Clinical Impact of Vonoprazan on the Use of Midazolam during Upper Gastrointestinal Endoscopy

Despite that the Japanese package insert for vonoprazan (VPZ) includes a precaution that the potassium ion-competitive acid blocker may potentiate the effects of midazolam (MDZ), reports on the actual effects in clinical practice are lacking. Therefore, in this study, we evaluated whether VPZ-taking patients experience clinical effects under MDZ sedation during endoscopy. The participants were outpatients who underwent upper gastrointestinal endoscopy under MDZ anesthesia between April 2021 and April 2022. Comparisons were made between the VPZ(+) and VPZ(-) groups, and the patient background was adjusted using propensity score matching. The post-examination observation time was prolonged in 16.4% of patients in the VPZ(+) group and 13.7% in the VPZ(-) group, but the difference was not statistically significant (p=0.818). The two patients groups also showed no statistically significant differences in the percentage of individuals who received oxygen administration during the examination or in post-examination oxygen saturation and blood pressure values. These results suggest that the use of MDZ for sedation during upper gastrointestinal endoscopy may have minimal clinical effects arising from drug interaction with VPZ.