Vonoprazan: Brands, Price & Uses in Bangladesh

Vonoprazan is a potassium-competitive acid blocker (P-CAB) indicated for the following uses:

Established / Approved Indications

• Healing of erosive esophagitis (EE): Vonoprazan is indicated for the healing of all grades of erosive esophagitis and relief of associated heartburn in adults.
• Maintenance of healed erosive esophagitis: Vonoprazan is indicated to maintain healing of erosive esophagitis and relief of heartburn for up to 6 months.
• Relief of heartburn associated with non-erosive gastroesophageal reflux disease (GERD): short-term (4-week) use for symptomatic relief.
• Helicobacter pylori (H. pylori) eradication: Vonoprazan is indicated in combination with antibiotics, as part of a triple therapy (with amoxicillin and clarithromycin) or dual therapy (with amoxicillin) regimen, to eradicate H. pylori infection. Vonoprazan is not used alone for this purpose.

Other Uses

• Peptic ulcer disease: Vonoprazan, as a potent acid suppressant, is used in the management of gastric and duodenal ulcers, including as part of H. pylori eradication regimens for ulcer-associated infection, in line with emerging clinical practice and guideline discussion, though this use may vary by local regulatory labeling.

Vonoprazan belongs to a newer drug class (P-CABs) that is distinct from proton pump inhibitors (PPIs), though it is used for overlapping acid-related indications.

Adult Dosing by Indication

Administration

Vonoprazan tablets should be swallowed whole and may be taken with or without food, generally at approximately the same time each day. When used for H. pylori eradication, Vonoprazan must always be taken together with the prescribed antibiotic(s) as a complete combination regimen — see Precautions and Warnings regarding treatment adherence.

Renal Impairment

No dose adjustment is needed for mild-to-moderate renal impairment. In severe renal impairment (GFR <30 mL/min), the erosive esophagitis dose should be reduced to 10 mg once daily; Vonoprazan-based H. pylori eradication regimens are not recommended in patients with severe renal impairment.

Hepatic Impairment

No dose adjustment is needed in mild hepatic impairment (Child-Pugh Class A). In moderate-to-severe hepatic impairment (Child-Pugh Class B or C), the erosive esophagitis dose should be reduced to 10 mg once daily, and Vonoprazan-based H. pylori eradication regimens are not recommended.

Vonoprazan is generally well tolerated. Reported adverse effects include:

Common

• Diarrhea
• Nausea and indigestion (dyspepsia)
• Abdominal pain and bloating
• Headache
• Elevated blood pressure
• Urinary tract infection

Less Common but Clinically Important

• Fundic gland polyps, particularly with long-term use beyond 1 year (see Precautions and Warnings)
• Low magnesium levels (hypomagnesemia) with prolonged use
• Vitamin B12 deficiency with long-term use
• Severe cutaneous adverse reactions (e.g., rash, in rare cases severe skin reactions)
• Acute interstitial nephritis (kidney inflammation) — rare

Patients should seek prompt medical attention for signs of severe allergic reaction, unexplained rash, severe or persistent diarrhea, muscle spasms, seizures, or unusual fatigue/weakness.