vonoprazan, amoxicillin and metronidazole

A02BD15

Forms & Strengths

Vonoprazan 20 mg / Amoxicillin 1000 mg / Metronidazole 500 mg co-packaged regimen
Dual/triple therapy combination packs for Helicobacter pylori eradication

Adult Dosing

Helicobacter pylori eradication: Vonoprazan 20 mg twice daily plus Amoxicillin 1000 mg twice daily plus Metronidazole 500 mg twice daily for 14 days

Pediatric Dosing

Safety and efficacy in pediatric patients below 18 years of age have not been established

Indications

Mechanism of Action

Vonoprazan: Potassium-competitive acid blocker (P-CAB) that reversibly inhibits H+/K+-ATPase in gastric parietal cells
Amoxicillin: Bactericidal beta-lactam antibiotic inhibiting bacterial cell wall synthesis
Metronidazole: Synthetic nitroimidazole antimicrobial that disrupts bacterial DNA synthesis in anaerobic environments

Contraindications

Known hypersensitivity to vonoprazan, amoxicillin, other penicillins, or metronidazole
Concomitant use with rilpivirine-containing products
History of alcohol consumption during or shortly after metronidazole therapy (disulfiram-like reaction)
First trimester of pregnancy (relative contraindication for metronidazole)

Adverse Reactions

Drug Interactions

CYP3A4 inhibitors and inducers may alter vonoprazan exposure
Drugs dependent on gastric pH for absorption (e.g., ketoconazole, iron salts)
Alcohol may cause a disulfiram-like reaction with metronidazole
Coumarin anticoagulants: Metronidazole may enhance the anticoagulant effect (increased bleeding risk)
Lithium: Metronidazole may decrease lithium clearance leading to toxicity
Methotrexate: Penicillins may reduce renal elimination increasing methotrexate toxicity

Curated Content: Needs Vetting Before Put to Clinical Use