Vonoprazan: A Newer Acid Blocker for Reflux and Ulcers

Table of Contents

1. What Vonoprazan Is
2. How It Differs From a Proton Pump Inhibitor
3. From Japan to the United States
4. Erosive Esophagitis Trial Results
5. Heartburn Without Visible Damage
6. Night-Time Heartburn: The 2026 Meta-Analysis
7. Helicobacter pylori Eradication
8. Ulcers Linked to Low-Dose Aspirin
9. Side Effects Reported in Trials
10. Warnings on the United States Label
11. Drug Interactions on the Label
12. Gastrin and Long-Term Safety Questions
13. Clostridioides difficile: What the Studies Found
14. What Is Not Known
15. Key Research Papers
16. Connections
17. Featured Videos

What Vonoprazan Is

The lining of the stomach contains parietal cells, which pump acid into the stomach. The pump itself is an enzyme called the hydrogen-potassium pump (H⁺,K⁺-ATPase). It swaps a potassium ion for a hydrogen ion, and the hydrogen ions are what make stomach juice acidic. Both proton pump inhibitors and vonoprazan work by stopping this pump. The stomach acid animation shows how the pump works and why acid matters for digestion.

The United States label describes vonoprazan's action this way: it blocks the pump "in a potassium-competitive manner", binds to active pumps "in a noncovalent and reversible manner", and "does not require activation by acid". In plain terms, vonoprazan sits in the spot where potassium normally enters the pump, so the pump cannot complete its cycle. It does not form a permanent chemical bond with the pump, and it works as soon as it arrives.

A 2016 review of the drug's pharmacology describes vonoprazan as a base that collects in the acidic channels of the parietal cells, which helps explain why one 20 mg dose suppressed acid for longer than 24 hours. The same review gives its potency at about 350 times that of the proton pump inhibitor lansoprazole in laboratory tests of the enzyme. The drug reaches its highest blood level 1.5 to 2 hours after a dose, and its half-life (the time for the blood level to fall by half) is about 7.7 hours in healthy adults, figures the label also reports.

In the United States it is sold as a tablet on its own (10 mg and 20 mg) and in two co-packaged kits for H. pylori infection: vonoprazan co-packaged with amoxicillin, and vonoprazan co-packaged with amoxicillin and clarithromycin.

How It Differs From a Proton Pump Inhibitor

Reviews of the drug class list several limits of proton pump inhibitors: a short half-life, acid suppression that is not always complete, a slow start, and large differences between people caused by a liver enzyme called CYP2C19. A 2016 review states that potassium-competitive acid blockers show "almost complete inhibition of gastric acid secretion from the first dose". A 2022 review sums up the class as having "rapid onset of action, meal independence, and prolonged control of intragastric acidity compared to PPIs". The main differences that sources describe are these:

• Speed. The label states that after a single 10 mg or 20 mg dose, acid suppression measured by stomach pH begins within 2 to 3 hours. The pharmacology review reports stomach pH rising above 4 as early as 4 hours after a 20 mg dose. The effect still builds with daily doses: the label gives steady state by day 4, and the review reports the time spent above pH 4 rising from 63% of the day on day 1 to 83% on day 7 at 20 mg once daily.
• Meals. The label states the tablet may be taken with or without food. In its food study, a high-fat meal raised peak blood level by 5% and total exposure by 15% and delayed the peak by 2 hours, changes the label describes as not clinically significant.
• Genetics. Many proton pump inhibitors are broken down mainly by CYP2C19, and people who carry fast or slow versions of that enzyme get very different acid control. Vonoprazan is broken down by several enzymes, mostly CYP3A4. The label states there were "no clinically meaningful differences" in vonoprazan's blood levels by CYP2C19 or CYP2D6 type. In a 2016 crossover study of 28 healthy Japanese volunteers, vonoprazan 20 mg twice daily kept stomach pH at 4 or higher for 100% of the day, against 91% for esomeprazole 20 mg twice daily, and esomeprazole once daily varied by CYP2C19 type while vonoprazan did not.
• Reversibility. The label states that intragastric pH stayed raised for 24 to 48 hours after the last dose on day 7, then fell back.

Stronger acid suppression is the reason for the drug's use and also the reason for some of its safety questions, because the body answers low acid by making more of the hormone gastrin (see Gastrin and Long-Term Safety Questions).

From Japan to the United States

Vonoprazan was developed in Japan. A 2016 review states it was approved there in 2014, and a 2016 pharmacology review states it has been on the market in Japan since February 2015. An integrated safety analysis dates its commercial start in Japan to 26 December 2014. In Japan its listed uses at the time included stomach and duodenal ulcers, reflux esophagitis and its prevention, prevention of ulcers in people taking low-dose aspirin or other anti-inflammatory painkillers, and H. pylori eradication with clarithromycin and amoxicillin.

Vonoprazan was not the first potassium-competitive acid blocker. The 2016 review notes that many companies tried to develop drugs of this kind, that most projects were stopped "due to safety concerns or a similar efficacy to PPIs", and that revaprazan, developed in Korea, was the first approved for sale. Other members of the class studied in trials include tegoprazan and fexuprazan.

The United States approvals, from the Food and Drug Administration (FDA) approval letters and the current label, came in three steps:

• 3 May 2022. The two H. pylori kits: vonoprazan co-packaged with amoxicillin, and vonoprazan co-packaged with amoxicillin and clarithromycin. The label gives "Initial U.S. Approval: 2022".
• 1 November 2023. Vonoprazan tablets on their own, for healing all grades of erosive esophagitis and relieving its heartburn, for maintaining that healing, and for use with the antibiotics against H. pylori. The letter refers to an earlier FDA action letter dated 7 February 2023, to which the company responded in May 2023.
• 17 July 2024. A 10 mg tablet for relief of heartburn in non-erosive gastroesophageal reflux disease in adults.

All the United States uses are for adults. The approval letters note that studies in children were waived for some ages and deferred for others.

Erosive Esophagitis Trial Results

Erosive esophagitis means that acid reflux has worn visible sores (erosions) in the lining of the esophagus, seen on an endoscopy. Doctors grade it from A (mild) to D (severe) using the Los Angeles classification. The gastroesophageal reflux disease page covers the condition itself.

The United States and European trial

The trial behind the United States approval (Laine and colleagues, 2023) enrolled 1,024 adults with erosive esophagitis. They received vonoprazan 20 mg or lansoprazole 30 mg once daily for up to 8 weeks. The label adds that 66% had mild disease (grades A or B) and 34% had moderate to severe disease (grades C or D).

• Healing by week 8: 92.9% on vonoprazan against 84.6% on lansoprazole, a difference of 8.3 percentage points. Vonoprazan met the main test of being no worse (non-inferior) and was better in a prespecified exploratory analysis.
• Severe grades C and D at week 2: healing was 17.6 points higher with vonoprazan.
• Heartburn-free days: no clear difference (2.7 points, with a confidence range from −1.6 to 7.0).
• Keeping it healed: 878 healed patients were re-randomised to vonoprazan 10 mg, vonoprazan 20 mg or lansoprazole 15 mg for 24 weeks. Both vonoprazan doses kept more people healed (8.7 points higher for 20 mg and 7.2 points for 10 mg), and the gap was larger in grades C and D (15.7 and 13.3 points).

The authors concluded that the benefit "was seen predominantly in more severe erosive esophagitis". In other words, for mild erosions both drugs healed most people, and the advantage of vonoprazan showed mostly in the worse cases.

Earlier Japanese trials

The first large Japanese trial (Ashida and colleagues, 2016) compared vonoprazan 20 mg with lansoprazole 30 mg in 409 patients. Healing by week 8 was 99.0% (203 of 205) against 95.5% (190 of 199). In a 52-week maintenance extension of 305 patients, fewer than 10% had their erosions come back on vonoprazan 10 mg or 20 mg.

The label states the doses the trials supported: 20 mg once daily for 8 weeks to heal erosive esophagitis, and 10 mg once daily for up to 6 months to keep it healed, with lower doses for people with severe kidney impairment or moderate to severe liver impairment during healing.

Heartburn Without Visible Damage

Many people with frequent heartburn have a normal-looking esophagus on endoscopy. This is called non-erosive reflux disease. The reflux and heartburn page describes the symptom and its many causes.

A United States trial (Laine and colleagues, 2024) enrolled 772 adults who had heartburn on at least 4 days a week and no erosions. For 4 weeks they received placebo, vonoprazan 10 mg or vonoprazan 20 mg. The main measure was the share of days with no daytime or night-time heartburn:

• Placebo: 27.7% of days heartburn-free.
• Vonoprazan 10 mg: 44.8%.
• Vonoprazan 20 mg: 44.4%.

The difference from placebo was about 17 percentage points for both doses, and the two doses worked about equally well. More people on vonoprazan had a full heartburn-free day from day 1 (8.3 and 11.6 points above placebo) and day 2 (18.1 and 23.2 points). In the 20-week extension, when everyone took vonoprazan, the average share of heartburn-free days was 61% to 63% in every group.

Put another way, heartburn did not vanish for most people: in the first 4 weeks, people on vonoprazan still had heartburn on more than half of days. The label gives 10 mg once daily for 4 weeks for this use. The trial compared vonoprazan with placebo, not with a proton pump inhibitor, so it does not show whether vonoprazan does better than standard treatment for non-erosive disease.

Night-Time Heartburn: The 2026 Meta-Analysis

Heartburn at night disturbs sleep and is a common reason people stay unhappy on a proton pump inhibitor. A 2026 systematic review and meta-analysis (Koo and Fass) gathered randomised trials comparing any potassium-competitive acid blocker (vonoprazan, tegoprazan or fexuprazan) with a proton pump inhibitor or placebo for night-time symptoms in adults with reflux disease, searching up to August 2024.

• Only three trials met the criteria.
• People on a potassium-competitive acid blocker were more than twice as likely to have complete resolution of night-time heartburn as people on a proton pump inhibitor (risk ratio 2.29, 95% confidence interval 1.36 to 3.87).
• The risk of side effects did not differ significantly (risk ratio 0.88, 95% confidence interval 0.53 to 1.45).

The authors wrote that the class "may provide better nighttime heartburn resolution than PPIs". The finding rests on three trials and covers the whole drug class, not vonoprazan alone. The paper's conflict-of-interest statement lists advisory and speaker roles for one author with several companies that make acid-suppressing drugs.

Helicobacter pylori Eradication

H. pylori is a bacterium that lives in the stomach lining and is the main known cause of stomach ulcers. Standard treatment regimens pair antibiotics with an acid blocker. The H. pylori treatment overview and triple and quadruple therapy page describe the full range of regimens.

The United States and European trial

A phase 3 trial (Chey and colleagues, 2022) randomised 1,046 adults with untreated H. pylori infection to one of three 14-day regimens:

• Vonoprazan dual therapy: the trial gave vonoprazan 20 mg twice daily with amoxicillin 1 g three times daily.
• Vonoprazan triple therapy: the trial gave vonoprazan 20 mg, amoxicillin 1 g and clarithromycin 500 mg, each twice daily.
• Standard triple therapy: the same, with lansoprazole 30 mg in place of vonoprazan.

The results, as the abstract reports them:

• Strains not resistant to clarithromycin or amoxicillin: 84.7% cured with vonoprazan triple therapy, 78.5% with dual therapy and 78.8% with lansoprazole triple therapy. Both vonoprazan regimens met the test of being no worse.
• Clarithromycin-resistant strains: 65.8% with vonoprazan triple therapy, 69.6% with dual therapy and 31.9% with lansoprazole triple therapy.
• All patients: 80.8%, 77.2% and 68.5%.
• The overall rate of side effects was similar between the vonoprazan and lansoprazole regimens.

The largest gap was in clarithromycin-resistant infections, where standard triple therapy cured fewer than one person in three. The dual regimen contains no clarithromycin at all, which matters where clarithromycin resistance is common. The label lists the same two regimens and doses.

Meta-analyses

A 2024 meta-analysis (Benito, Nyssen and Gisbert) pooled 77 studies, 24 of them randomised trials, covering 44,162 patients. Overall, vonoprazan regimens cured 88% of infections: 86% for dual, 88% for triple and 94% for quadruple regimens. In people treated for the first time, vonoprazan regimens cured 87% against 70% for proton pump inhibitor regimens. In clarithromycin-resistant infections the figures were 76% against 40%. The authors found no clear advantage in rescue treatment after an earlier failure, in clarithromycin-sensitive infections, or with quadruple regimens. Side effects were reported in 19% of people on vonoprazan regimens, which the authors judged comparable to proton pump inhibitor regimens.

A 2024 network meta-analysis of 21 randomised trials and 5,481 patients (Huang and colleagues) ranked 14-day and 10-day vonoprazan-based quadruple regimens highest for cure and reported all the regimens studied as well tolerated.

Ulcers Linked to Low-Dose Aspirin

People who take low-dose aspirin every day for the heart and who have had an ulcer before are at risk of the ulcer coming back. A Japanese phase 3 trial (Kawai and colleagues, 2018) enrolled 621 such patients at 104 sites and gave them lansoprazole 15 mg, vonoprazan 10 mg or vonoprazan 20 mg once daily for 24 weeks.

• Ulcers came back in 2.8% on lansoprazole, 0.5% on vonoprazan 10 mg and 1.5% on vonoprazan 20 mg. Vonoprazan met the test of being no worse.
• In an extension of up to 2 years (439 patients), a later analysis found fewer recurrences on vonoprazan 10 mg than on lansoprazole, but not on 20 mg.
• Bleeding from the digestive tract was more frequent on lansoprazole than on either vonoprazan dose.

This use is part of vonoprazan's Japanese approvals; it is not among the uses on the United States label. The peptic ulcer disease page covers ulcers and their causes.

Side Effects Reported in Trials

In the United States erosive esophagitis trial, the label lists the side effects reported in at least 2% of people on vonoprazan 20 mg during healing. The rates were small and close to those on lansoprazole:

• Gastritis (stomach lining irritation): 3% on vonoprazan, 2% on lansoprazole.
• Diarrhoea: 2% against 3%.
• Bloating (abdominal distension), abdominal pain and nausea: 2% each against 1%.

During the 24-week maintenance phase on vonoprazan 10 mg, the label lists gastritis (6% against 3%), abdominal pain (4% against 2%), indigestion (4% against 3%), raised blood pressure (3% against 2%) and urinary tract infection (3% against 2%). In the non-erosive reflux trial, abdominal pain, constipation, diarrhoea, nausea and urinary tract infection each affected about 2%.

In the H. pylori trials, the label reports diarrhoea in 5% on vonoprazan dual therapy, 4% on vonoprazan triple therapy and 10% on lansoprazole triple therapy, and a changed sense of taste in 1%, 5% and 6%. Between 0.9% and 2.3% of people in the three groups stopped treatment because of a side effect.

A 2025 integrated analysis (Howden and colleagues) pooled 14 trials from several countries, with 5,318 people on vonoprazan. The only side effect reported by at least 5% was nasopharyngitis (a common cold): 6.94% on vonoprazan, 5.07% on proton pump inhibitors and 4.49% on placebo. Serious adverse events occurred at 10.39 per 100 person-years on vonoprazan and 10.65 on proton pump inhibitors. One person on vonoprazan and one on lansoprazole were diagnosed with stomach cancer. Raised liver enzymes were uncommon and no more frequent than on proton pump inhibitors. Several of the authors were employees of, or consultants to, the companies that make and sell the drug.

The label also lists rarer reactions reported after marketing, where the number of people taking the drug is not known: anaphylactic shock, liver injury including liver failure and jaundice, low platelet counts, low magnesium, potassium and calcium, vitamin B12 deficiency, and serious skin reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis.

Warnings on the United States Label

Most of vonoprazan's label warnings are the same ones that appear on proton pump inhibitor labels, because they come from strong acid suppression itself. The label lists:

• Hidden stomach cancer. Relief of symptoms "does not preclude the presence of gastric malignancy". The label describes further testing, including endoscopy in older patients, when the response is poor or symptoms return early.
• Acute tubulointerstitial nephritis. An inflammation of the kidneys that has been reported with vonoprazan.
• Clostridioides difficile diarrhoea. The label notes that observational studies link proton pump inhibitors to this gut infection, especially in hospital, and that vonoprazan "may also increase the risk".
• Bone fracture. Observational studies link long-term, high-dose proton pump inhibitor use (a year or longer) to fractures of the hip, wrist or spine, and the label states that fracture "has also been reported with vonoprazan".
• Severe skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis.
• Vitamin B12 deficiency with long-term use, because acid helps free vitamin B12 from food.
• Low magnesium, which can in turn lower calcium and potassium. The label describes checking magnesium in people on long treatment or on drugs such as digoxin or diuretics.
• False results on a tumour test. Low acid raises chromogranin A, a blood marker used to look for neuroendocrine tumours, which can give a false positive.

Two contraindications are listed: a known allergy to vonoprazan, and use with medicines that contain rilpivirine, an HIV drug.

On pregnancy, the label states there are no adequate studies in pregnant women. In rats, pups exposed through their mothers' milk developed liver damage. In a study of 15 nursing women, the amount of vonoprazan in breast milk was less than 0.03% of the mother's dose, and the label states there are no data on effects in breastfed babies.

Drug Interactions on the Label

Vonoprazan affects other drugs in two ways: it lowers stomach acid, which some drugs need in order to be absorbed, and it slows two liver enzymes that break down other drugs.

• HIV medicines. Rilpivirine-containing products are contraindicated with vonoprazan. The label also advises against combining it with atazanavir or nelfinavir, which need acid to be absorbed.
• Other drugs that need acid, such as iron salts, erlotinib, dasatinib, nilotinib, mycophenolate mofetil, ketoconazole and itraconazole, may be absorbed less well.
• Clopidogrel. Vonoprazan slows CYP2C19, the enzyme that turns clopidogrel into its active form. The label states that this may lower clopidogrel's anti-platelet effect.
• Citalopram and cilostazol. Blood levels of these drugs may rise for the same reason.
• Drugs broken down by CYP3A4. Vonoprazan is a weak inhibitor of this enzyme, and the label singles out drugs for which small changes in blood level can cause serious toxicity.
• Clarithromycin. In the H. pylori kits, clarithromycin brings its own long list of interactions, including some that can cause dangerous heart rhythms. The pharmacology review reports that when the two were given together, the blood levels of vonoprazan and of clarithromycin rose 1.8-fold and 1.5-fold.

Gastrin and Long-Term Safety Questions

When stomach acid falls, the stomach releases more gastrin, a hormone that tells parietal cells to make acid. Gastrin also makes certain stomach cells, the enterochromaffin-like (ECL) cells, grow. This is the background to the main long-term question about every strong acid blocker. The pharmacology review reports that vonoprazan raised gastrin levels two to three times higher than lansoprazole did.

What happened in animals

The label reports that in two-year studies in mice and rats, vonoprazan caused overgrowth of neuroendocrine cells and benign or malignant neuroendocrine tumours (carcinoids) in the stomach. In rats this happened at the lowest dose tested, about 0.6 times human exposure. Liver tumours also appeared at higher doses in both species. The label notes that similar stomach carcinoids have been seen in rats given long-term proton pump inhibitors or high-dose H2 blockers, and calls the finding "a rodent-specific phenomenon".

What happened in people over five years

The VISION study (Uemura and colleagues, 2025) was set up in Japan to look for these changes in people. Patients with healed erosive esophagitis took vonoprazan 10 mg (139 people) or lansoprazole 15 mg (69 people) once daily for 260 weeks, about five years, with stomach biopsies along the way.

• No cancerous changes and no stomach neuroendocrine tumours were found in either group. There was one adenoma (a benign growth) in each group.
• Median gastrin was 625 pg/mL on vonoprazan against 200 pg/mL on lansoprazole.
• At five years, parietal cell overgrowth was found in 97.1% against 86.5%, and foveolar overgrowth (thickening of the surface lining) in 14.7% against 1.9%.
• ECL cell overgrowth was similar: 4.9% against 7.7%.

The authors described the study as exploratory. It was open-label and small, and it lasted five years.

Gastrin in everyday use

A Japanese study of 48 people on vonoprazan 10 mg a day for more than a year (Shinozaki and colleagues, 2022) found a median gastrin of 100 pg/mL before treatment and 700 to 1,200 pg/mL during it, against a laboratory reference range of 37 to 172 pg/mL. Levels levelled off at about 1.5 years and did not keep climbing over four years. They were higher in people with severe thinning of the stomach lining (atrophy). The label and the integrated safety analysis both report that gastrin returned to normal within 4 weeks of stopping.

Clostridioides difficile: What the Studies Found

Clostridioides difficile (C. difficile) is a gut bacterium that can cause severe diarrhoea, often after antibiotics and in hospital. Acid blockers have been linked to it in observational studies. Because vonoprazan lowers acid more, researchers have asked whether the link is stronger. The studies so far point in different directions:

• A Japanese national hospital database (Watanabe and colleagues, 2021) compared 4,466 cases with 13,220 controls. Both proton pump inhibitors (odds ratio 1.3) and vonoprazan (1.4) were linked to C. difficile, and vonoprazan was not more strongly linked than proton pump inhibitors (1.07, with a range from 0.91 to 1.26).
• A single Japanese hospital (Saruta and colleagues, 2023) followed 25,821 patients and found 91 hospital-onset cases. Both drug types were linked to infection (odds ratios 3.15 and 2.63) to a comparable degree.
• Two adverse-event reporting databases, Japan's and the FDA's (Ouyang and colleagues, 2024), showed a much stronger reporting signal for vonoprazan than for proton pump inhibitors (reporting odds ratios 15.84 against 2.51 in Japan and 11.50 against 1.42 in the United States). The authors state that this kind of analysis "could not establish causality".

The two studies that compared actual patients found a similar link for both drug types. The reporting databases showed a stronger signal, but such databases count reports, not risk. In the H. pylori kits, vonoprazan is taken together with antibiotics, which carry a C. difficile risk of their own.

What Is Not Known

• Very long-term use. The longest controlled study in people, VISION, lasted five years and followed 139 people on vonoprazan. Whether decades of high gastrin matter in humans is not known. The United States label lists maintenance for up to 6 months.
• Populations outside Japan. Much of the long-term data comes from Japan, where the drug has been sold the longest. The longer United States and European trials ran for 24 weeks.
• Head-to-head comparison in non-erosive reflux. The United States trial compared vonoprazan with placebo, not with a proton pump inhibitor.
• Mild disease. In erosive esophagitis the advantage over lansoprazole was seen mainly in severe grades C and D.
• Children and pregnancy. The United States approvals cover adults only, and the label states there are no adequate studies in pregnant women.
• Who funded the evidence. The main trials and the integrated safety analysis list employees of, or consultants to, the companies that make and sell vonoprazan among their authors. Independent long-term studies are fewer.
• Cost and access. The sources used for this page do not report prices or insurance coverage, so this page does not compare costs.

Decisions about acid-lowering medicines belong with a clinician who knows the person's history and other medicines.

Key Research Papers

1. Laine L, DeVault K, Katz P, Mitev S, Lowe J, Hunt B, Spechler S. Vonoprazan Versus Lansoprazole for Healing and Maintenance of Healing of Erosive Esophagitis: A Randomized Trial. Gastroenterology. 2023;164(1):61-71. PubMed PMID: 36228734
2. Laine L, Spechler S, Yadlapati R, Schnoll-Sussman F, Smith N, Leifke E, Harris T, Hunt B, Fass R, Katz P. Vonoprazan is Efficacious for Treatment of Heartburn in Non-erosive Reflux Disease: A Randomized Trial. Clin Gastroenterol Hepatol. 2024;22(11):2211-2220.e10. PubMed PMID: 38750866
3. Koo TH, Fass R. A systematic review and meta-analysis of randomized controlled trials: the effect of potassium-competitive acid blockers on nighttime symptoms of gastroesophageal reflux disease. Esophagus. 2026;23(2):275-291. PubMed PMID: 41524830
4. Chey WD, Mégraud F, Laine L, López LJ, Hunt BJ, Howden CW. Vonoprazan Triple and Dual Therapy for Helicobacter pylori Infection in the United States and Europe: Randomized Clinical Trial. Gastroenterology. 2022;163(3):608-619. PubMed PMID: 35679950
5. Benito BM, Nyssen OP, Gisbert JP. Efficacy and Safety of Vonoprazan in Dual/Triple/Quadruple Regimens Both in First-Line and Rescue Therapy for Helicobacter pylori Eradication: A Systematic Review With Meta-Analysis. Helicobacter. 2024;29(6):e13148. PubMed PMID: 39533409
6. Huang S, Li B, Pang XY, Gao WW. Efficacy and safety of Vonoprazan-based treatment of Helicobacter pylori infection: a systematic review and network meta-analysis. BMC Infect Dis. 2024;24(1):953. PubMed PMID: 39261752
7. Echizen H. The First-in-Class Potassium-Competitive Acid Blocker, Vonoprazan Fumarate: Pharmacokinetic and Pharmacodynamic Considerations. Clin Pharmacokinet. 2016;55(4):409-18. PubMed PMID: 26369775
8. Inatomi N, Matsukawa J, Sakurai Y, Otake K. Potassium-competitive acid blockers: Advanced therapeutic option for acid-related diseases. Pharmacol Ther. 2016;168:12-22. PubMed PMID: 27514776
9. Choi YJ. [Treatment of Acid-related Diseases Using Potassium-competitive Acid Blockers]. Korean J Gastroenterol. 2022;80(6):247-253. PubMed PMID: 36567437
10. Kagami T, Sahara S, Ichikawa H, Uotani T, Yamade M, Sugimoto M, Hamaya Y, Iwaizumi M, Osawa S, Sugimoto K, Miyajima H, Furuta T. Potent acid inhibition by vonoprazan in comparison with esomeprazole, with reference to CYP2C19 genotype. Aliment Pharmacol Ther. 2016;43(10):1048-59. PubMed PMID: 26991399
11. Ashida K, Sakurai Y, Hori T, Kudou K, Nishimura A, Hiramatsu N, Umegaki E, Iwakiri K. Randomised clinical trial: vonoprazan, a novel potassium-competitive acid blocker, vs. lansoprazole for the healing of erosive oesophagitis. Aliment Pharmacol Ther. 2016;43(2):240-51. PubMed PMID: 26559637
12. Kawai T, Oda K, Funao N, Nishimura A, Matsumoto Y, Mizokami Y, Ashida K, Sugano K. Vonoprazan prevents low-dose aspirin-associated ulcer recurrence: randomised phase 3 study. Gut. 2018;67(6):1033-1041. PubMed PMID: 29196436
13. Howden CW, Katz P, DeVault KR, Metz DC, Tamene D, Smith N, Hunt B, Chang YM, Spechler SJ. Integrated Analysis of Vonoprazan Safety for Symptomatic Gastro-Oesophageal Reflux Disease or Erosive Oesophagitis. Aliment Pharmacol Ther. 2025;61(5):835-851. PubMed PMID: 39720884
14. Uemura N, Kinoshita Y, Haruma K, Kushima R, Yao T, Akiyama J, Aoyama N, Baba Y, Suzuki C, Ishiguro K. Vonoprazan as a Long-term Maintenance Treatment for Erosive Esophagitis: VISION, a 5-Year, Randomized, Open-label Study. Clin Gastroenterol Hepatol. 2025;23(5):748-757.e5. PubMed PMID: 39209187
15. Shinozaki S, Osawa H, Miura Y, Hayashi Y, Sakamoto H, Yano T, Lefor AK, Yamamoto H. Long-term changes in serum gastrin levels during standard dose vonoprazan therapy. Scand J Gastroenterol. 2022;57(12):1412-1416. PubMed PMID: 35830502
16. Watanabe K, Shimodaira Y, Takahashi S, Fukuda S, Koizumi S, Matsuhashi T, Iijima K. Potent Acid Suppression With Vonoprazan vs Proton Pump Inhibitors Does Not Have Higher Association With Clostridioides difficile Infection. Am J Gastroenterol. 2021;116(8):1632-1637. PubMed PMID: 33989224
17. Saruta Y, Watanabe K, Tsuji T, Takahashi Y, Matsuzawa H, Yoshida T, Takahashi S, Shimodaira Y, Matsuhashi T, Iijima K. Vonoprazan poses no additional risk of developing Clostridioides difficile infection compared to proton pump inhibitors. J Gastroenterol Hepatol. 2023;38(6):940-947. PubMed PMID: 36882162
18. Ouyang M, Zou S, Cheng Q, Shi X, Zhao Y, Sun M. Vonoprazan-associated Clostridioides difficile infection: an analysis of the Japanese Adverse Drug Event Report and the FDA Adverse Event Reporting System. Ther Adv Drug Saf. 2024;15:20420986241260211. PubMed PMID: 39091466

PubMed Topic Searches

1. PubMed: vonoprazan and erosive esophagitis
2. PubMed: vonoprazan and Helicobacter pylori
3. PubMed: vonoprazan and gastrin
4. PubMed: potassium-competitive acid blockers

Other Sources

1. DailyMed: vonoprazan fumarate tablets, prescribing label (United States National Library of Medicine)
2. DailyMed: vonoprazan co-packaged with amoxicillin, and with amoxicillin and clarithromycin, prescribing label (United States National Library of Medicine)
3. FDA approval letter, vonoprazan tablets for erosive esophagitis and H. pylori, 1 November 2023 (NDA 215151)
4. FDA approval letter, vonoprazan 10 mg for heartburn in non-erosive reflux disease, 17 July 2024 (NDA 218710)

Connections

• Drugs — every drug page on the site
• Gastroesophageal Reflux Disease (GERD) — the condition behind most of vonoprazan's uses
• Reflux and Heartburn — the symptom and its causes
• Peptic Ulcer Disease — stomach and duodenal ulcers
• H. pylori Treatment and Eradication — overview of every regimen
• Triple and Quadruple Antibiotic Therapy — where vonoprazan regimens fit
• H. pylori (Helicobacter pylori) — the bacterium itself
• Stomach Acid, pH and the Proton Pump Inhibitor Trade-off — animation of the acid pump

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