Formulary
Finerenone: Indications, Dosing, Side Effects and Interactions
Finerenone is a non-steroidal mineralocorticoid receptor antagonist that inhibits receptor-mediated sodium reabsorption and decreases receptor overactivation,...
MedNext Academy | 3 min read
Finerenone: Indications, Dosing, Side Effects and Interactions
Finerenone is a non-steroidal mineralocorticoid receptor antagonist that inhibits receptor-mediated sodium reabsorption and decreases receptor overactivation,...
Drug action
Finerenone is a non-steroidal mineralocorticoid receptor antagonist that inhibits receptor-mediated sodium reabsorption and decreases receptor overactivation, thereby reducing the inflammation and fibrosis that lead to kidney damage.
Indications and dose
**Chronic kidney disease (stage 3 and 4 with albuminuria) associated with type 2 diabetes [if serum-potassium 5 mmol/L and eGFR 60 mL/min/1.73 m2]**
- **Adult** (By Mouth): Chronic kidney disease (stage 3 and 4 with albuminuria) associated with type 2 diabetes [if serum-potassium 5 mmol/L and eGFR 60 mL/min/1.73 m 2 ] 20 mg once daily, for dose adjustments and interruption according to serum-potassium levels-consult product literature.
**Chronic kidney disease (stage 3 and 4 with albuminuria) associated with type 2 diabetes [if serum-potassium 5 mmol/L and eGFR 25 to 59 mL/min/1.73 m2]**
- **Adult** (By Mouth): Chronic kidney disease (stage 3 and 4 with albuminuria) associated with type 2 diabetes [if serum-potassium 5 mmol/L and eGFR 25 to 59 mL/min/1.73 m 2 ] Initially 10 mg once daily; increased if necessary up to 20 mg once daily, dose to be adjusted according to serum-potassium levels and eGFR, for dose adjustments, interruption, and discontinuation according to serum-potassium levels and eGFR-consult product literature.
Contraindications
Addison's disease; hyperkalaemia Contra-indications, further information Hyperkalaemia Do not initiate treatment if serum-potassium > 5 mmol/L. M Withhold if serum-potassium increases to > 5.5 mmol/L during treatment. M
Side effects
Common or very common Electrolyte imbalance; hypotension; pruritus
Interactions
**Other interactions (11):**
- Finerenone is cleared almost exclusively via cytochrome P450 (CYP)-mediated oxidative metabolism (mainly CYP3A4 [90%] with a small contribution of CYP2C8 [10%]).
- Concomitant use not recommended Strong and moderate CYP3A4 inducers Kerendia should not be used concomitantly with rifampicin and other strong CYP3A4 inducers (e.g., carbamazepine, phenytoin,...
- These CYP3A4 inducers are expected to markedly decrease finerenone plasma concentration and result in reduced therapeutic effect (see section 4.4).
- Certain medicinal products that increase serum potassium Kerendia should not be used concomitantly with potassium-sparing diuretics (e.g., amiloride, triamterene) and other MRAs (e.g., eplerenone,...
- It is anticipated that these medicinal products increase the risk for hyperkalaemia (see section 4.4) Grapefruit Grapefruit or grapefruit juice should not be consumed during finerenone treatment, as...
- Concomitant use with precautions Moderate CYP3A4 inhibitors In a clinical study, concomitant use of erythromycin (500 mg three times a day) led to a 3.5-fold increase in finerenone AUC and 1.9-fold...
Pregnancy
Avoid unless potential benefit outweighs risk-reproductive toxicity in animal studies. M
Breast feeding
Avoid unless potential benefit outweighs risk- animal studies have reported excretion into milk with adverse reactions in the exposed offspring. M
Hepatic impairment
Avoid in severe impairment (no information available). M Consider additional serum-potassium monitoring in moderate impairment. M
Renal impairment
Avoid initiation if eGFR less than 25 mL/minute/1.73 m 2 (limited information available). M Discontinue if eGFR falls persistently below 15 mL/minute/1.73 m 2 (end-stage renal disease) during treatment (limited information available). M See Prescribing in renal impairment .
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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