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新藥介紹Finerenone
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孫鴻 周
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新藥介紹Finerenone
1.
Finerenone Kerendia® 周孫鴻藥師
2.
3.
開發背景 第二型糖尿病,若血糖沒控制好容易產 生小血管病變~腎臟、視網膜和周邊神 經病變 若第二型糖尿病且有嚴重蛋白尿(例如 UACR≥300
mg/day),能服用ACEI或ARB 來減緩腎功能惡化; 但血壓太低或血鉀 太高不適合用 若第二型糖尿病且蛋白尿,能服用 SGLT2i來減緩腎功能惡化和心血管事 件; 但eGFR <30 mL/min/1.73 m2 或有截 肢風險的人不適合用
4.
機轉 Finerenone 透過抑制礦物性皮質 激素受體
(mineralocorticoid receptor),能增加血中鉀離子,也能 減少心臟、腎臟和血管的發炎及 纖維化
5.
好處 若第二型糖尿病且蛋白尿, finerenone能減緩腎功能惡化和 心血管事件
6.
劑量 腎功能 劑量 eGFR ≥60
mL/minute/1.73 m2 每天一次,20mg eGFR ≥25 to <60 mL/minute/1.73 m2 每天一次,10mg eGFR <25 mL/minute/1.73 m2 不建議使用 上述劑量還要考量血中鉀離子,太高要減量甚至不要用
7.
副作用 高血鉀 低血壓
低血鈉
8.
交互作用 Finerenone本身經由肝臟酵素 CYP3A4代謝 所以若併用到CYP3A4抑制劑或 CYP3A4促進劑,要調整劑量