Finerenone is a nonsteroidal, selective antagonist of the mineralocorticoid receptor (MR), which is activated by aldosterone and cortisol and regulates gene transcription. Finerenone blocks MR mediated sodium reabsorption and MR overactivation in both epithelial (e.g., kidney) and nonepithelial (e.g., heart, and blood vessels) tissues. MR overactivation is thought to contribute to fibrosis and inflammation. Finerenone has a high potency and selectivity for the MR and has no relevant affinity for androgen, progesterone, estrogen, and glucocorticoid receptors.
Finerenone is indicated to reduce the risk of sustained eGFR decline, end-stage kidney disease (ESRD), cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure in adult patients with chronic kidney disease (CKD) associated with type 2 diabetes (T2D).
Prior to Initiation of Finerenone
Serum potassium levels and estimated glomerular filtration rate (eGFR) are measured before initiation. Do not initiate treatment if serum potassium is > 5.0 mEq/L.
Recommended Starting Dosage
The recommended starting dose of Finerenone is based on eGFR and is presented as
eGFR (mL/min/1.73m2) Starting Dose
≥ 60 20 mg once daily
≥ 25 to < 60 10 mg once daily
< 25 Not Recommended
For patients who are unable to swallow whole tablets, the tablets may be crushed and mixed with water or soft foods, such as apple sauce, immediately prior to use and administered orally.
The target daily dose of Finerenone is 20 mg.
Serum potassium is measured 4 weeks after initiating treatment and dose is adjusted; if serum potassium levels are >4.8-5.0 mEq/L, initiation of treatment may be considered with additional serum potassium monitoring within the first 4 weeks based on clinical judgement and serum potassium levels. Serum potassium is monitored 4 weeks after a dose adjustment and throughout treatment, and the doses are adjusted as needed.
If eGFR has decreased by more than 30% compared to previous measurement, maintain 10mg dose.
Current Finerenone Dose
Current Serum Potassium(mEq/L) | 10 mg once daily | 20 mg once daily
≤ 4.8 | Increase the dose to 20 mg once daily.* | Maintain 20 mg once daily.
4.8 – 5.5 | Maintain 10 mg once daily. | Maintain 20 mg once daily.
5.5 | Withhold Finerenone. Restart at 10 mg once daily when serum potassium ≤ 5.0 mEq/L. | Withhold Finerenone. Consider restarting at 10 mg once daily when serum potassium ≤ 5.0 mEq/L.
Finerenone is contraindicated in patients:
• who are receiving concomitant treatment with strong CYP3A4 inhibitors
• with adrenal insufficiency.
Finerenone can cause hyperkalemia. The risk for developing hyperkalemia increases with decreasing kidney function and is greater in patients with higher baseline potassium levels or other risk
