Table 2.
Pharmacological comparisons between PPI and Vonoprazan.
| Parameter | PPI | Vonoprazan | |
|---|---|---|---|
| First Generation PPI | Second Generation PPI | ||
| Acid activation | Yes | No | |
| Active drug | No | Yes | |
| Acid Stability | No | Yes | |
| Main P450 metabolizer | CYP2C19 | CYP3A4 | |
| Meal’s influence | Yes | No | |
| Mechanism of Action | Covalent bond to gastric proton pump | Potassium ion competitive reversible inhibitor to gastric proton pump | |
| Days required for reaching maximal acid suppression | 3–5 | 1 | |
| pH > 4 holding time (%) | OMZ 30.4 LPZ 39.1 |
ESO 43.1 RPZ 42.8 |
10 mg 38.4–43.1 20 mg 62.7–63.3 |
| Time Needed to Reach Maximum Plasma Concentration (h) | OMZ 1–4 LPZ 1.2–2.1 |
ESO 1–3.5 RPZ 1.14 |
10 mg 1.75 20 mg 1.50 |
| Half-life (h) | OMZ 0.5–1.2 LPZ 0.9–2.1 |
ESO 1.3–1.6 RPZ 0.6–1.4 |
10 mg 6.95 ± 1.03 20 mg 6.85 ± 0.80 |
| Cmax (μmol/L) | OMZ 0.23–23.2 LPZ 1.62–3.25 |
ESO 2.1–2.4 RPZ 1.14 |
10 mg 9.7 ± 2.1 μg/L 20 mg 25.0 ± 5.6 μg/L |
| AUC (μmol.h/L) | OMZ 0.58–3.47 LPZ 4.60–13.5 |
ESO 4.2 RPZ 2.22 |
10 mg 60.1 ± 9.0 μg.h/L 20 mg 160.3 ± 38.6 μg.h/L |
AUC: Area Under Curve; Cmax: Maximum Plasma Concentration; CYP: Cytochrome P450 OMZ: Omeprazole 20 mg; LPZ: Lansoprazole 30 mg; ESO: Esomeprazole 40 mg; RPZ: Rabeprazole 20 mg.