Finerenone
KERENDIA
Pronunciation: fin-ER-e-noen
“Finer renal K-renderer”
Approved for CKD in type 2 diabetes
Bananas in bunches → ↑ serum potassium
“Finer” = nonsteroidal, highly selective for mineralocorticoid receptors
No relevant affinity for androgen, progesterone, estrogen, or glucocorticoid receptors
More cardio-renal benefit than other MRAs
What it isNon-steroidal mineralocorticoid receptor antagonist; diabetic kidney disease.
Why this oneCardiovascular and renal outcome benefit without the gynecomastia of spironolactone, because it is non-steroidal.
What limits itHyperkalemia is the limiting toxicity and needs a potassium check before and during. CYP3A4-dependent.
FDA-approved for
- chronic kidney disease in type 2 diabetes (2021)
Off-label
- heart failure with preserved ejection fraction
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| CKD associated with T2DM | adult | 10–20 mg QD (by eGFR) | 20 mg QD | 20 mg QD |
| Heart failure with LVEF ≥40% | adult | 10–20 mg QD (by eGFR) | 20–40 mg QD | 40 mg QD |
Titration Up-titrate after 4 weeks based on serum potassium and eGFR.
Renal eGFR ≥60: start 20 mg QD; eGFR 25 to <60: start 10 mg QD; eGFR <25: initiation not recommended.
Hepatic Undefined
Instructions
- Take with or without food.
- May crush and mix with water or soft food (e.g., applesauce) if unable to swallow whole.
- Measure serum potassium and eGFR before initiation; do not start if potassium >5.0 mEq/L.
- Measure serum potassium 4 weeks after initiation/adjustment and periodically.
Available strengths
- tab 10, 20, 40 mg
Contraindications
- Concomitant use with strong CYP3A4 inhibitors
- Adrenal insufficiency
Cautions
- Hyperkalemia (greater with decreased kidney function/higher baseline potassium) — monitor
- Worsening of renal function in patients with heart failure
Adverse reactions
- Hyperkalemia
- Hypotension
- Hyponatremia
Pregnancy No human data; animal developmental toxicity at ~2x expected human exposure.
Lactation No data; avoid breastfeeding during treatment and for 1 day after.
Cost
| Strength | #/mo | generic $/mo | brand $/mo | CostPlus | |
|---|---|---|---|---|---|
| 10 mg | tab | 30 qd | — | $685.67 | not offered |
| 20 mg | tab | 30 qd | — | $685.55 | not offered |
| 40 mg | tab | 30 qd | — | $685.93 | not offered |
Generic entry2035 est.
NO BOXED WARNINGS
Principal riskHyperkalemia
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityHyperkalemia and kidney dysfunction, especially with RAAS blockers or impaired renal function.
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