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Kerendia
finerenone
Adult Dosing .
Dosage forms: TAB: 10 mg, 20 mg, 40 mg
kidney disease progression and cardiovascular-associated risk reduction - DM type 2 patients with CKD
- [20 mg PO qd]
- Info: if K greater than 5.5 mEq/L, hold tx until K 5 mEq/L or less and restart at 10 mg/day, then after 4wk incr. to 20 mg/day if K 4.8 mEq/L or less and eGFR decr. <30%
heart failure-associated risk reduction - heart failure patients with LVEF >40%
- [target dosing for patients with baseline eGFR >60]
- Dose: 40 mg PO qd; Start: 20 mg PO qd, then after 4wk incr. to 40 mg PO qd if K less than 5 mEq/L and eGFR decr. <30%; Info: if K 5.5 to less than 6 mEq/L, decr. dose by 50%; if K 6 mEq/L or greater, hold tx until K less than 5-5.5 mEq/L and restart at 10 mg/day
- [dose adjusted to 20 mg/day]
- Dose: 20 mg PO qd; Info: if baseline eGFR >60, incr. dose to 40 mg PO qd after 4wk if K less than 5 mEq/L and eGFR decr. <30%; if K 5.5 to less than 6 mEq/L, decr. dose by 50%; if K 6 mEq/L or greater, hold tx until K less than 5-5.5 mEq/L and restart at 10 mg/day
- [dose adjusted to 10 mg/day]
- Dose: 10 mg PO qd; Info: incr. dose to 20 mg PO qd after 4wk if K less than 5 mEq/L and eGFR decr. <30%; if K 5.5 mEq/L or greater, hold tx until K less than 5-5.5 mEq/L and restart at 10 mg/day
renal dosing
- [DM type 2-associated CKD]
- eGFR 25-59: start 10 mg qd, then after 4wk incr. to 20 mg/day if K 4.8 mEq/L or less and eGFR decr. <30%; eGFR <25: avoid tx initiation
- HD/PD: not defined
- [heart failure with LVEF >40%]
- eGFR 25-59: start 10 mg qd, then after 4wk incr. to target 20 mg/day if K less than 5 mEq/L and eGFR decr. <30%; eGFR <25: avoid tx initiation
- HD/PD: not defined
hepatic dosing
- [see below]
- Child-Pugh Class C: avoid use
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- K >5
- eGFR <25 (tx initiation use)
- adrenal insufficiency
- avoid: breastfeeding during tx and x1 day after D/C
- caution: eGFR 25-59
- caution: hepatic impairment
- caution: hyperkalemia risk
Drug Interactions .
Overview
finerenone
mineralocorticoid antagonist
- CYP3A4 substrate
- CYP2C8 inhibitor, weak
- CYP3A4 inhibitor, weak
- hyperkalemia
Contraindicated
- adagrasib
- atazanavir
- ceritinib
- chloramphenicol
- cisapride
- clarithromycin
- cobicistat
- eliglustat
- idelalisib
- itraconazole
- ketoconazole
- levoketoconazole
- lonafarnib
- lopinavir/ritonavir
- mifepristone
- nefazodone
- nelfinavir
- posaconazole
- ribociclib
- ritonavir
- tipranavir
- tucatinib
- voriconazole
Avoid/Use Alternative
- alprazolam
- amiloride
- apalutamide
- bosentan
- butalbital
- carbamazepine
- cenobamate
- codeine
- colchicine
- dabrafenib
- efavirenz
- encorafenib
- enzalutamide
- etravirine
- fexinidazole
- fosphenytoin
- hydrocodone
- ivosidenib
- lorlatinib
- lumacaftor/ivacaftor
- mavacamten
- meperidine
- methadone
- mitapivat
- mitotane
- modafinil
- nafcillin
- netupitant
- oxycodone
- pacritinib
- pentobarbital
- pexidartinib
- phenobarbital
- phenytoin
- pimozide
- potassium chloride
- pralsetinib
- primidone
- propafenone
- repotrectinib
- rifabutin
- rifampin
- rifapentine
- simvastatin
- sotorasib
- St. John's wort
- tacrolimus
Monitor/Modify Tx
- abemaciclib
- acalabrutinib
- alfentanil
- aliskiren
- amiodarone
- amlodipine
- aprepitant
- asciminib
- atorvastatin
- avacopan
- avanafil
- avapritinib
- belumosudil
- benazepril
- berberine
- berotralstat
- bicalutamide
- brigatinib
- candesartan cilexetil
- capivasertib
- captopril
- celecoxib
- chlorzoxazone
- cilostazol
- cimetidine
- ciprofloxacin
- clofazimine
- clotrimazole oropharyngeal
- clozapine
- conivaptan
- cranberry
- crizotinib
- cyclosporine
- danazol
- daridorexant
- darunavir
- decitabine
- diclofenac
- diclofenac topical
- diflunisal
- diltiazem
- diosmin
- disopyramide
- docetaxel
- dofetilide
- domperidone
- dronedarone
- drospirenone (contraceptive)
- drospirenone (hormone replacement)
- duvelisib
- elinzanetant
- enalapril
- enalaprilat
- entrectinib
- eplerenone
- erythromycin
- ethinyl estradiol (contraceptive)
- etodolac
- everolimus
- fedratinib
- felodipine
- fenoprofen
- fentanyl
- flibanserin
- fluconazole
- flurbiprofen
- fluvoxamine
- fosamprenavir
- fosaprepitant
- fosinopril
- fostamatinib
- gepirone
- gepotidacin
- ginkgo
- givinostat
- givosiran
- glecaprevir
- goldenseal
- grapefruit
- grazoprevir
- heparin
- ibrutinib
- ibuprofen
- imatinib
- indomethacin
- irbesartan
- isavuconazonium
- isoniazid
- istradefylline
- ivabradine
- ivacaftor
- ixabepilone
- ketoprofen
- ketorolac
- kratom
- landiolol
- lapatinib
- larotrectinib
- lazertinib
- lefamulin
- lemborexant
- lenacapavir
- letermovir
- lisinopril
- lomitapide
- losartan
- lovastatin
- lumateperone
- lurasidone
- lurbinectedin
- maribavir
- mavorixafor
- meclofenamate
- mefenamic acid
- meloxicam
- midazolam
- mobocertinib
- moexipril
- nabumetone
- naproxen
- nicardipine
- nifedipine
- nilotinib
- nimodipine
- nirogacestat
- nisoldipine
- oliceridine
- olmesartan medoxomil
- osilodrostat
- oxaprozin
- paclitaxel
- palbociclib
- pazopanib
- pemigatinib
- peppermint
- perindopril
- pibrentasvir
- pioglitazone
- piroxicam
- pirtobrutinib
- potassium acid phosphate
- potassium bicarbonate
- potassium citrate
- potassium iodide
- potassium phosphate
- primaquine
- quercetin
- quinapril
- quinidine (antiarrhythmic)
- ramipril
- ranolazine
- red yeast rice
- remdesivir
- repaglinide
- resveratrol
- rilzabrutinib
- ritlecitinib
- rucaparib
- selpercatinib
- sevabertinib
- sirolimus
- sirolimus albumin-bound
- sparsentan
- spironolactone
- stiripentol
- succinylcholine
- sufentanil
- sulindac
- tadalafil
- taletrectinib
- telmisartan
- temsirolimus
- ticagrelor
- tolmetin
- tolvaptan
- trandolapril
- treosulfan
- triamterene
- triazolam
- trimethoprim
- trofinetide
- ubrogepant
- valsartan
- vardenafil
- venetoclax
- verapamil
- viloxazine
- vinblastine
- vincristine
- vinorelbine
- voclosporin
- vonoprazan
- warfarin
- xanomeline
- zanubrutinib
- ziftomenib
- zileuton
Caution Advised
- armodafinil
- artemether/lumefantrine
- belzutifan
- bexarotene
- cariprazine
- clobazam
- cobimetinib
- cyclophosphamide
- danshen
- darolutamide
- dexamethasone
- dicloxacillin
- dihydroergotamine
- echinacea
- elafibranor
- elagolix
- enasidenib
- ergotamine
- eslicarbazepine acetate
- felbamate
- garlic
- ginseng, Asian
- glycerol phenylbutyrate
- griseofulvin
- meropenem
- methylergonovine
- nevirapine
- odevixibat
- olutasidenib
- omaveloxolone
- oxcarbazepine
- palovarotene
- perampanel
- prednisone
- roflumilast
- roflumilast topical
- rufinamide
- sarilumab
- sirolimus topical
- sunvozertinib
- suzetrigine
- tazemetostat
- tecovirimat
- telotristat ethyl
- tocilizumab
- topiramate
- tovorafenib
- vaborbactam
- vamorolone
- vemurafenib
- vorasidenib
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- angioedema
- hyperkalemia, severe
- renal impairment (patients with heart failure)
Common Reactions
- hyperkalemia
- renal impairment (patients with heart failure)
- eGFR decr.
- hypotension
- acute kidney injury (patients with heart failure)
- renal failure (patients with heart failure)
- hyponatremia
Safety/Monitoring .
Monitoring Parameters
eGFR at baseline, then if heart failure, 4wk after tx start or dose adjustment, then periodically; K at baseline, then 4wk after tx start or dose adjustment (or more frequently if DM type 2-associated CKD and baseline K 4.9-5), then periodically, or consider more frequently if Child-Pugh Class B hepatic impairment or hyperkalemia risk
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; no human data available; possible risk of developmental toxicity based on animal data at 2x or 4x systemic exposure
Lactation
Clinical Summary
avoid breastfeeding during tx and x1 day after D/C; no human data available to assess risk of infant harm, though possible drug excretion into milk based on drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for finerenone: liver; CYP450: 2C8, 3A4 (primary) substrate
Excretion: for finerenone: urine 80% (<1% unchanged), feces 20% (<0.2% unchanged); Half-life: 2-3h
Subclass: Mineralocorticoid Receptor Antagonists, Nonsteroidal
Mechanism of Action
for finerenone: selectively antagonizes mineralocorticoid receptors, inhibiting Na reabsorption and mineralocorticoid receptor overactivation in epithelial and nonepithelial tissues
Formulary .
No Formulary Selected
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