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