Filspari

Measure serum AST/ALT levels and total bilirubin prior to initiation, monthly for the first 12 months or restarting following an interruption due to elevated transaminases, then every 3 months during therapy. Interrupt therapy if AST/ALT levels are abnormal at any time; closely monitor those who develop AST/ALT elevations >3×ULN. Avoid initiation in patients with elevated AST/ALT (>3×ULN). Embryo-fetal toxicity. Advise males and females of reproductive potential to use effective contraception prior to initiation, during and for 1 month after treatment discontinuation. Pregnancy: exclude status prior to initiation, monthly during and for 1 month after treatment. Risk for hypotension; consider adjusting other antihypertensive medications or Filspari if develops. Monitor renal function, serum potassium periodically. Risk for acute renal injury (esp. those with renal artery stenosis, chronic kidney disease, severe CHF, volume depletion). Increased risk for hyperkalemia esp. those with advanced kidney disease or concomitant K⁺-increasing drugs. Heart failure. Fluid retention. Evaluate if significant fluid retention develops, may need to initiate or modify diuretic treatment, or consider modifying Filspari. Hepatic impairment: avoid. Nursing mothers: not recommended.