Finerenone

# Finerenone ## Overview - **Classification**: Non-steroidal Mineralocorticoid Receptor Antagonist (MRA) - **Mechanism**: Selectively blocks mineralocorticoid receptors (MR) to reduce MR overactivation, which contributes to kidney and heart inflammation and fibrosis. ## Primary Indications 1. **Chronic Kidney Disease (CKD) associated with Type 2 Diabetes (T2D)**: To reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure. ## Adult Dosing ### Standard Dosing **Chronic Kidney Disease associated with Type 2 Diabetes** - **Dose**: Initial dose **10 mg** or **20 mg** - Start **10 mg** QD if eGFR 25-60 mL/min/1.73m² and serum K ≤4.8 mmol/L. - Start **20 mg** QD if eGFR ≥60 mL/min/1.73m² and serum K ≤4.8 mmol/L. - Target dose **20 mg** QD after 4 weeks if serum K ≤4.8 mmol/L and eGFR stable. - **Frequency**: Once daily (QD) - **Route**: Oral - **Maximum Dose**: **20 mg** once daily ### Dose Adjustments - **Renal Impairment**: - **eGFR < 25 mL/min/1.73 m²**: Not recommended to initiate. - **eGFR 25 to 60 mL/min/1.73 m²**: Initial **10 mg** QD. - **eGFR ≥ 60 mL/min/1.73 m²**: Initial **20 mg** QD. - Monitor serum potassium and eGFR closely. - **Hepatic Impairment**: - **Mild (Child-Pugh A)**: No adjustment needed. - **Moderate (Child-Pugh B)**: No adjustment needed. - **Severe (Child-Pugh C)**: Avoid use. - **Elderly Patients**: No specific adjustment beyond renal/hepatic function. ## Pediatric Dosing ### Neonates (0-28 days) - **Dose**: Not indicated. - **Special Notes**: Safety and effectiveness not established in pediatric patients. ### Infants (1-12 months) - **Dose**: Not indicated. - **Special Notes**: Safety and effectiveness not established in pediatric patients. ### Children (1-12 years) - **Dose**: Not indicated. - **Special Notes**: Safety and effectiveness not established in pediatric patients. ### Adolescents (13-18 years) - **Dose**: Not indicated. - **Special Notes**: Safety and effectiveness not established in pediatric patients. ## Safety Information ### Contraindications - **Absolute**: Concomitant use with strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin, ritonavir). - **Absolute**: Adrenal insufficiency. ### Common Adverse Effects - **Very Common (>10%)**: Hyperkalemia, Hypotension. - **Common (1-10%)**: Hyponatremia, GFR decrease, Nausea, Fatigue. - **Serious but Rare**: Severe hyperkalemia (monitor carefully). ### Key Drug Interactions - **Strong CYP3A4 Inhibitors (e.g., itraconazole, clarithromycin)**: **CONTRAINDICATED**. Significantly increases finerenone levels; high risk of severe hyperkalemia. - **Strong CYP3A4 Inducers (e.g., rifampin, phenytoin)**: Avoid co-administration. Significantly decreases finerenone levels, reducing efficacy. - **Moderate CYP3A4 Inhibitors (e.g., erythromycin, diltiazem)**: Avoid co-administration. Increases finerenone exposure; monitor potassium closely if unavoidable. - **Potassium-sparing Diuretics (e.g., spironolactone, eplerenone)**: Avoid co-administration. Increased risk of hyperkalemia. - **Potassium Supplements/Salt Substitutes**: Avoid co-administration. Increased risk of hyperkalemia. ## Monitoring & Follow-up - **Before Treatment**: Baseline serum potassium and eGFR. - **During Treatment**: - **Serum potassium & eGFR**: At 4 weeks after initiation or dose increase. - **Serum potassium & eGFR**: Periodically thereafter (e.g., every 3-6 months or as clinically indicated). - **Blood pressure**: Regular monitoring. - **Clinical Signs**: Watch for symptoms of hyperkalemia (e.g., muscle weakness, fatigue, paresthesias, heart palpitations), hypotension (e.g., dizziness, lightheadedness). ## Clinical Pearls - 💡 **Administration**: Take **once daily** with or without food. - 💡 **Missed Dose**: If a dose is missed, take the next dose at the regularly scheduled time; do not take two doses. - 💡 **Hyperkalemia Prevention**: Counsel patients to avoid potassium supplements, salt substitutes containing potassium, and other potassium-sparing agents. - 💡 **Strict Monitoring**: Emphasize the importance of consistent monitoring for serum potassium and eGFR. - 💡 **BP Effects**: Finerenone may cause a small reduction in blood pressure. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.