Target daily dose: 20 mg. 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 w/ current dose of 10 mg once daily: Current serum K ≤4.8 mEq/L Increase dose to 20 mg once daily. If eGFR has decreased by >30% from previous measurement, maintain 10 mg dose, >4.8-5.5 mEq/L Maintain 10 mg once daily, >5.5 mEq/L Withhold & restart at 10 mg once daily when serum K is ≤5 mEq/L; current dose of 20 mg once daily: Current serum K ≤4.8 mEq/L & >4.8-5.5 mEq/L Maintain 20 mg once daily, >5.5 mEq/L Withhold & restart at 10 mg once daily when serum K is ≤5 mEq/L.
View Firialta overdosage for action to be taken in the event of an overdose.
Administration
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.
Contraindications
Adrenal insufficiency. Concomitant use w/ strong CYP3A4 inhibitors.
Not to be initiated if serum K is >5 mEq/L. Increased risk of hyperkalemia w/ decreasing kidney function. Patients w/ higher baseline K levels or other risk factors for hyperkalemia. Measure serum K levels & eGFR before treatment initiation; serum K 4 wk after treatment initiation, dose adjustment & periodically during treatment. Concomitant use w/ medications that impair K excretion or increase serum K. Avoid use in severe hepatic impairment (Child-Pugh C). Moderate hepatic impairment (Child-Pugh B). Pregnancy. Avoid breastfeeding during & 1 day after treatment. Ped <18 yr.
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