Voquezna, also known by its active ingredient vonoprazan, is a prescription medication used to treat conditions caused by excess stomach acid, including erosive esophagitis (severe acid reflux) and H. pylori bacterial infections. As a potassium-competitive acid blocker (PCAB), it works differently than traditional proton pump inhibitors (PPIs). While it offers a new treatment option, it is important for patients and healthcare providers to understand the potential side effects, which can vary from common and mild to more serious and long-term concerns.
Common Side Effects of Voquezna
Like all medications, Voquezna has common side effects that are typically mild and may resolve as the body adjusts. These side effects can differ slightly depending on the condition being treated.
- Gastrointestinal issues: The most frequently reported side effects in clinical trials include gastritis (stomach inflammation), abdominal pain, nausea, bloating, indigestion, diarrhea, and constipation. When used with antibiotics for H. pylori, diarrhea is also a very common side effect.
- Headache: Headaches were reported by some patients during clinical trials, especially when Voquezna was used in combination with antibiotics.
- High Blood Pressure: Hypertension has been observed as a side effect, particularly in patients on longer-term maintenance therapy for erosive esophagitis.
- Infections: Some patients have reported minor infections, such as a cold, urinary tract infections (UTIs), and vaginal yeast infections.
- Altered Taste: A temporary change in the sense of taste, or dysgeusia, can occur, especially during treatment for H. pylori.
Serious and Rare Side Effects
Though less common, Voquezna can cause serious side effects that require immediate medical attention.
- Clostridioides difficile-associated diarrhea (C. diff): This infection can lead to severe, watery stools, persistent fever, and stomach cramps. The risk is particularly relevant when Voquezna is taken with antibiotics.
- Acute Tubulointerstitial Nephritis (TIN): This is a type of acute kidney inflammation that can manifest as swelling in the legs, fatigue, or changes in urination.
- Severe Cutaneous Adverse Reactions (SCAR): In rare cases, Voquezna can trigger severe skin reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). These can be life-threatening and start with fever, flu-like symptoms, and a painful rash that may blister or peel.
- Masking Gastric Malignancy: As with other acid-suppressing drugs, Voquezna may mask the symptoms of stomach cancer. Patients with persistent or worsening symptoms after treatment may need additional diagnostic testing.
- Allergic reactions: Serious hypersensitivity reactions are possible, including anaphylactic shock. Symptoms like trouble breathing, rash, itching, and swelling of the face, lips, or throat necessitate immediate medical help.
Long-Term Risks Associated with Voquezna
Some side effects are linked to long-term use (typically more than one year) and involve mineral deficiencies and physical changes in the stomach.
- Low Magnesium and Calcium Levels: Long-term use can lead to hypomagnesemia (low magnesium), which can cause seizures, muscle weakness, and irregular heartbeat. This can also affect calcium levels. Monitoring is advised for patients on prolonged therapy.
- Low Vitamin B12 Levels: Reduced stomach acid can inhibit the absorption of vitamin B12. Symptoms of a deficiency can include irregular heartbeat, muscle weakness, and mood changes.
- Fundic Gland Polyps: Small growths called fundic gland polyps can develop in the stomach with prolonged use. These are usually benign and asymptomatic but are typically discovered incidentally during an endoscopy.
- Bone Fractures: Like PPIs, long-term use of Voquezna may be associated with an increased risk of hip, wrist, or spine fractures.
Drug Interactions and Contraindications
Voquezna has important drug interactions that must be considered before treatment begins. Its impact on gastric acidity and certain liver enzymes can affect how other medications are absorbed and processed.
- HIV medications: Voquezna is contraindicated with rilpivirine-containing products, as it can make rilpivirine less effective. It should also be avoided with atazanavir and nelfinavir.
- Other drugs: Voquezna may reduce the absorption and effectiveness of drugs that require stomach acid, such as certain antifungals (itraconazole, ketoconazole) and certain cancer drugs (erlotinib).
- Impact on Enzymes: As a weak inhibitor of CYP2C19, Voquezna can increase the concentration of drugs like citalopram or decrease the effectiveness of others like clopidogrel. It also interacts with drugs metabolized by CYP3A4.
- Diagnostic Test Interference: Voquezna can interfere with blood tests for neuroendocrine tumors by increasing serum chromogranin A (CgA) levels, leading to false-positive results. The medication should be stopped prior to these tests.
Comparison Table: Voquezna vs. Traditional PPIs
| Feature | Voquezna (vonoprazan) | Traditional PPIs (e.g., lansoprazole) |
|---|---|---|
| Mechanism | Potassium-competitive acid blocker (PCAB) | Proton pump inhibitor (irreversible) |
| Onset of Action | Works faster and provides longer-lasting acid suppression | Slower onset, may require several days for full effect |
| Food Requirement | Can be taken with or without food | Typically requires taking on an empty stomach |
| Common Side Effects | Diarrhea, abdominal pain, nausea, headache, high blood pressure | Diarrhea, nausea, headache, abdominal pain |
| Long-Term Risks | Bone fracture, low B12, low magnesium, fundic gland polyps | Bone fracture, low B12, low magnesium, fundic gland polyps |
Safety Considerations for Special Populations
Special precautions are necessary for certain groups to ensure safe use of Voquezna.
- Pregnancy and Breastfeeding: Limited data exists on use during pregnancy and it is not known if the drug passes into breast milk. Breastfeeding is not recommended during treatment.
- Liver or Kidney Problems: Patients with moderate to severe liver or kidney impairment may require a lower dose, and in some cases, use is not recommended.
- Individuals at Risk of Mineral Deficiency: Those with pre-existing low magnesium, calcium, or potassium, or those taking diuretics, should be monitored.
Conclusion
While Voquezna offers a promising alternative to traditional acid-suppressing medications, it is not without potential side effects. The majority of reported issues are mild gastrointestinal complaints, but rare, serious reactions such as kidney inflammation and severe skin conditions can occur. Long-term use carries risks of mineral deficiencies, bone fractures, and gastric polyps, similar to other acid-reducing drugs. It is crucial for patients to have an open discussion with their healthcare provider about their full medical history and current medications to assess potential drug interactions and contraindications. For more in-depth information, patients can refer to the official Voquezna prescribing information. Ultimately, using the lowest effective dose for the shortest duration necessary helps mitigate risk while managing symptoms effectively.
