Drug reference

finerenone

Nonsteroidal Mineralocorticoid Receptor Antagonist · Diuretic

Nonsteroidal Mineralocorticoid Receptor AntagonistDiuretic

CDSCO approved

EXCRETION

—

not curated

INTERACTIONS

2 major

incl. contraindicated

PREGNANCY

FDA category + note

Top interactions

ItraconazoleContraindicatedTextbookG&G 14e · p570
KetoconazoleContraindicatedTextbookG&G 14e · p570

Mechanism

Finerenone competitively inhibits the binding of aldosterone to the mineralocorticoid receptor (MR). This blocks aldosterone's effects on gene expression, thereby preventing the synthesis of aldosterone-induced proteins (AIPs) that enhance Na+ reabsorption and K+/H+ secretion in the late distal tubule and collecting duct. It is a nonsteroidal MRA with very low affinity for progesterone and androgen receptors.

Indications

edema (coadministered with thiazide or loop diuretics)hypertension (coadministered with thiazide or loop diuretics)primary hyperaldosteronismrefractory edema associated with secondary aldosteronism (cardiac failure, hepatic cirrhosis, nephrotic syndrome, severe ascites)hepatic cirrhosisheart failure with reduced ejection fraction (as adjunct to standard therapy)proteinuria in chronic kidney diseasedecrease the risk of renal function decline in adult patients with CKD associated with type 2 diabetesdecrease the risk of nonfatal myocardial infarction in adult patients with CKD associated with type 2 diabetesdecrease the risk of hospitalization for heart failure in adult patients with CKD associated with type 2 diabetesdecrease the risk of death due to cardiovascular disease in adult patients with CKD associated with type 2 diabetesreduce the risk of end-stage kidney disease in diabetic patients with CKDheart failurehypertensionhyperaldosteronismhypokalemiaasciteschronic kidney disease in diabetic patients

Dosing

Adult: 10–20 mg once daily
Renal adjustment: Starting dose should be decreased from 20 mg to 10 mg in patients with creatinine clearance ≤60 mL/min.

Pharmacokinetics

Half-life

Bioavailability

44%

Metabolism

eliminated primarily by metabolism by CYP3A4 to inactive metabolites

Contraindications

hyperkalemia
patients at increased risk of developing hyperkalemia (e.g., renal failure)
creatinine clearance ≤25 mL/min
strong inhibitors of CYP3A4 (e.g., ketoconazole, itraconazole)

Side effects

Common

reduces heart failure events and renal function decline in diabetic patients with chronic kidney diseaseHyperkalemia, especially in CKD and with potassium-sparing agents

Serious