finerenone
Brand: Kerendia
Prototype: spironolactone
Drug Class: mineralocorticoid receptor antagonist
Drug Family: diuretic
Subclass: non-steroidal selective MRA
Organ Systems: cardiovascularrenal
Mechanism of Action
Non-steroidal MRA with high aldosterone receptor selectivity; larger volume of distribution; reduces inflammation and fibrosis in kidneys and heart.
mineralocorticoid receptor
Indications
- CKD with type 2 diabetes (FIDELIO-DKD, FIGARO-DKD)
- HFrEF (FINEARTS-HF, emerging)
Contraindications
- hyperkalemia
- severe renal impairment
- Addison's disease
- strong CYP3A4 inhibitors
- grapefruit
Adverse Effects
Common
- hyperkalemia
- hypotension
- hyponatremia
Serious
- serious hyperkalemia
Pharmacokinetics (ADME)
| Absorption | ~43% oral bioavailability; reduced by grapefruit |
| Distribution | large Vd |
| Metabolism | CYP3A4 (major), CYP2C8 (minor) |
| Excretion | renal 80%, fecal 20% |
| Half-life | 2-3 hours |
| Onset | 0.5-1.25 hours |
| Peak | ~1.5 hours |
| Duration | 24 hours |
| Protein Binding | 92% |
| Vd | 52.6 L |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| strong CYP3A4 inhibitors | increased finerenone levels — contraindicated | major |
| ACE inhibitors/ARBs | additive hyperkalemia | major |
| grapefruit juice | increases finerenone AUC — avoid | moderate |
Nursing Considerations
- FIDELIO-DKD: reduced progression to ESRD in T2DM+CKD
- Monitor K+ at initiation and 1 month, then periodically
- Avoid grapefruit; avoid strong CYP3A4 inhibitors
- Non-steroidal: no hormonal side effects
Clinical Pearls
- First non-steroidal MRA approved for diabetic CKD
- FIDELIO-DKD + FIGARO-DKD: reduced CV events and CKD progression in T2DM
- No gynecomastia or menstrual effects unlike spironolactone
Safety Profile
Pregnancy avoid
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Required
TDM Not required
Guideline Update pending
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.