Vicadrostat

Vicadrostat
INN: Vicadrostat
Clinical data
Other namesBI 690517; CS-1099562, VICADROSTAT (USAN US)
Routes of
administration		oral
Drug classInhibitor of aldosterone and cortisol synthesis; SGLT2 inhibitor (in combination with empagliflozin)
ATC code
  • none
Pharmacokinetic data
Elimination half-life4.4 to 6.3 hours
Identifiers
  • 2-Chloro-4-[(6R)-6-(hydroxymethyl)-6-methyl-4-oxo-7H-pyrano[3,4-d]imidazol-3-yl]benzonitrile
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
UNII
KEGG
ChEMBL
Chemical and physical data
FormulaC15H12ClN3O3
Molar mass317.73 g·mol−1
3D model (JSmol)
  • C[C@@]1(CC2=C(C(=O)O1)N(C=N2)C3=CC(=C(C=C3)C#N)Cl)CO
  • InChI=1S/C15H12ClN3O3/c1-15(7-20)5-12-13(14(21)22-15)19(8-18-12)10-3-2-9(6-17)11(16)4-10/h2-4,8,20H,5,7H2,1H3/t15-/m1/s1
  • Key:MCVIVPZYYMNCAW-OAHLLOKOSA-N

Vicadrostat is also known by a number of code names; one of the best known is BI 690517. This is an experimental low-molecular-weight drug which acts as an inhibitor of aldosterone and cortisol synthesis and is proposed for use in combination with the SGLT2 inhibitor empagliflozin (is abbreviated to VicaEmpa) to treat people with type 2 diabetes, high blood pressure, cardiovascular disease and kidney disease.

Pharmacology

Pharmacodynamics

Vicadrostat is an aldosterone synthase inhibitor; Phase II clinical trials (involving 586 patients) have shown that a 10 mg dose of vicadrostat reduces the urinary albumin-to-creatinine ratio by approximately 40% compared with placebo; this effect is achieved both with and without concomitant use of an SGLT2 inhibitor (empagliflozin).

References

  1. ↑ Schulze F, Schaible J, Goettel M, Tanaka Y, Hohl K, Schultz A, et al. (2025). "Phase 1 studies of the safety, tolerability, pharmacokinetics, and pharmacodynamics of BI 690517 (vicadrostat), a novel aldosterone synthase inhibitor, in healthy male volunteers". Naunyn-Schmiedeberg's Archives of Pharmacology. 398 (7): 9083–9098. doi:10.1007/s00210-025-03838-0. PMC 12263707. PMID 39899058.
  2. ↑ Anderson JE, Wright EE, Shaefer CF (February 2017). "Empagliflozin: Role in Treatment Options for Patients with Type 2 Diabetes Mellitus". Diabetes Therapy: Research, Treatment and Education of Diabetes and Related Disorders. 8 (1): 33–53. doi:10.1007/s13300-016-0211-x. PMC 5306110. PMID 27837465.
  3. 1 2 3 Helmeczi W, Hundemer GL (May 2025). "Targeting aldosterone to improve cardiorenal outcomes: from nonsteroidal mineralocorticoid receptor antagonists to aldosterone synthase inhibitors". Current Opinion in Nephrology and Hypertension. 34 (3): 241–246. doi:10.1097/MNH.0000000000001067. PMID 40012539.
  4. 1 2 Mazzieri A, Battistoni S, Reboldi G (May 2026). "Aldosterone synthase inhibitors in hypertension and chronic kidney disease: double the benefit?". Current Opinion in Nephrology and Hypertension. 35 (3): 337–346. doi:10.1097/MNH.0000000000001175. PMID 41816811.
  5. 1 2 Gashaw IA, Tuttle KR, Monroy Kuhn M, Pleiner S, Delic D, Cronin L, et al. (January 2026). "Pharmacodynamics of vicadrostat for aldosterone synthase inhibition in patients with CKD". European Journal of Endocrinology. 194 (1): 46–57. doi:10.1093/ejendo/lvaf265. PMID 41436034.
  6. ↑ Judge PK, Tuttle KR, Staplin N, Hauske SJ, Zhu D, Sardell R, et al. (May 2025). "The potential for improving cardio-renal outcomes in chronic kidney disease with the aldosterone synthase inhibitor vicadrostat (BI 690517): a rationale for the EASi-KIDNEY trial". Nephrology, Dialysis, Transplantation: Official Publication of the European Dialysis and Transplant Association - European Renal Association. 40 (6): 1175–1186. doi:10.1093/ndt/gfae263. PMC 12209857. PMID 39533115.
  7. ↑ Cherney DZ, Rossing P, Canziani ME, Caramori ML, Correa-Rotter R, Cronin L, et al. (July 2026). "Effects of Vicadrostat/Empagliflozin in People With Chronic Kidney Disease: Metabolic Subgroup Analyses". Diabetes, Obesity & Metabolism. 28 (7): 6324–6333. doi:10.1111/dom.70836. PMC 13243991. PMID 42086479.