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Finerenone

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Finerenone, Kerendia

  • See Also
  1. Aldosterone Antagonist
  2. Diabetic Nephropathy
  • Indications
  1. Diabetic Nephropathy (Type 2 Diabetes)
    1. May limit renal fibrosis and inflammation and may decrease CKD progression (in combination with ACE or ARB)
  • Contraindications
  1. eGFR <25 ml/min (increased risk of Hyperkalemia)
  2. Serum Potassium > 5.0 mmol/L (at time of starting medication)
  • Mechanism
  1. Non-Steroidal Aldosterone Antagonist (mineralcorticoid receptor Antagonist)
  2. Similar anti-Aldosterone effects of steroidal Aldosterone Antagonists (Eplerenone, Spironolactone)
    1. Unlike Spironolactone, not associated with Gynecomastia
  • Dosing
  1. Released in 2021 at $610/month
  2. Normal Renal Function (eGFR >60 ml/min)
    1. Start: 10 to 20 mg orally once daily for 4 weeks, then 20 mg orally daily
    2. Indications to continue at 10 mg dose
      1. Serum Potassium >4.8 mmol/L
      2. eGFR decreases >30% from baseline
  3. Reduced Renal Function (eGFR 25 to 60 ml/min)
    1. Take 10 mg orally once daily
  • Monitoring
  1. Serum Creatinine (and eGFR)
    1. Limit to 10 mg/day if eGFR <60 ml/min or eGFR decreases >30% from baseline
    2. Discontinue if eGFR <25 ml/min
  2. Serum Potassium
    1. Obtain baseline, at four weeks and regularly afterward
    2. Hold Finerenone if Serum Potassium >5.5 mmol/L
      1. May restart if Serum Potassium <5.0 mmol/L
  • Adverse Effects
  1. Hyperkalemia (14%)
  2. Hypotension (4.6%)
  3. Hyponatremia (1.3%)
  • Drug Interactions
  1. Medications that raise Serum Potassium
    1. Finerenone is typically combined with ACE Inhibitors (or ARBs) - monitor Serum Potassium
    2. Avoid with NSAIDs
    3. Avoid with Potassium supplements
  2. Strong CYP3A4 inhibitors (increased adverse effects and toxicity)
    1. Itraconazole
    2. Amiodarone
    3. Diltiazem
    4. Ritonavir
  3. Strong CYP3A4 Inducers (decreased efficacy)
    1. Rifampin
    2. Phenytoin
    3. Carbamazepine
    4. Efavirenz
  • Safety
  1. Unknown safety in pregnancy
  2. Contraindicated in Lactation
  • Resources
  1. Finerenone (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=fc726765-5d5a-4d6e-b037-b847bda9fb7c
  • References
  1. (2021) Presc Lett 28(10): 58-9
  2. Bakris (2020) N Engl J Med 383:2219-29 [PubMed]