Colin Howden, MD, discusses the mechanisms at work in vonoprazan as well as patient monitoring and potential future uses following a recent FDA approval for the treatment of erosive esophagitis.
Following the recent FDA approval for vonoprazan (Voquenza) in the treatment of gastroesophageal reflux disease, Colin Howden, MD, professor of medicine at the University of Tennessee Health Science Center, joined for an interview to discuss the inner workings of the drug, patient monitoring, and potential future uses.
Transcript
Can you explain the mechanism of action of vonoprazan and how it differs from other acid-blocking medications?
Vonoprazan belongs to a class of drugs called potassium-competitive acid blockers, often abbreviated P-CABs, and these are drugs that interact with the proton pump that hydrogen potassium ATPase to block the secretion of acid by parietal cells. P-CABS, including vonoprazan, bind in a non-covalent manner to the potassium-binding site of the proton pump, and they prevent the exchange of potassium ions for hydrogen ions. They work in a different mechanism from proton pump inhibitors because they're binding is ionic and non-covalent. Vonoprazan and other P-CABS do not require chemical conversion in the parietal cell before they are activated, unlike proton pump inhibitors. In comparison to proton pump inhibitors, vonoprazan starts to inhibit gastric acid secretion more rapidly and it produces a greater degree of suppression of gastric acidity that'll last for longer than conventional doses of proton pump inhibitors.
Are there steps health care providers should take to monitor and manage patients on vonoprazan therapy?
While there are no specific requirements or recommendations, if patients are receiving other drugs that may influence serum magnesium levels, notably diuretics, then there's a suggestion that they may want to check magnesium levels. But this is not a requirement.
Do you foresee any additional indications or developments for vonoprazan, or is it primarily intended for erosive esophagitis treatment?
Aside from erosive esophagitis, the Food and Drug Administration is also reviewing it for a possible indication of non-erosive reflux disease, sometimes referred to as NERD. As I said, that's currently under review by the Food and Drug Administration, and their decision will be offered by the middle of 2024.
This transcript has been lightly edited for clarity.
IgE Mediation in Pediatric Atopic Dermatitis, Concurrent Immune Disorders: Amy Paller, MD
August 4th 2025Amy Paller, MD, pediatric dermatologist and clinical researcher at Northwestern Medicine's Feinberg School of Medicine, discussed the potential impact of reducing immunoglobulin E (IgE) levels in pediatric patients with atopic dermatitis.
Read More
LLMs Show Promise, But Challenges Remain in Improving Inefficient Clinical Trial Screening
July 31st 2025Large language models (LLMs) such as GPT-3.5 and GPT-4 may offer a solution to the costly and inefficient process of manual clinical trial screening, which is often hindered by the inability of structured electronic health record data to capture all necessary criteria.
Read More
Trends in Insulin Out-of-Pocket Costs and Use Disparities, 2008-2021
July 31st 2025Given trends in cost and use, insulin out-of-pocket cost reduction policies would be more efficient if they targeted members in high-deductible health plans with savings options and low-income patients.
Read More