Finerenone

Aka: Finerenone, Kerendia, Nonsteroidal Mineralocorticoid Receptor Antagonist, NMRA

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II. 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)
  2. Congestive Heart Failure
    1. Finerenone is FDA approved for Heart Failure with EF >40%
    2. May be used as an expensive alternative to Spironolactone or Eplerenone (but not together, similar mechanisms)

III. Contraindications

  1. eGFR <25 ml/min (increased risk of Hyperkalemia)
  2. Serum Potassium > 5.0 mmol/L (at time of starting medication)

IV. 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

V. 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

VI. 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

VII. Adverse Effects

  1. Hyperkalemia (14%)
  2. Hypotension (4.6%)
  3. Hyponatremia (1.3%)

VIII. 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

IX. Safety

  1. Unknown safety in pregnancy
  2. Contraindicated in Lactation

X. Efficacy

  1. Congestive Heart Failure
    1. May be used as an alternative to Spironolactone or Eplerenone (but not together, similar mechanisms)
    2. Finerenone is FDA approved for Heart Failure with EF >40%
      1. May reduce Heart Failure exacerbations, hospitalizations and cardiovascular mortality
      2. Furqan (2025) Ann Med Surg 87(11):7735-6 +PMID: 41180728 [PubMed]

XI. Resources

  1. Finerenone (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=fc726765-5d5a-4d6e-b037-b847bda9fb7c

XII. References

  1. (2021) Presc Lett 28(10): 58-9
  2. Bakris (2020) N Engl J Med 383:2219-29 [PubMed]

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Cost: Medications

kerendia (on 7/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
KERENDIA 10 MG TABLET $19.14 each
KERENDIA 20 MG TABLET $19.08 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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