Aldosterone Synthase Inhibitor

Aka: Aldosterone Synthase Inhibitor, Baxdrostat, Baxfendy

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II. Indications

  1. Resistant Hypertension
    1. Uncontrolled by other combination therapy

III. Contraindications

  1. Chronic Kidney Disease stage 3b or worse (eGFR <45 ml/min)
  2. Concurrent use of Potassium-Sparing Diuretic (Amiloride, Triamterene, Spironolactone, Eplerenone)
    1. Hyperkalemia risk
    2. Wait at least 3-5 days after stopping other agents (e.g. Spironolactone)

IV. Mechanism

  1. Aldosterone Synthase Inhibitor
    1. Inhibits Aldosterone formation by the zona glomerulosa of the Adrenal Cortex
    2. Reduced circulating Aldosterone, decreases Sodium and water retention
  2. Contrast with mineralcorticoid receptor Antagonists (e.g. Spironolactone, Eplerenone)
    1. Block Aldosterone activity at the distal convoluted tubules and collecting ducts

V. Medications

  1. Baxdrostat (Baxfendy)
    1. First Aldosterone Synthase Inhibitor available as of 2026

VI. Dosing: Baxdrostat (Baxfendy)

  1. Standard dose: 2 mg orally daily
  2. Lower dose (Hyperkalemia or Hyponatremia risk): 1 mg orally daily

VII. Adverse Effects

  1. Hyperkalemia
  2. Hyponatremia

VIII. Drug Interactions

  1. Hyperkalemia risk with Potassium-Sparing Diuretics
    1. Aldosterone independent (Amiloride and Triamterene)
    2. Aldosterone Antagonists (Spironolactone, Eplerenone)
  2. Strong CYP3A4 Inducers (e.g. Rifampin)
    1. Reduce Baxdrostat effects

IX. Efficacy

  1. Lowers systolic Blood Pressure by 10 mmHg more than Placebo when added to Resistant Hypertension regimen
  2. Unclear if Aldosterone Synthase Inhibitors reduce cardiovascular events

X. Safety

  1. New Medication Class as of 2026 (Baxdrostat is first) and safety data is limited
  2. Monitor baseline level before starting, at 2 weeks of therapy, then periodically
    1. Serum Potassium
    2. Serum Sodium
    3. Serum Creatinine (eGFR)
      1. Expect an initial mild decrease in eGFR, but typically normalizes
      2. Discontinue if eGFR decrease is >30% or persists

XI. Resources

  1. Baxdrostat (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b1fc1ee7-facc-4099-b3db-a4c1daeaa4be

XII. References

  1. (2026) Presc Lett 33(8): 4

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