Potassium Competitive Acid Blocker

Aka: Potassium Competitive Acid Blocker, PCAB

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II. Mechanism

  1. Potassium Competitive Acid Blocker (PCAB)
    1. Hydrogen, Potassium-ATPase enzyme inhibition
    2. Similar mechanism as Proton Pump Inhibitors (PPIs)
    3. In addition to blocking active proton pumps (as with PPIs), PCABs also block resting proton pumps
      1. Allows for PCAB onset of activity within hours (as compared with days for PPIs)
      2. PCABs may be taken with or without food (contrast with PPIs taken 60 minutes before eating)
  2. Contrast with Proton Pump Inhibitors (PPIs)
    1. PPIs block only active proton pumps
    2. PPI full action is delayed up to 7 days
    3. PPIs are best taken 30 to 60 minutes before a meal

III. Medications

  1. Vonoprazan Fumarate (Takecab)

IV. Adverse Effects

  1. Diarrhea
  2. Nausea
  3. Longterm adverse effects are similar to Proton Pump Inhibitors
    1. Increased Fracture risk
    2. Clostridioides difficile
    3. Vitamin B12 Deficiency
    4. Hypomagnesemia (and Hypokalemia, Hypocalcemia)
  4. Atypical and rare serious effects
    1. Fundic gland polyps
    2. Acute Tubulointerstitial Nephritis
    3. Stevens Johnson Syndrome
    4. Toxic Epidermal Necrolysis

V. References

  1. Echizen (2016) Clin Pharmacokinet 55(4):409-18 +PMID: 26369775 [PubMed]

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