-competitive acid blocker vonoprazan is as effective as proton-pump inhibitors (PPIs) in healing gastric and duodenal ulcers To determine if it is also as effective as PPIs in reducing the risk for recurrent nonsteroidal anti-inflammatory drug Vonoprazan fumarate is a first-in-class potassium-competitive acid blocker. It was approved in the Japanese market in February 2015.
Vonoprazan Fumarate is the fumarate salt form of vonoprazan, a pyrrole derivative and reversible potassium-competitive acid blocker (P-CAB), with potential antacid activity. Upon administration, vonoprazan specifically and competitively binds to the gastric hydrogen-potassium ATPase (H+/K+ ATPase) proton pump at or, more likely, near its potassium ion (K+) binding site and sterically inhibits K+ binding. This blocks the activation of the H+/K+ ATPase by K+, inhibits the proton pump and prevents gastric acid secretion, thereby lowering gastric acid levels.
The fumarate salt form of vonoprazan, a pyrrole derivative and reversible potassium-competitive acid blocker (P-CAB), with potential antacid activity. Upon administration, vonoprazan specifically and competitively binds to the gastric hydrogen-potassium ATPase (H+/K+ ATPase) proton pump at or, more likely, near its potassium ion (K+) binding site and sterically inhibits K+ binding. This blocks the activation of the H+/K+ ATPase by K+, inhibits the proton pump, and prevents gastric acid secretion, thereby lowering gastric acid levels.
Mechanism of Actions
Vonoprazan is a potassium-competitive acid blocker (PCAB) that inhibits the H+, K+-ATPase enzyme system in a potassium-competitive manner. Through this mechanism, vonoprazan suppresses basal and stimulated gastric acid secretion at the secretory surface of gastric parietal cells. Although both classes of drugs inhibit the H+, K+-ATPase, the mechanism of action of PCABs differs from that of proton-pump inhibitors (PPIs). PPIs form a covalent disulfide bond with a cysteine residue on the H+, K+-ATPase, which leads to the inactivation of the enzyme, while PCABs interfere with the binding of K+ to the H+, K+-ATPase.
The use of vonoprazan leads to an increase in intragastric pH. The inhibitory effect of vonoprazan on acid secretion increases with repeated daily dosing. Although the antisecretory effect of vonoprazan decreases after drug discontinuation, intragastric pH remains elevated for 24 to 48 hours. Vonoprazan does not have a clinically significant effect on QT prolongation. Compared to other potassium-competitive acid blockers (PCABs), vonoprazan has a higher point-positive charge (pKa of 9.06). This allows vonoprazan to accumulate at higher concentrations in the canalicular space of the gastric parietal cells, where it binds H+, K+-ATPase in a K+-competitive and reversible manner. Compared to other PCABs, such as SCH28080, or proton-pump inhibitors, such as lansoprazole, vonoprazan has a more potent H+, K+-ATPase inhibitory activity.
Vonoprazan suppresses basal and stimulated gastric acid secretion at the secretory surface of the gastric parietal cell through inhibition of the H+, K+-ATPase enzyme system in a potassium competitive manner. Because this enzyme is regarded as the acid (proton) pump within the parietal cell, vonoprazan has been characterized as a type of gastric proton-pump inhibitor, in that it blocks
the final step of acid production. Vonoprazan does not require activation by acid. Vonoprazan may selectively concentrates in the parietal cells in both the resting and stimulated states. Vonoprazan binds to the active proton pumps in a non-covalent and reversible manner. Amoxicillin is an antibacterial drug. Clarithromycin is a macrolide antimicrobial drug [see Microbiology (12.4)]. Acid suppression enhances the replication of H. pylori bacteria and the stability and effectiveness of antimicrobials in the treatment of H. pylori infection.
Indications
- Vonoprazan, in combination with amoxicillin and clarithromycin in a co-packaged product, is indicated for the treatment of _Helicobacter pylori_ (_H. pylori_) infection in adults. Another co-packaged product with only vonoprazan and amoxicillin is also indicated for the treatment of _H. pylori_ infection in adults.
- Treatment of gastroesophageal reflux disease, Treatment of Helicobacter pylori infection.
- Duodenal Ulcer
- Gastric Ulcer
- Gastric or Duodenal Ulcers Caused by Low-dose Aspirin
- Helicobacter Pylori Infection
- Reflux Esophagitis (RE)
- Develop NSAID-induced gastric ulcers
Contraindications
Vonoprazan TRIPLE PAK and VOQUEZNA DUAL PAK:
- Known hypersensitivity to vonoprazan, amoxicillin or any other betalactams, clarithromycin or any other macrolide antimicrobial or any component of VOQUEZNA TRIPLE PAK. (4.1)
- Known hypersensitivity to vonoprazan, amoxicillin or any other beta-lactams or any component of VOQUEZNA DUAL PAK. (4.1)
- Rilpivirine-containing products. (4.1) VOQUEZNA TRIPLE PAK Due to the Clarithromycin Component:
- Pimozide. (4.2)
- Lomitapide, lovastatin, and simvastatin. (4.2)
- Ergot alkaloids (ergotamine or dihydroergotamine). (4.2)
- Colchicine in renal or hepatic impairment. (4.2)
- History of cholestatic j
Dosage
Voquezna Triple Pak:
Vonoprazan 20 mg plus amoxicillin 1,000 mg plus clarithromycin 500 mg, each given twice daily (morning and evening, 12 hours apart), with or without food, for 14 days Voquezna Dual Pak: vonoprazan 20 mg twice daily (morning and evening) plus amoxicillin 1,000 mg, three times a day (morning, mid-day, and evening), with or without food, for 14 days
VonoprazanTRIPLE PAK:
- The recommended dosage regimen is vonoprazan 20 mg plus amoxicillin 1,000 mg plus clarithromycin 500 mg, each given twice daily (morning and evening, 12 hours apart), with or without food, for 14 days. (2.1)
Vonoprazan DUAL PAK:
- The recommended dosage regimen is vonoprazan 20 mg twice daily (morning and evening) plus amoxicillin 1,000 mg, three times a day (morning, mid-day, and evening), with or without food, for 14 days. (2.2)
VonoprazanTRIPLE PAK:
Carton of 14 daily administration packs for morning and evening dosing, each containing the following three drug products (3.1):
- Tablets: Vonoprazan 20 mg
- Tablets: Clarithromycin 500 mg
- Capsules: Amoxicillin 500 mg
Vonoprazan DUAL PAK:
Carton of 14 daily administration packs for the morning, mid-day, and evening dosing, each containing the following
two drug products (3.2):
- Tablets: Vonoprazan 20 mg
- Capsules: Amoxicillin 500 mg
Side Effects
The Most Common
- diarrhea
- stomach pain
- change in ability to taste food
- headache
- sore throat
- vaginal itching and/or discharge
More Common
- blistering or peeling skin
- rash; hives; itching; swelling of the lips, face, or tongue; shortness of breath; difficulty breathing or swallowing
- yellow eyes or skin, loss of appetite, dark urine; itching, abdominal pain, unexplained bruising or bleeding, or loss of appetite
- severe diarrhea (watery or bloody stools) that may occur with or without fever and stomach cramps (may occur up to 2 months or more after your treatment)
Drugs Interactions
| DRUG | INTERACTION |
|---|---|
| Abametapir | The serum concentration of Vonoprazan can be increased when it is combined with Abametapir. |
| Abatacept | The metabolism of Vonoprazan can be increased when combined with Abatacept. |
| Abrocitinib | The metabolism of Abrocitinib can be decreased when combined with Vonoprazan. |
| Acalabrutinib | The metabolism of Vonoprazan can be decreased when combined with Acalabrutinib. |
| Acenocoumarol | The metabolism of Acenocoumarol can be decreased when combined with Vonoprazan. |
| Adalimumab | The metabolism of Vonoprazan can be increased when combined with Adalimumab. |
| Albendazole | The metabolism of Albendazole can be decreased when combined with Vonoprazan. |
| Alfentanil | The metabolism of Vonoprazan can be decreased when combined with Alfentanil. |
| Alprazolam | The metabolism of Vonoprazan can be decreased when combined with Alprazolam. |
| Ambrisentan | The metabolism of Vonoprazan can be decreased when combined with Ambrisentan. |
| Amiodarone | The metabolism of Vonoprazan can be decreased when combined with Amiodarone. |
| Amitriptyline | The metabolism of Amitriptyline can be decreased when combined with Vonoprazan. |
| Amprenavir | The metabolism of Vonoprazan can be decreased when combined with Amprenavir. |
| Anakinra | The metabolism of Vonoprazan can be increased when combined with Anakinra. |
| Apalutamide | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with Apalutamide. |
| Apixaban | The metabolism of Apixaban can be decreased when combined with Vonoprazan. |
| Apomorphine | The metabolism of Vonoprazan can be decreased when combined with Apomorphine. |
| Apremilast | The metabolism of Vonoprazan can be increased when combined with Apremilast. |
| Aprepitant | The metabolism of Vonoprazan can be decreased when combined with Aprepitant. |
| Aripiprazole | The metabolism of Vonoprazan can be decreased when combined with Aripiprazole. |
| Aripiprazole lauro | The metabolism of Aripiprazole lauroxil can be decreased when combined with Vonoprazan. |
| Armodafinil | The metabolism of Vonoprazan can be increased when combined with Armodafinil. |
| Artemether | The metabolism of Artemether can be decreased when combined with Vonoprazan. |
| Astemizole | The metabolism of Astemizole can be decreased when combined with Vonoprazan. |
| Asunaprevir | Vonoprazan can cause a decrease in the absorption of Asunaprevir resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Atazanavir | Vonoprazan can cause a decrease in the absorption of Atazanavir resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Atorvastatin | The metabolism of Vonoprazan can be decreased when combined with Atorvastatin. |
| Avanafil | The serum concentration of Avanafil can be increased when it is combined with Vonoprazan. |
| Axitinib | The metabolism of Axitinib can be decreased when combined with Vonoprazan. |
| Azelastine | The metabolism of Vonoprazan can be decreased when combined with Azelastine. |
| Beclomethasone dip | The metabolism of Vonoprazan can be increased when combined with Beclomethasone dipropionate. |
| Belzutifan | The serum concentration of Belzutifan can be increased when it is combined with Vonoprazan. |
| Benzocaine | The metabolism of Benzocaine can be decreased when combined with Vonoprazan. |
| Berotralstat | The metabolism of Vonoprazan can be decreased when combined with Berotralstat. |
| Betamethasone | The metabolism of Vonoprazan can be increased when combined with Betamethasone. |
| Betamethasone pho | The metabolism of Vonoprazan can be increased when combined with Betamethasone phosphate. |
| Bimekizumab | The metabolism of Vonoprazan can be increased when combined with Bimekizumab. |
| Bisacodyl | The therapeutic efficacy of Bisacodyl can be decreased when used in combination with Vonoprazan. |
| Boceprevir | The metabolism of Vonoprazan can be decreased when combined with Boceprevir. |
| Bosutinib | Vonoprazan can cause a decrease in the absorption of Bosutinib resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Budesonide | The metabolism of Vonoprazan can be increased when combined with Budesonide. |
| Buprenorphine | The metabolism of Vonoprazan can be decreased when combined with Buprenorphine. |
| Buspirone | The metabolism of Vonoprazan can be decreased when combined with Buspirone. |
| Cabazitaxel | The metabolism of Cabazitaxel can be decreased when combined with Vonoprazan. |
| Canakinumab | The metabolism of Vonoprazan can be increased when combined with Canakinumab. |
| Cannabidiol | The metabolism of Vonoprazan can be decreased when combined with Cannabidiol. |
| Captopril | Vonoprazan can cause a decrease in the absorption of Captopril resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Carbamazepine | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with Carbamazepine. |
| Carisoprodol | The metabolism of Carisoprodol can be decreased when combined with Vonoprazan. |
| Cefditoren | The serum concentration of Cefditoren can be decreased when it is combined with Vonoprazan. |
| Cefuroxime | The serum concentration of Cefuroxime can be decreased when it is combined with Vonoprazan. |
| Cenobamate | The serum concentration of Vonoprazan can be decreased when it is combined with Cenobamate. |
| Cerivastatin | The metabolism of Vonoprazan can be decreased when combined with Cerivastatin. |
| Certolizumab pegol | The metabolism of Vonoprazan can be increased when combined with Certolizumab pegol. |
| Chloramphenicol | The metabolism of Vonoprazan can be decreased when combined with Chloramphenicol. |
| Chloroquine | The metabolism of Vonoprazan can be decreased when combined with Chloroquine. |
| Chlorpheniramine | The metabolism of Vonoprazan can be decreased when combined with Chlorpheniramine. |
| Cilostazol | The risk or severity of adverse effects can be increased when Vonoprazan is combined with Cilostazol. |
| Cimetidine | The metabolism of Vonoprazan can be decreased when combined with Cimetidine. |
| Ciprofloxacin | The metabolism of Vonoprazan can be decreased when combined with Ciprofloxacin. |
| Cisapride | The metabolism of Vonoprazan can be decreased when combined with Cisapride. |
| Citalopram | The risk or severity of adverse effects can be increased when Vonoprazan is combined with Citalopram. |
| Clarithromycin | The metabolism of Vonoprazan can be decreased when combined with Clarithromycin. |
| Clindamycin | The metabolism of Vonoprazan can be decreased when combined with Clindamycin. |
| Clobazam | The metabolism of Clobazam can be decreased when combined with Vonoprazan. |
| Clobetasol propion | The metabolism of Vonoprazan can be increased when combined with Clobetasol propionate. |
| Clofazimine | The metabolism of Vonoprazan can be decreased when combined with Clofazimine. |
| Clomipramine | The metabolism of Clomipramine can be decreased when combined with Vonoprazan. |
| Clonidine | The metabolism of Clonidine can be decreased when combined with Vonoprazan. |
| Clopidogrel | The therapeutic efficacy of Clopidogrel can be decreased when used in combination with Vonoprazan. |
| Clozapine | The metabolism of Vonoprazan can be decreased when combined with Clozapine. |
| Cobicistat | The metabolism of Vonoprazan can be decreased when combined with Cobicistat. |
| Conivaptan | The metabolism of Vonoprazan can be decreased when combined with Conivaptan. |
| Copanlisib | The metabolism of Copanlisib can be decreased when combined with Vonoprazan. |
| Cortisone acetate | The metabolism of Vonoprazan can be increased when combined with Cortisone acetate. |
| Crizotinib | The metabolism of Crizotinib can be decreased when combined with Vonoprazan. |
| Curcumin | The metabolism of Vonoprazan can be decreased when combined with Curcumin. |
| Cyclophosphamide | The metabolism of Cyclophosphamide can be decreased when combined with Vonoprazan. |
| Cyclosporine | The metabolism of Cyclosporine can be decreased when combined with Vonoprazan. |
| Cysteamine | The bioavailability of Cysteamine can be decreased when combined with Vonoprazan. |
| Dabigatran etexilate | Vonoprazan can cause a decrease in the absorption of Dabigatran etexilate resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Dabrafenib | Vonoprazan can cause a decrease in the absorption of Dabrafenib resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Daclatasvir | The metabolism of Vonoprazan can be decreased when combined with Daclatasvir. |
| Danazol | The metabolism of Vonoprazan can be decreased when combined with Danazol. |
| Dapsone | The metabolism of Vonoprazan can be decreased when combined with Dapsone. |
| Darunavir | The metabolism of Vonoprazan can be decreased when combined with Darunavir. |
| Dasatinib | Vonoprazan can cause a decrease in the absorption of Dasatinib resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Daunorubicin | The metabolism of Vonoprazan can be increased when combined with Daunorubicin. |
| Delavirdine | Vonoprazan can cause a decrease in the absorption of Delavirdine resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Desvenlafaxine | The metabolism of Vonoprazan can be decreased when combined with Desvenlafaxine. |
| Deutetrabenazine | The metabolism of Deutetrabenazine can be decreased when combined with Vonoprazan. |
| Dexamethasone | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with Dexamethasone. |
| Dexamethasone acet | The metabolism of Vonoprazan can be increased when combined with Dexamethasone acetate. |
| Dexlansoprazole | The metabolism of Dexlansoprazole can be decreased when combined with Vonoprazan. |
| Dexmethylphenidate | Vonoprazan can cause an increase in the absorption of Dexmethylphenidate resulting in an increased serum concentration and potentially a worsening of adverse effects. |
| Dextromethorphan | The metabolism of Vonoprazan can be decreased when combined with Dextromethorphan. |
| Diazepam | The metabolism of Diazepam can be decreased when combined with Vonoprazan. |
| Difluocortolone | The metabolism of Vonoprazan can be increased when combined with Difluocortolone. |
| Diltiazem | The metabolism of Vonoprazan can be decreased when combined with Diltiazem. |
| Disulfiram | The metabolism of Vonoprazan can be decreased when combined with Disulfiram. |
| Docetaxel | The metabolism of Docetaxel can be decreased when combined with Vonoprazan. |
| Domperidone | The metabolism of Vonoprazan can be decreased when combined with Domperidone. |
| Doravirine | The metabolism of Doravirine can be decreased when combined with Vonoprazan. |
| Doxazosin | The metabolism of Doxazosin can be decreased when combined with Vonoprazan. |
| Doxepin | The metabolism of Doxepin can be decreased when combined with Vonoprazan. |
| Dronedarone | The metabolism of Dronedarone can be decreased when combined with Vonoprazan. |
| Dutasteride | The metabolism of Vonoprazan can be decreased when combined with Dutasteride. |
| Efavirenz | The metabolism of Vonoprazan can be decreased when combined with Efavirenz. |
| Elbasvir | The metabolism of Vonoprazan can be decreased when combined with Elbasvir. |
| Elexacaftor | The metabolism of Elexacaftor can be decreased when combined with Vonoprazan. |
| Elvitegravir | The metabolism of Vonoprazan can be decreased when combined with Elvitegravir. |
| Emapalumab | The metabolism of Vonoprazan can be increased when combined with Emapalumab. |
| Enasidenib | The metabolism of Enasidenib can be decreased when combined with Vonoprazan. |
| Enzalutamide | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with Enzalutamide. |
| Epcoritamab | The serum concentration of Vonoprazan can be increased when it is combined with Epcoritamab. |
| Eplerenone | The metabolism of Vonoprazan can be decreased when combined with Eplerenone. |
| Ergotamine | The metabolism of Vonoprazan can be decreased when combined with Ergotamine. |
| Erlotinib | Vonoprazan can cause a decrease in the absorption of Erlotinib resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Erythromycin | The serum concentration of Vonoprazan can be increased when it is combined with Erythromycin. |
| Escitalopram | The metabolism of Escitalopram can be decreased when combined with Vonoprazan. |
| Esketamine | The metabolism of Esketamine can be decreased when combined with Vonoprazan. |
| Esomeprazole | The metabolism of Esomeprazole can be decreased when combined with Vonoprazan. |
| Estradiol | The metabolism of Estradiol can be decreased when combined with Vonoprazan. |
| Estradiol acetate | The metabolism of Estradiol acetate can be decreased when combined with Vonoprazan. |
| Estradiol benzoate | The metabolism of Estradiol benzoate can be decreased when combined with Vonoprazan. |
| Estradiol cypionate | The metabolism of Estradiol cypionate can be decreased when combined with Vonoprazan. |
| Estradiol dienanthate | The metabolism of Estradiol dienanthate can be decreased when combined with Vonoprazan. |
| Estradiol valerate | The metabolism of Estradiol valerate can be decreased when combined with Vonoprazan. |
| Etanercept | The metabolism of Vonoprazan can be increased when combined with Etanercept. |
| Ethinylestradiol | The metabolism of Vonoprazan can be decreased when combined with Ethinylestradiol. |
| Etoposide | The metabolism of Etoposide can be decreased when combined with Vonoprazan. |
| Etravirine | The metabolism of Etravirine can be decreased when combined with Vonoprazan. |
| Fedratinib | The serum concentration of Vonoprazan can be increased when it is combined with Fedratinib. |
| Felodipine | The metabolism of Vonoprazan can be decreased when combined with Felodipine. |
| Ferric ammonium | Vonoprazan can cause a decrease in the absorption of Ferric ammonium citrate resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Ferric cation | Vonoprazan can cause a decrease in the absorption of Ferric cation resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Ferric maltol | Vonoprazan can cause a decrease in the absorption of Ferric maltol resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Ferric sulfate | Vonoprazan can cause a decrease in the absorption of Ferric sulfate resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Ferrous bisglycin | Vonoprazan can cause a decrease in the absorption of Ferrous bisglycinate resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Ferrous fumarate | Vonoprazan can cause a decrease in the absorption of Ferrous fumarate resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Ferrous gluconate | Vonoprazan can cause a decrease in the absorption of Ferrous gluconate resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Ferrous succinate | Vonoprazan can cause a decrease in the absorption of Ferrous succinate resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Ferrous sulfate anhyd | Vonoprazan can cause a decrease in the absorption of Ferrous sulfate anhydrous resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Ferumoxides | Vonoprazan can cause a decrease in the absorption of Ferumoxides resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Ferumoxsil | Vonoprazan can cause a decrease in the absorption of Ferumoxsil resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Fexinidazole | The metabolism of Fexinidazole can be decreased when combined with Vonoprazan. |
| Finasteride | The metabolism of Vonoprazan can be decreased when combined with Finasteride. |
| Fluconazole | The metabolism of Vonoprazan can be decreased when combined with Fluconazole. |
| Fluocinonide | The metabolism of Vonoprazan can be increased when combined with Fluocinonide. |
| Fluocortolone | The metabolism of Vonoprazan can be increased when combined with Fluocortolone. |
| Fluoxetine | The metabolism of Fluoxetine can be decreased when combined with Vonoprazan. |
| Flutamide | The metabolism of Vonoprazan can be decreased when combined with Flutamide. |
| Fluticasone | The metabolism of Vonoprazan can be decreased when combined with Fluticasone. |
| Fluticasone furoate | The metabolism of Vonoprazan can be decreased when combined with Fluticasone furoate. |
| Fluticasone propio | The metabolism of Vonoprazan can be decreased when combined with Fluticasone propionate. |
| Fluvastatin | The metabolism of Vonoprazan can be decreased when combined with Fluvastatin. |
| Fluvoxamine | The metabolism of Vonoprazan can be decreased when combined with Fluvoxamine. |
| Formoterol | The metabolism of Formoterol can be decreased when combined with Vonoprazan. |
| Fosamprenavir | Vonoprazan can cause a decrease in the absorption of Fosamprenavir resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Fosnetupitant | The metabolism of Vonoprazan can be decreased when combined with Fosnetupitant. |
| Fosphenytoin | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with Fosphenytoin. |
| Fusidic acid | The metabolism of Vonoprazan can be decreased when combined with Fusidic acid. |
| Gefitinib | Vonoprazan can cause a decrease in the absorption of Gefitinib resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Gliclazide | The metabolism of Gliclazide can be decreased when combined with Vonoprazan. |
| Glofitamab | The serum concentration of Vonoprazan can be increased when it is combined with Glofitamab. |
| Glyburide | The metabolism of Glyburide can be decreased when combined with Vonoprazan. |
| Golimumab | The metabolism of Vonoprazan can be increased when combined with Golimumab. |
| Halofantrine | The metabolism of Vonoprazan can be decreased when combined with Halofantrine. |
| Haloperidol | The serum concentration of Haloperidol can be increased when it is combined with Vonoprazan. |
| Hydrocortisone | The metabolism of Vonoprazan can be decreased when combined with Hydrocortisone. |
| Hydrocortisone acet | The metabolism of Hydrocortisone acetate can be decreased when combined with Vonoprazan. |
| Hydrocortisone buty | The metabolism of Hydrocortisone butyrate can be decreased when combined with Vonoprazan. |
| Hydrocortisone cypi | The metabolism of Hydrocortisone cypionate can be decreased when combined with Vonoprazan. |
| Hydrocortisone ph | The metabolism of Hydrocortisone phosphate can be decreased when combined with Vonoprazan. |
| Hydroxyprogesterone | The metabolism of Vonoprazan can be decreased when combined with Hydroxyprogesterone caproate. |
| Hydroxyzine | The metabolism of Vonoprazan can be decreased when combined with Hydroxyzine. |
| Ibrutinib | The metabolism of Vonoprazan can be decreased when combined with Ibrutinib. |
| Ifosfamide | The metabolism of Ifosfamide can be decreased when combined with Vonoprazan. |
| Iloperidone | The metabolism of Vonoprazan can be decreased when combined with Iloperidone. |
| Imatinib | The metabolism of Vonoprazan can be decreased when combined with Imatinib. |
| Imipramine | The metabolism of Imipramine can be decreased when combined with Vonoprazan. |
| Indinavir | The metabolism of Vonoprazan can be decreased when combined with Indinavir. |
| Infigratinib | The serum concentration of Infigratinib can be decreased when it is combined with Vonoprazan. |
| Infliximab | The metabolism of Vonoprazan can be increased when combined with Infliximab. |
| Irinotecan | The metabolism of Vonoprazan can be decreased when combined with Irinotecan. |
| Iron | Vonoprazan can cause a decrease in the absorption of Iron resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Iron Dextran | Vonoprazan can cause a decrease in the absorption of Iron Dextran resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Iron sucrose | Vonoprazan can cause a decrease in the absorption of Iron sucrose resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Isavuconazole | The metabolism of Vonoprazan can be decreased when combined with Isavuconazole. |
| Isavuconazonium | The metabolism of Vonoprazan can be decreased when combined with Isavuconazonium. |
| Isoniazid | The metabolism of Vonoprazan can be decreased when combined with Isoniazid. |
| Isradipine | The metabolism of Vonoprazan can be decreased when combined with Isradipine. |
| Istradefylline | The metabolism of Istradefylline can be decreased when combined with Vonoprazan. |
| Itraconazole | Vonoprazan can cause a decrease in the absorption of Itraconazole resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Ivacaftor | The serum concentration of Vonoprazan can be increased when it is combined with Ivacaftor. |
| Ivosidenib | The metabolism of Vonoprazan can be increased when combined with Ivosidenib. |
| Ketoconazole | Vonoprazan can cause a decrease in the absorption of Ketoconazole resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Labetalol | The metabolism of Labetalol can be decreased when combined with Vonoprazan. |
| Lacosamide | The metabolism of Lacosamide can be decreased when combined with Vonoprazan. |
| Lansoprazole | The metabolism of Lansoprazole can be decreased when combined with Vonoprazan. |
| Lapatinib | The metabolism of Lapatinib can be decreased when combined with Vonoprazan. |
| Ledipasvir | Vonoprazan can cause a decrease in the absorption of Ledipasvir resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Lemborexant | The metabolism of Lemborexant can be decreased when combined with Vonoprazan. |
| Lercanidipine | The metabolism of Vonoprazan can be decreased when combined with Lercanidipine. |
| Letermovir | The metabolism of Vonoprazan can be decreased when combined with Letermovir. |
| Levamlodipine | The metabolism of Vonoprazan can be decreased when combined with Levamlodipine. |
| Levoketoconazole | Vonoprazan can cause a decrease in the absorption of Levoketoconazole resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Levonorgestrel | The metabolism of Vonoprazan can be decreased when combined with Levonorgestrel. |
| Levothyroxine | Vonoprazan can cause a decrease in the absorption of Levothyroxine resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Lidocaine | The metabolism of Vonoprazan can be decreased when combined with Lidocaine. |
| Linagliptin | The metabolism of Vonoprazan can be decreased when combined with Linagliptin. |
| Lonafarnib | The metabolism of Vonoprazan can be decreased when combined with Lonafarnib. |
| Lopinavir | The metabolism of Vonoprazan can be decreased when combined with Lopinavir. |
| Lorlatinib | The metabolism of Lorlatinib can be decreased when combined with Vonoprazan. |
| Lovastatin | The metabolism of Vonoprazan can be decreased when combined with Lovastatin. |
| Lumacaftor | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with Lumacaftor. |
| Lynestrenol | The metabolism of Lynestrenol can be decreased when combined with Vonoprazan. |
| Mavacamten | The serum concentration of Vonoprazan can be decreased when it is combined with Mavacamten. |
| Memantine | Vonoprazan may decrease the excretion rate of Memantine which could result in a higher serum level. |
| Meprednisone | The metabolism of Vonoprazan can be increased when combined with Meprednisone. |
| Mesalazine | Vonoprazan can cause a decrease in the absorption of Mesalazine resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Methadone | The metabolism of Methadone can be decreased when combined with Vonoprazan. |
| Methenamine | The therapeutic efficacy of Methenamine can be decreased when used in combination with Vonoprazan. |
| Methimazole | The metabolism of Vonoprazan can be decreased when combined with Methimazole. |
| Methsuximide | The metabolism of Methsuximide can be decreased when combined with Vonoprazan. |
| Methylene blue | The metabolism of Vonoprazan can be decreased when combined with Methylene blue. |
| Methylphenidate | Vonoprazan can cause an increase in the absorption of Methylphenidate resulting in an increased serum concentration and potentially a worsening of adverse effects. |
| Methylphenobarbi | The metabolism of Methylphenobarbital can be decreased when combined with Vonoprazan. |
| Metreleptin | The metabolism of Vonoprazan can be increased when combined with Metreleptin. |
| Metronidazole | The metabolism of Vonoprazan can be decreased when combined with Metronidazole. |
| Miconazole | The metabolism of Vonoprazan can be decreased when combined with Miconazole. |
| Midazolam | The metabolism of Vonoprazan can be decreased when combined with Midazolam. |
| Midostaurin | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with Midostaurin. |
| Mifepristone | The metabolism of Vonoprazan can be decreased when combined with Mifepristone. |
| Milnacipran | The metabolism of Vonoprazan can be decreased when combined with Milnacipran. |
| Mitotane | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with Mitotane. |
| Mobocertinib | The metabolism of Mobocertinib can be decreased when combined with Vonoprazan. |
| Moclobemide | The metabolism of Moclobemide can be decreased when combined with Vonoprazan. |
| Modafinil | The metabolism of Vonoprazan can be increased when combined with Modafinil. |
| Mometasone furoate | The metabolism of Vonoprazan can be increased when combined with Mometasone furoate. |
| Mycophenolate mofetil | Vonoprazan can cause a decrease in the absorption of Mycophenolate mofetil resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Mycophenolic acid | Vonoprazan can cause a decrease in the absorption of Mycophenolic acid resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Nateglinide | The metabolism of Vonoprazan can be decreased when combined with Nateglinide. |
| Nebivolol | The metabolism of Nebivolol can be decreased when combined with Vonoprazan. |
| Nefazodone | The metabolism of Vonoprazan can be decreased when combined with Nefazodone. |
| Nelfinavir | The absorption of Nelfinavir can be decreased when combined with Vonoprazan. |
| Netupitant | The metabolism of Vonoprazan can be decreased when combined with Netupitant. |
| Nevirapine | The metabolism of Vonoprazan can be decreased when combined with Nevirapine. |
| Nicardipine | The metabolism of Vonoprazan can be decreased when combined with Nicardipine. |
| Nifedipine | The metabolism of Vonoprazan can be decreased when combined with Nifedipine. |
| Nilotinib | The metabolism of Vonoprazan can be decreased when combined with Nilotinib. |
| Nilutamide | The metabolism of Nilutamide can be decreased when combined with Vonoprazan. |
| Nilvadipine | The metabolism of Vonoprazan can be decreased when combined with Nilvadipine. |
| Nisoldipine | The metabolism of Vonoprazan can be decreased when combined with Nisoldipine. |
| Nitrendipine | The metabolism of Vonoprazan can be decreased when combined with Nitrendipine. |
| Norethisterone | The metabolism of Vonoprazan can be decreased when combined with Norethisterone. |
| Octreotide | Vonoprazan can cause a decrease in the absorption of Octreotide resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Olaparib | The metabolism of Olaparib can be decreased when combined with Vonoprazan. |
| Omaveloxolone | The serum concentration of Vonoprazan can be decreased when it is combined with Omaveloxolone. |
| Omeprazole | The metabolism of Omeprazole can be decreased when combined with Vonoprazan. |
| Ondansetron | The metabolism of Vonoprazan can be decreased when combined with Ondansetron. |
| Osilodrostat | The metabolism of Vonoprazan can be decreased when combined with Osilodrostat. |
| Oxcarbazepine | The metabolism of Vonoprazan can be increased when combined with Oxcarbazepine. |
| Oxybutynin | The metabolism of Vonoprazan can be decreased when combined with Oxybutynin. |
| Oxycodone | The metabolism of Vonoprazan can be decreased when combined with Oxycodone. |
| Paclitaxel | The metabolism of Paclitaxel can be decreased when combined with Vonoprazan. |
| Palbociclib | The absorption of Palbociclib can be decreased when combined with Vonoprazan. |
| Paliperidone | The metabolism of Vonoprazan can be decreased when combined with Paliperidone. |
| Pantoprazole | The metabolism of Pantoprazole can be decreased when combined with Vonoprazan. |
| Paritaprevir | The metabolism of Vonoprazan can be decreased when combined with Paritaprevir. |
| Paroxetine | The metabolism of Paroxetine can be decreased when combined with Vonoprazan. |
| Pazopanib | Vonoprazan can cause a decrease in the absorption of Pazopanib resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Pentamidine | The metabolism of Pentamidine can be decreased when combined with Vonoprazan. |
| Pentobarbital | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with Pentobarbital. |
| Perampanel | The metabolism of Vonoprazan can be decreased when combined with Perampanel. |
| Perflubutane | Vonoprazan can cause a decrease in the absorption of Perflubutane resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Phenobarbital | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with Phenobarbital. |
| Phenytoin | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with Phenytoin. |
| Pimozide | The metabolism of Pimozide can be decreased when combined with Vonoprazan. |
| Pirfenidone | The metabolism of Pirfenidone can be decreased when combined with Vonoprazan. |
| Pitolisant | The serum concentration of Vonoprazan can be decreased when it is combined with Pitolisant. |
| Ponatinib | The metabolism of Ponatinib can be decreased when combined with Vonoprazan. |
| Ponesimod | The metabolism of Ponesimod can be decreased when combined with Vonoprazan. |
| Posaconazole | The metabolism of Vonoprazan can be decreased when combined with Posaconazole. |
| Pralsetinib | The metabolism of Vonoprazan can be decreased when combined with Pralsetinib. |
| Praziquantel | The metabolism of Praziquantel can be decreased when combined with Vonoprazan. |
| Prednisolone pho | The metabolism of Vonoprazan can be increased when combined with Prednisolone phosphate. |
| Prednisone acetate | The metabolism of Vonoprazan can be increased when combined with Prednisone acetate. |
| Primaquine | The metabolism of Vonoprazan can be decreased when combined with Primaquine. |
| Primidone | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with Primidone. |
| Progesterone | The metabolism of Progesterone can be decreased when combined with Vonoprazan. |
| Proguanil | The metabolism of Proguanil can be decreased when combined with Vonoprazan. |
| Propranolol | The serum concentration of Propranolol can be increased when it is combined with Vonoprazan. |
| Prussian blue | Vonoprazan can cause a decrease in the absorption of Prussian blue resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Quetiapine | The metabolism of Vonoprazan can be decreased when combined with Quetiapine. |
| Quinine | The metabolism of Quinine can be decreased when combined with Vonoprazan. |
| Rabeprazole | The metabolism of Rabeprazole can be decreased when combined with Vonoprazan. |
| Raltegravir | Vonoprazan can cause an increase in the absorption of Raltegravir resulting in an increased serum concentration and potentially a worsening of adverse effects. |
| Ramelteon | The metabolism of Ramelteon can be decreased when combined with Vonoprazan. |
| Relugolix | The metabolism of Relugolix can be decreased when combined with Vonoprazan. |
| Reserpine | The metabolism of Vonoprazan can be increased when combined with Reserpine. |
| Ribociclib | The metabolism of Vonoprazan can be decreased when combined with Ribociclib. |
| Rifampicin | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with Rifampicin. |
| Rifamycin | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with Rifamycin. |
| Rifapentine | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with Rifapentine. |
| Rilonacept | The metabolism of Vonoprazan can be increased when combined with Rilonacept. |
| Rilpivirine | The absorption of Rilpivirine can be decreased when combined with Vonoprazan. |
| Riociguat | Vonoprazan can cause a decrease in the absorption of Riociguat resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Risperidone | The metabolism of Vonoprazan can be decreased when combined with Risperidone. |
| Ritonavir | The serum concentration of Vonoprazan can be increased when it is combined with Ritonavir. |
| Rivaroxaban | The metabolism of Vonoprazan can be decreased when combined with Rivaroxaban. |
| Romidepsin | The metabolism of Vonoprazan can be decreased when combined with Romidepsin. |
| Rosuvastatin | The metabolism of Vonoprazan can be decreased when combined with Rosuvastatin. |
| Rucaparib | The metabolism of Vonoprazan can be decreased when combined with Rucaparib. |
| Salmeterol | The metabolism of Vonoprazan can be decreased when combined with Salmeterol. |
| Saquinavir | The metabolism of Vonoprazan can be decreased when combined with Saquinavir. |
| Satralizumab | The serum concentration of Vonoprazan can be decreased when it is combined with Satralizumab. |
| Saxagliptin | The metabolism of Vonoprazan can be decreased when combined with Saxagliptin. |
| Secukinumab | The metabolism of Vonoprazan can be increased when combined with Secukinumab. |
| Selumetinib | The metabolism of Selumetinib can be decreased when combined with Vonoprazan. |
| Sertraline | The metabolism of Sertraline can be decreased when combined with Vonoprazan. |
| Sildenafil | The metabolism of Vonoprazan can be decreased when combined with Sildenafil. |
| Siltuximab | The metabolism of Vonoprazan can be increased when combined with Siltuximab. |
| Simeprevir | The metabolism of Vonoprazan can be decreased when combined with Simeprevir. |
| Simvastatin | The metabolism of Vonoprazan can be decreased when combined with Simvastatin. |
| Sirolimus | The metabolism of Sirolimus can be decreased when combined with Vonoprazan. |
| Sodium ferede | Vonoprazan can cause a decrease in the absorption of Sodium feredetate resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Somatrogon | The metabolism of Vonoprazan can be increased when combined with Somatrogon. |
| Sorafenib | The metabolism of Sorafenib can be decreased when combined with Vonoprazan. |
| Sotorasib | The serum concentration of Vonoprazan can be decreased when it is combined with Sotorasib. |
| St. John’s Wort | The therapeutic efficacy of Vonoprazan can be decreased when used in combination with St. John’s Wort. |
| Stiripentol | The metabolism of Vonoprazan can be decreased when combined with Stiripentol. |
| Sulpiride | The therapeutic efficacy of Sulpiride can be increased when used in combination with Vonoprazan. |
| Sunitinib | The metabolism of Sunitinib can be decreased when combined with Vonoprazan. |
| Tacrolimus | The metabolism of Tacrolimus can be decreased when combined with Vonoprazan. |
| Tadalafil | The metabolism of Vonoprazan can be decreased when combined with Tadalafil. |
| Tamoxifen | The metabolism of Tamoxifen can be decreased when combined with Vonoprazan. |
| Tegafur | The metabolism of Tegafur can be decreased when combined with Vonoprazan. |
| Telaprevir | The metabolism of Vonoprazan can be decreased when combined with Telaprevir. |
| Telithromycin | The metabolism of Vonoprazan can be decreased when combined with Telithromycin. |
| Telotristat ethyl | The serum concentration of Vonoprazan can be decreased when it is combined with Telotristat ethyl. |
| Temsirolimus | The metabolism of Temsirolimus can be decreased when combined with Vonoprazan. |
| Teniposide | The metabolism of Teniposide can be decreased when combined with Vonoprazan. |
| Terfenadine | The metabolism of Vonoprazan can be decreased when combined with Terfenadine. |
| Testosterone | The metabolism of Testosterone can be decreased when combined with Vonoprazan. |
| Testosterone cypionate | The metabolism of Testosterone cypionate can be decreased when combined with Vonoprazan. |
| Testosterone enanth | The metabolism of Testosterone enanthate can be decreased when combined with Vonoprazan. |
| Tetraferric tricitrate | Vonoprazan can cause a decrease in the absorption of Tetraferric tricitrate decahydrate resulting in a reduced serum concentration and potentially a decrease in efficacy. |
| Tezacaftor | The metabolism of Vonoprazan can be decreased when combined with Tezacaftor. |
| Thalidomide | The metabolism of Vonoprazan can be increased when combined with Thalidomide. |
| Thiopental | The metabolism of Thiopental can be decreased when combined with Vonoprazan. |
| Thioridazine | The metabolism of Thioridazine can be decreased when combined with Vonoprazan. |
| Ticagrelor | The metabolism of Vonoprazan can be decreased when combined with Ticagrelor. |
| Ticlopidine | The metabolism of Ticlopidine can be decreased when combined with Vonoprazan. |
| Timolol | The metabolism of Timolol can be decreased when combined with Vonoprazan. |
| Tipranavir | The metabolism of Vonoprazan can be decreased when combined with Tipranavir. |
| Tocilizumab | The metabolism of Vonoprazan can be increased when combined with Tocilizumab. |
| Tolevamer | The therapeutic efficacy of Tolevamer can be decreased when used in combination with Vonoprazan. |
| Trabectedin | The metabolism of Trabectedin can be decreased when combined with Vonoprazan. |
| Trastuzumab emtansine | The metabolism of Trastuzumab emtansine can be decreased when combined with Vonoprazan. |
| Trazodone | The metabolism of Vonoprazan can be decreased when combined with Trazodone. |
| Tretinoin | The metabolism of Vonoprazan can be decreased when combined with Tretinoin. |
| Triamcinolone | The metabolism of Vonoprazan can be increased when combined with Triamcinolone. |
| Triazolam | The metabolism of Vonoprazan can be decreased when combined with Triazolam. |
| Triclabendazole | The metabolism of Triclabendazole can be decreased when combined with Vonoprazan. |
| Trimethadione | The metabolism of Trimethadione can be decreased when combined with Vonoprazan. |
| Trimipramine | The metabolism of Trimipramine can be decreased when combined with Vonoprazan. |
| Troglitazone | The metabolism of Vonoprazan can be decreased when combined with Troglitazone. |
| Troleandomycin | The metabolism of Vonoprazan can be decreased when combined with Troleandomycin. |
| Tucatinib | The metabolism of Tucatinib can be decreased when combined with Vonoprazan. |
| Udenafil | The metabolism of Vonoprazan can be decreased when combined with Udenafil. |
| Vadadustat | The serum concentration of Vonoprazan can be increased when it is combined with Vadadustat. |
| Valbenazine | The metabolism of Valbenazine can be decreased when combined with Vonoprazan. |
| Valproic acid | The metabolism of Valproic acid can be decreased when combined with Vonoprazan. |
| Vardenafil | The metabolism of Vonoprazan can be decreased when combined with Vardenafil. |
| Venetoclax | The metabolism of Vonoprazan can be decreased when combined with Venetoclax. |
| Verapamil | The metabolism of Vonoprazan can be decreased when combined with Verapamil. |
| Vilazodone | The metabolism of Vilazodone can be decreased when combined with Vonoprazan. |
| Viloxazine | The metabolism of Vonoprazan can be decreased when combined with Viloxazine. |
| Vincristine | The metabolism of Vincristine can be decreased when combined with Vonoprazan. |
| Voriconazole | The metabolism of Vonoprazan can be decreased when combined with Voriconazole. |
| Vortioxetine | The metabolism of Vortioxetine can be decreased when combined with Vonoprazan. |
| Voxelotor | The metabolism of Voxelotor can be decreased when combined with Vonoprazan. |
| Zaleplon | The metabolism of Vonoprazan can be decreased when combined with Zaleplon. |
| Zimelidine | The metabolism of Vonoprazan can be decreased when combined with Zimelidine. |
| Ziprasidone | The metabolism of Vonoprazan can be decreased when combined with Ziprasidone. |
| Zolpidem | The metabolism of Zolpidem can be decreased when combined with Vonoprazan. |
| Zonisamide | The metabolism of Zonisamide can be decreased when combined with Vonoprazan. |
Pregnancy and Lactation
Pregnancy
Based on findings from animal studies and observational studies in pregnant women with the use of clarithromycin, the use of VOQUEZNA TRIPLE PAK is not recommended in pregnant women except in clinical circumstances where no alternative therapy is appropriate. There are no adequate and well-controlled studies of VOQUEZNA TRIPLE PAK in pregnant women to evaluate for drug-associated
risks of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. If VOQUEZNA TRIPLE PAK is used during pregnancy, advise pregnant women of the potential risk to a fetus. No reproductive and developmental toxicity studies with the combination of vonoprazan, amoxicillin, and/or clarithromycin were conducted.
VOQUEZNA DUAL PAK
There are no adequate and well-controlled studies of VOQUEZNA DUAL PAK in pregnant women to evaluate for drug-associated risks of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. Individual Components of VOQUEZNA TRIPLE PAK and VOQUEZNA DUAL PAK
Clarithromycin:
Published observational studies in pregnant women have demonstrated adverse effects on pregnancy outcomes, including an increased risk of miscarriage and in some studies an increased incidence of fetal malformations (see Data). In animal reproduction studies, administration of oral clarithromycin to pregnant mice, rats, rabbits, and monkeys during the period of organogenesis produced malformations in rats (cardiovascular anomalies) and mice (cleft palate) at clinically relevant doses. Fetal effects in mice, rats, and monkeys (e.g., reduced fetal survival, body weight, body weight gain) and implantation losses in rabbits were generally considered to be secondary to
maternal toxicity (see Data).
Vonoprazan:
Available data from pharmacovigilance reports with vonoprazan use in pregnant women are not sufficient to evaluate for a drug-associated risk for major birth defects, miscarriage, or other adverse maternal or fetal outcomes. In pregnant rats, no adverse effects were noted after oral administration of vonoprazan during organogenesis at approximately 27 times the maximum recommended human dose (MRHD) based
on AUC exposure comparisons. In a pre-and postnatal development (PPND) study, pups from dams orally administered vonoprazan
during organogenesis and through lactation, exhibited liver discoloration, which in follow-up mechanistic animal studies was associated with necrosis, fibrosis, and hemorrhage at a dose of approximately 22 times the MRHD based on AUC comparisons which were likely attributable to
exposure during lactation [see Use in Specific Populations (8.2)]. These effects were not observed at the next lower dose in this study, which was approximately equal to the MRHD based on AUC comparison, however, they were seen at clinically relevant exposures in dose range finding studies in
rats
Amoxicillin:
Available data from published epidemiologic studies and pharmacovigilance case reports over several decades with amoxicillin use have not established drug-associated risks of major birth defects, miscarriage, or adverse maternal or fetal outcomes. Reproduction studies with amoxicillin have been performed in mice and rats (5 and 10 times the human dose 2 g human dose for mice and rats, respectively, 3 and 6 times the 3 g human dose for mice and rats, respectively). There was no evidence of harm to the fetus due to amoxicillin. The estimated background risks of major birth defects and miscarriage for the indicated population are unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the US general population, the estimated background risk of major birth defects and
miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Report pregnancies to the Phathom Pharmaceuticals, Inc. Adverse Event reporting line at 1-800-775-
Clarithromycin:
Available data from prospective and retrospective observational studies with clarithromycin use in pregnant women demonstrate an increased risk of miscarriage. Data from these same studies regarding major congenital malformations are inconsistent, with some studies reporting an increased risk (atrioventricular septal defects, genital malformations, orofacial clefts) and others finding no
difference between those exposed to clarithromycin and those exposed to nonteratogenic controls. Available studies have methodologic limitations, including small sample size, under-capture of nonlive births, exposure misclassification and inconsistent comparator groups.
Lactation
No information is available on the clinical use of vonoprazan during breastfeeding. Because of liver damage that occurred in nursing rodents, the manufacturer recommends that nursing mothers should pump and discard human milk while taking and for 2 days after the last dose. An alternate drug may be preferred. Relevant published information was not found as of the revision date. Relevant published information was not found as of the revision date.
There are no data regarding the presence of vonoprazan in human milk, the effects on the breastfed infant or the effects on milk production. Vonoprazan and its metabolites are present in rat milk. The liver injury occurred in offspring from pregnant and lactating rats administered oral vonoprazan at AUC exposures approximately equal to and greater than the MRHD (see Data). When a drug is present in
animal milk, it is likely that the drug will be present in human milk. Because of the potential risk of adverse liver effects shown in animal studies with vonoprazan, a woman should pump and discard human milk for the duration of VOQUEZNA TRIPLE PAK or VOQUEZNA DUAL PAK therapy, and for 2 days after therapy ends, and feed her infant stored human milk (collected prior to therapy) or formula.
Based on data from a published lactation study, clarithromycin and its active metabolite 14-OH clarithromycin are present in human milk at less than 2% of the maternal weight-adjusted dose (see Data). In a separate observational study of lactating women exposed to clarithromycin, reported adverse effects on breastfed children (rash, diarrhea, loss of appetite, somnolence) were comparable to amoxicillin. No data are available to assess the effects of clarithromycin or 14-OH clarithromycin on milk production.
Toxicology
Overdose with vonoprazan has not been reported. No serious adverse reactions were observed during clinical studies in subjects given a single dose of 120 mg of vonoprazan. Vonoprazan is not removed from the circulation by hemodialysis. In case of overdose, the FDA label for Voquezna Triple Pak and Voquezna Dual Pak recommends symptomatic and supportive treatment. Animal studies evaluating vonoprazan mutagenicity (Ames test) have reported negative results. No effects on fertility and reproductive performance were observed in rats given 300 mg/kg/day of vonoprazan orally (133, the maximum recommended human dose). Mice given 6, 20, 60, and 200 mg/kg/day of vonoprazan orally (0.4, 4, 19, and 93 times the maximum recommended human dose) developed hyperplasia of neuroendocrine cells, gastropathy and benign and/or malignant neuroendocrine cell tumors (carcinoids) in the stomach.
Vonoprazan is metabolized by several cytochrome P450 (CYP) isoforms, mainly CYP3A4, and to a lesser extent CYP3A5, CYP2B6, CYP2C19, CYP2C9 and CYP2D6. Sulfo- and glucuronosyl-transferases also participate in the metabolism of vonoprazan, and all metabolites are pharmacologically inactive. CYP3A4 converts vonoprazan into metabolites M-I and M-II, which are then converted to glucuronic-acid-conjugated products M-I-G and M-II-G, respectively. Unlike proton pump inhibitors, the presence of CYP2C19 polymorphisms does not have a significant effect on the pharmacokinetics of vonoprazan.
How should this medicine be used?
Vonoprazan comes as a tablet, clarithromycin comes as a tablet, and amoxicillin comes as a capsule, all to be taken by mouth. These medications are usually taken with or without food twice a day, 12 hours apart, for 14 days. To help you take the right number of capsules and tablets at each dose, the medication is packaged in dosing cards. Each dosing card contains all of the medication needed for both daily doses. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take the medication exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Take vonoprazan, clarithromycin, and amoxicillin until you finish the prescription, even if you feel better. If you stop taking antibiotics too soon your infection may not be completely treated and the bacteria may become resistant to antibiotics. If your condition does not improve or gets worse, call your doctor. Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.
Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
What special precautions should I follow?
Before taking vonoprazan, clarithromycin, and amoxicillin,
- tell your doctor and pharmacist if you are allergic to vonoprazan; clarithromycin; amoxicillin (Amoxil, Larotid); penicillin antibiotics; cephalosporin antibiotics such as cefaclor, cefadroxil, cefdinir, cefixime (Suprax), cefpodoxime, cefprozil, cefuroxime, and cephalexin; other antibiotics such as azithromycin (Zithromax) or erythromycin (E.E.S., Ery-Tab, others); any other medications; or any of the ingredients in vonoprazan tablets, clarithromycin tablets, or amoxicillin capsules. Ask your pharmacist for a list of the ingredients.
- Some medications should not be taken with vonoprazan, clarithromycin, and amoxicillin. Make sure you have discussed any medications you are currently taking or plan to take before starting vonoprazan, clarithromycin, and amoxicillin with your doctor and pharmacist. Before starting, stopping or changing any medications while taking vonoprazan, clarithromycin, and amoxicillin, get the advice of your healthcare provider.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while taking vonoprazan, clarithromycin, and amoxicillin. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had jaundice (yellowing of the skin or eyes) or other liver problems while taking vonoprazan, clarithromycin, and amoxicillin. Your doctor will probably tell you not to take vonoprazan, clarithromycin, and amoxicillin.
- tell your doctor if you have or have ever had QT prolongation (an irregular heart rhythm that can lead to fainting, loss of consciousness, seizures, or sudden death) or an irregular heartbeat; low levels of potassium or magnesium in your blood; mononucleosis (a virus; also called ‘mono’); myasthenia gravis (a disease that causes muscle weakness); or kidney or liver disease.
- tell your doctor if you are pregnant or plan to become pregnant. If you become pregnant while taking vonoprazan, clarithromycin, and amoxicillin, call your doctor.
- tell your doctor if you are breastfeeding. You should not breastfeed while taking vonoprazan, clarithromycin, and amoxicillin and for 2 days after your final dose.
- you should know that vonoprazan, clarithromycin, and amoxicillin may make you dizzy, confused, or disoriented. Do not drive a car or operate machinery until you know how this medication affects you.
