Firialta

Finerenone

Reduce risk of sustained estimated GFR (eGFR) decline, ESRD, CV death, non-fatal MI, & hospitalization for heart failure in adults w/ CKD associated w/ type 2 diabetes.

Target dose: 20 mg once daily. Starting dose: eGFR ≥60 mL/min/1.73 m² 20 mg once daily, ≥25 to <60 mL/min/1.73 m² 10 mg once daily. Dose adjustment after 4 wk & thereafter: Serum K ≤4.8 mmol/L Maintain 20 mg once daily. If eGFR has not decreased >30% from previous measurement, increase dose to 20 mg once daily for patients on 10 mg once daily, >4.8-5.5 mmol/L Maintain dose, >5.5 mmol/L Withhold & restart at 10 mg once daily if serum K ≤5 mmol/L. Max daily dose: 20 mg.

May be taken with or without food: For patients w/ difficulty swallowing whole tab, tab may be crushed & mixed w/ water or soft foods (eg, applesauce) immediately prior to administration.

Addison's disease. Concomitant use w/ strong CYP3A4 inhibitors (eg, itraconazole, ketoconazole, ritonavir, nelfinavir, cobicistat, clarithromycin, telithromycin & nefazodone).

Not recommended to be initiated if serum K is >5 mmol/L & in patients w/ eGFR <25 mL/min/1.73 m². Remeasure serum K & eGFR in all patients 4 wk after initiation or re-start or uptitration treatment. Avoid concomitant use w/ K-sparing diuretics (eg, amiloride, triamterene), other mineralocorticoid receptor antagonists (MRAs) (eg, eplerenone, esaxerenone, spironolactone, canrenone); strong (eg, rifampicin, carbamazepine, phenytoin, phenobarb, St. John's wort) or moderate (eg, efavirenz) CYP3A4 inducers. Monitor serum K when concomitant use w/ moderate (eg, erythromycin & verapamil) or weak (eg, amiodarone & fluvoxamine) CYP3A4 inhibitors, K supplements, trimethoprim, or trimethoprim-sulfamethoxazole. Temporary discontinuation w/ trimethoprim, or trimethoprim-sulfamethoxazole, may be necessary. Avoid concomitant intake of grapefruit or grapefruit juice. Increased risk of hyperkalemia w/ decreasing renal function. Avoid use in severe hepatic impairment (Child Pugh C). Moderate hepatic impairment (Child Pugh B). Advise women of childbearing potential to use effective contraception during treatment. Pregnancy. Discontinue breastfeeding if therapy is considered essential. Not recommended in ped patients <18 yr.

Hyperkalemia. Hyponatremia, hyperuricemia; hypotension; decreased GFR.

Increased AUC & C_max w/ itraconazole, clarithromycin & other strong CYP3A4 inhibitors (eg, ketoconazole, ritonavir, nelfinavir, cobicistat, telithromycin or nefazodone); & exposure w/ moderate (eg, erythromycin & verapamil) or weak (eg, amiodarone & fluvoxamine) CYP3A4 inhibitors. Increased plasma conc w/ grapefruit or grapefruit juice. Decreased plasma conc & reduced therapeutic effect w/ strong (eg, rifampicin, carbamazepine, phenytoin, phenobarb, St. John's wort) or moderate (eg, efavirenz) CYP3A4 inducers. Increased risk of hyperkalemia w/ medications that increase serum K including K-sparing diuretics (eg, amiloride, triamterene); other MRAs (eg, eplerenone, esaxerenone, spironolactone, canrenone); K supplements; trimethoprim, or trimethoprim-sulfamethoxazole.

Diuretics

C03DA05 - finerenone ; Belongs to the class of aldosterone antagonists. Used as potassium-sparing diuretics.

Rx