Select a medication above to begin.
Filspari
sparsentan
Black Box Warnings .
Appropriate Use
avail. only through restricted distribution program (Filspari REMS) due to risk of hepatotoxicity; prescribers, patients, and pharmacies must enroll at 1-833-513-1325 or www.filsparirems.com
Hepatotoxicity
AST/ALT incr. >3x ULN in up to 3.5% of patients, incl. cases confirmed w/ rechallenge; endothelin receptor antagonists have caused elevated AST/ALT, hepatotoxicity, and liver failure; monitor AST/ALT and bilirubin before tx start, then q3mo; interrupt tx and closely monitor if AST/ALT >3x ULN; avoid use if AST/ALT >3x ULN at baseline since monitoring for hepatotoxicity may be more difficult and patients may be at increased risk for serious hepatotoxicity
Embryo-Fetal Toxicity
contraindicated in pregnancy due to risk of fetal harm; obtain negative pregnancy test before tx start; avoid pregnancy by using effective contraception before tx start, during tx, and x2wk after D/C; D/C ASAP if pregnancy detected
Adult Dosing .
Dosage forms: TAB: 200 mg, 400 mg
Restricted Distribution in US
- [1-833-513-1325 or www.filsparirems.com for more info]
IgA nephropathy, primary
- [400 mg PO qd]
- Start: 200 mg PO qd x14 days; Info: for patients w/ dz progression risk; see pkg insert for dose adjustments based on AST/ALT; give before meals; consider retitrating from 200 mg PO qd if tx interrupted
renal dosing
- [see below]
- eGFR >30: no adjustment; eGFR <30: not defined
- HD/PD: not defined
hepatic dosing
- [see below]
- Child-Pugh Class A, B, or C: avoid use
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hepatic impairment
- ALT or AST >3x ULN
- breastfeeding
- pregnancy
- caution: patients of childbearing potential
- caution: renal impairment, chronic
- caution: renal artery stenosis
- caution: CHF, severe
- caution: volume depletion
- caution: hypotension risk
Drug Interactions .
Overview
sparsentan
endothelin antagonist; angiotensin II antagonist
- CYP3A4 substrate
- CYP2B6 inducer, weak
- CYP2C9 inducer, weak
- CYP2C19 inducer, weak
- P-gp inhibitor, weak
- BCRP inhibitor
- angiotensin II Type 1 antagonist
- gastric pH sensitive
- hyperkalemia
- hypotensive effects
- nephrotoxicity
Contraindicated
- aliskiren
- ambrisentan
- azilsartan medoxomil
- bosentan
- candesartan cilexetil
- cidofovir
- colchicine
- irbesartan
- losartan
- macitentan
- olmesartan medoxomil
- telmisartan
- valsartan
Avoid/Use Alternative
- adagrasib
- alpelisib
- amikacin
- amikacin inhaled
- amiloride
- angiotensin II
- apalutamide
- apixaban
- atazanavir
- benazepril
- bumetanide
- butalbital
- captopril
- carbamazepine
- ceritinib
- chloramphenicol
- cimetidine
- cladribine oral
- clarithromycin
- clofarabine
- cobicistat
- dabigatran
- dexlansoprazole
- enalapril
- enalaprilat
- encorafenib
- ensartinib
- enzalutamide
- esomeprazole
- estradiol (contraceptive)
- ethinyl estradiol (contraceptive)
- famotidine
- foscarnet
- fosinopril
- fosphenytoin
- futibatinib
- ganciclovir
- gentamicin
- idelalisib
- itraconazole
- ivosidenib
- ketoconazole
- lansoprazole
- levoketoconazole
- lisinopril
- lofexidine
- lonafarnib
- lopinavir/ritonavir
- lumacaftor/ivacaftor
- mannitol
- mavacamten
- meperidine
- methotrexate
- mifepristone
- mitotane
- moexipril
- nefazodone
- nelfinavir
- neratinib
- nizatidine
- norgestimate (contraceptive)
- omeprazole
- oxaliplatin
- pantoprazole
- pazopanib
- pentamidine
- pentobarbital
- perindopril
- phenobarbital
- phenytoin
- polymyxin B
- posaconazole
- potassium chloride
- potassium phosphate
- pralsetinib
- primidone
- quinapril
- rabeprazole
- ramipril
- relugolix
- repotrectinib
- ribociclib
- rifabutin
- rifampin
- ritonavir
- rivaroxaban
- sirolimus albumin-bound
- St. John's wort
- streptomycin
- streptozocin
- tacrolimus
- tenofovir disoproxil
- tipranavir
- tobramycin
- tobramycin inhaled
- topotecan
- trandolapril
- tucatinib
- valganciclovir
- venetoclax
- vonoprazan
- voriconazole
Monitor/Modify Tx
- acebutolol
- acyclovir
- adefovir dipivoxil
- afatinib
- aldesleukin
- alectinib
- alfentanil
- alfuzosin
- aluminum hydroxide
- amantadine
- amifostine
- amitriptyline
- amlodipine
- amoxapine
- amphotericin
- anthrax immune globulin
- apomorphine
- apraclonidine ophthalmic
- aprepitant
- aprocitentan
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- articaine
- asenapine
- aspirin
- atenolol
- atorvastatin
- auranofin
- avacopan
- avanafil
- axitinib
- balsalazide
- berberine
- berotralstat
- betaxolol
- betaxolol ophthalmic
- bethanechol
- bevacizumab
- bexagliflozin
- bisoprolol
- bleomycin
- bortezomib
- botulism immune globulin
- brexpiprazole
- brimonidine ophthalmic
- brimonidine topical
- bromocriptine
- bupivacaine
- bupivacaine liposomal
- buprenorphine
- butorphanol
- cabergoline
- cabozantinib
- calcium carbonate
- canagliflozin
- cannabis
- capecitabine
- carboplatin
- carfilzomib
- cariprazine
- carteolol ophthalmic
- carvedilol
- celecoxib
- chloroprocaine
- chlorothiazide
- chlorpromazine
- chlorthalidone
- cilostazol
- ciprofloxacin
- cisplatin
- clevidipine
- clindamycin
- clofazimine
- clomipramine
- clonidine
- clozapine
- codeine
- coenzyme Q-10
- colistimethate
- conivaptan
- creatine
- crizotinib
- cyclophosphamide
- cyclosporine
- cytomegalovirus immune globulin
- danazol
- dapagliflozin
- darunavir
- decitabine
- deferasirox
- deferoxamine
- denileukin diftitox
- desflurane
- desipramine
- dexmedetomidine
- dexmedetomidine injection
- diclofenac
- diclofenac topical
- diflunisal
- digoxin
- dihydrocodeine
- diltiazem
- dinutuximab
- dipyridamole
- doxazosin
- doxepin
- dronabinol
- dronedarone
- drospirenone (contraceptive)
- drospirenone (hormone replacement)
- duloxetine
- duvelisib
- edoxaban
- empagliflozin
- enfortumab vedotin
- entacapone
- entrectinib
- eplerenone
- epoprostenol
- ertugliflozin
- erythromycin
- esmolol
- ethacrynic acid
- ethanol
- etodolac
- everolimus
- fedratinib
- felodipine
- fenoldopam
- fenoprofen
- fentanyl
- ferumoxytol
- finerenone
- flaxseed
- flibanserin
- fluconazole
- flucytosine
- fluphenazine
- flurbiprofen
- fluvastatin
- fosamprenavir
- foslevodopa
- furosemide
- garlic
- gilteritinib
- grapefruit
- guanfacine
- haloperidol
- heparin
- hydralazine
- hydrochlorothiazide
- hydrocodone
- hydromorphone
- hydroxocobalamin IV
- ibuprofen
- ibuprofen lysine
- ifosfamide
- iloperidone
- iloprost
- iloprost inhaled
- imatinib
- imipramine
- immune globulin
- indapamide
- indomethacin
- iohexol
- iomeprol
- iopamidol
- irinotecan
- iron sucrose
- isavuconazonium
- isocarboxazid
- isoflurane
- isosorbide dinitrate
- isosorbide mononitrate
- isradipine
- ketoprofen
- ketorolac
- labetalol
- landiolol
- lapatinib
- lefamulin
- lenacapavir
- lenvatinib
- letermovir
- levobunolol ophthalmic
- levodopa
- levorphanol
- lidocaine
- lifileucel
- lithium
- loxapine
- lubiprostone
- lumateperone
- lurasidone
- lutetium Lu 177 vipivotide tetraxetan
- magnesium carbonate
- magnesium citrate
- magnesium hydroxide
- magnesium oxide
- magnesium salicylate
- magnesium sulfate
- maraviroc
- mavorixafor
- meclofenamate
- mefenamic acid
- meloxicam
- mepivacaine
- mesalamine
- mesalamine rectal
- methadone
- methohexital
- methyldopa
- methylene blue injection
- metolazone
- metoprolol
- midazolam
- milrinone
- minoxidil
- mirtazapine
- mitomycin
- mitoxantrone
- molindone
- morphine
- nabumetone
- nadolol
- nalbuphine
- naproxen
- nattokinase
- naxitamab
- nebivolol
- neomycin
- netupitant
- niacin (vitamin B3)
- nicardipine
- nifedipine
- nilotinib
- nimodipine
- nirogacestat
- nisoldipine
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- nortriptyline
- nusinersen
- olanzapine
- oliceridine
- olsalazine
- opicapone
- opium
- oxaprozin
- oxazepam
- oxycodone
- oxymorphone
- paliperidone
- palopegteriparatide
- pamidronate
- paromomycin
- pemetrexed
- penicillamine
- pentazocine
- pentostatin
- perphenazine
- phenelzine
- phenoxybenzamine
- phentolamine
- pindolol
- piroxicam
- pitavastatin
- plazomicin
- polyethylene glycol
- polyethylene glycol/electrolytes
- potassium acid phosphate
- potassium bicarbonate
- potassium citrate
- potassium iodide
- pramipexole
- pravastatin
- prazosin
- procarbazine
- prochlorperazine
- promethazine
- propafenone
- propofol
- propranolol
- protriptyline
- quetiapine
- quinidine (antiarrhythmic)
- ramucirumab
- ranolazine
- rasagiline
- remifentanil
- remimazolam
- Rho(D) immune globulin
- riociguat
- risperidone
- rituximab
- ropeginterferon alfa-2b
- ropinirole
- ropivacaine
- rosuvastatin
- rotigotine transdermal
- sacubitril
- safinamide
- salsalate
- selegiline
- selegiline transdermal
- sevoflurane
- sildenafil
- silodosin
- simvastatin
- sirolimus
- sitagliptin
- sodium bicarbonate
- sodium citrate
- sodium ferric gluconate complex
- sodium zirconium cyclosilicate
- sotagliflozin
- sotalol
- spironolactone
- sufentanil
- sulfate bowel prep
- sulindac
- sunitinib
- tadalafil
- tagraxofusp
- talazoparib
- tamsulosin
- tapentadol
- taurine
- telavancin
- temsirolimus
- tenofovir alafenamide
- terazosin
- thalidomide
- thioridazine
- thiothixene
- timolol
- timolol ophthalmic
- tiopronin
- tivozanib
- tizanidine
- tolcapone
- tolmetin
- tolvaptan
- torsemide
- tramadol
- tranylcypromine
- trazodone
- treprostinil
- triamterene
- trifluoperazine
- trimethoprim
- trimipramine
- ubrogepant
- vaccinia immune globulin
- valacyclovir
- vancomycin
- vardenafil
- verapamil
- voclosporin
- vosoritide
- warfarin
- willow bark
- yohimbe
- ziprasidone
- ziv-aflibercept
- zoledronic acid
- zonisamide
Caution Advised
- bupropion
- carisoprodol
- cenobamate
- dabrafenib
- darolutamide
- efavirenz
- etravirine
- fexinidazole
- glecaprevir
- lorlatinib
- mitapivat
- modafinil
- nafcillin
- naldemedine
- nevirapine
- pacritinib
- pexidartinib
- pibrentasvir
- rifapentine
- seladelpar
- sotorasib
- sulfasalazine
- velpatasvir
Adverse Reactions .
Serious Reactions
- acute kidney injury
- hypotension
- hyperkalemia
Common Reactions
- hyperkalemia
- hypotension
- edema, peripheral
- dizziness
- anemia
- acute kidney injury
- ALT or AST elevated
- eGFR decr.
Safety/Monitoring .
Monitoring Parameters
AST/ALT, bilirubin before tx start, then q3mo; pregnancy test before tx start; Cr; K
Pregnancy/Lactation .
Pregnancy
Clinical Summary
contraindicated during pregnancy; inadequate human data available; risk of fetal harm, incl. craniofacial malformations, skeletal abnormalities, decr. fetal wt, and embryo-fetal death based on animal data at 10x MRHD
Individuals of Reproductive Potential
obtain negative pregnancy test before tx start; avoid pregnancy by using effective contraception before tx start, during tx, and x2wk after D/C in patients of childbearing potential
Lactation
Clinical Summary
avoid use while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: liver; CYP450: 3A (primary) substrate
Excretion: feces 80% (9% unchanged), urine 2% (minimally unchanged); Half-life: 9.6h
Subclass: Endothelin and Angiotensin II Receptor Antagonists
Mechanism of Action
selectively antagonizes endothelin type A receptor and angiotensin II type 1 receptor
Formulary .
No Formulary Selected
Join Now to View Patient Handouts!
Create a FREE epocrates Online account to access patient medication instructions. Your patients and caregivers will appreciate you printing these friendly handouts, available in English and Spanish. Each handout addresses common concerns such as how to take the medication, and possible side effects.
Current Members: Sign In.
Pill Pictures
Join Now to View Pill Pictures!
Create a FREE epocrates Online account to access full-color images of medications within the drug monograph.
Current Members: Sign In.