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Non-Steroidal Selective Mineralocorticoid Receptor Antagonist (MRA) — CKD in T2DM Pregnancy: There are no data from the use of finerenone in pregnant women; animal studies have shown reproductive toxicity. Kerendia should not be used during pregnancy unless the clinical condition of the woman requires treatment with finerenone; if a woman becomes pregnant while taking it she should be informed of potential risks to the foetus. Women of childbearing potential should use effective contraception during treatment. Breast-feeding: it is unknown whether finerenone or its metabolites are excreted in human milk; animal data show excretion in milk and adverse reactions in exposed rat pups, so a risk to the newborn/infant cannot be excluded — a decision must be made whether to discontinue breast-feeding or to discontinue/abstain from therapy. Fertility: no human data; animal studies showed impaired female fertility at exposures in excess of maximum human exposure, indicating low clinical relevance. (UK SPC section 4.6.)

Finerenone

Brand names: Kerendia

Finerenone is an oral non-steroidal selective mineralocorticoid receptor antagonist used to slow progression of chronic kidney disease associated with type 2 diabetes.

Adult dose

Dose: Chronic kidney disease (stage 3 and 4 with albuminuria) associated with type 2 diabetes, in adults — recommended TARGET dose 20 mg once daily. STARTING dose is eGFR-based: 10 mg once daily if eGFR is 25 to under 60 mL/min/1.73 m2; not recommended if eGFR is below 25. Initiate only if serum potassium is 4.8 mmol/L or below; if potassium is above 4.8 to 5.0 mmol/L initiation may be considered with additional potassium monitoring within the first 4 weeks; do not initiate if potassium is above 5.0 mmol/L. Remeasure serum potassium and eGFR 4 weeks after initiation and increase 10 mg to 20 mg once daily if potassium is 4.8 mmol/L or below — but maintain 10 mg once daily if eGFR has decreased by more than 30% compared with the previous measurement. SCOPE OF THIS FIGURE: the UK SPC Table 1 as sourced prints a starting dose only for the eGFR 25-to-under-60 band and 'not recommended' below 25 — it carries no row for eGFR 60 or above, so no starting dose is stated here for that band; check the current SPC. This is the CKD-with-type-2-diabetes regimen only; the heart failure (LVEF 40% or greater) regimen in the same SPC is different and is not applied on this page.
Route: Oral — tablets may be taken with a glass of water and with or without food. Tablets should not be taken with grapefruit or grapefruit juice. For patients unable to swallow whole tablets, tablets may be crushed and mixed with water or soft foods such as apple sauce directly before oral use.
Frequency: Once daily
Max: 20 mg once daily — SPC section 4.2 states verbatim 'The maximum recommended dose is 20 mg finerenone once daily' for chronic kidney disease associated with type 2 diabetes. (The 40 mg once daily maximum printed in the same SPC belongs to the separate heart failure with LVEF 40% or greater indication and must not be applied to this page.)
The fetched product's section 4.1 reads verbatim: 'Kerendia is indicated for the treatment of chronic kidney disease (stage 3 and 4 with albuminuria) associated with type 2 diabetes in adults. Kerendia is indicated for the treatment of symptomatic chronic heart failure with left ventricular ejection fraction (LVEF) >= 40% in adults.' Only the CKD-with-T2D regimen has been extracted. || PROVENANCE OF THE PUBLISHED FIGURES: every number above is quoted from section 4.2 of the UK SPC in this bundle. NO US LABELLING WAS USED FOR ANY PUBLISHED FIGURE. This corrects the previous draft, which imported the US label's 'eGFR >= 60 -> 20 mg' starting-dose row into the UK dose line; the 2026-09-10 refetch of the UK SPC again returns a Table 1 containing only 'eGFR >= 25 to < 60 -> 10 mg' and '< 25 Not recommended', so that band is left unstated in the dose text rather than filled from another jurisdiction's label. Under-stating a starting dose for the eGFR 60-or-above band is conservative (the target dose of 20 mg once daily is reached by titration at 4 weeks in any case); importing it would not be. || CONTINUATION (SPC Table 2, CKD with T2D). On 10 mg once daily: potassium 4.8 mmol/L or below - increase to 20 mg once daily, but maintain 10 mg if eGFR has decreased by more than 30% compared with the previous measurement; potassium above 4.8 to 5.5 - maintain 10 mg once daily; potassium above 5.5 - withhold, and consider re-starting at 10 mg once daily when potassium is 5.0 mmol/L or below. On 20 mg once daily: potassium 4.8 mmol/L or below, or above 4.8 to 5.5 - maintain 20 mg once daily; potassium above 5.5 - withhold, and re-start at 10 mg once daily when potassium is 5.0 mmol/L or below. || MISSED DOSE: take as soon as noticed, but only on the same day; do not take 2 doses to make up for a missed dose. || ELDERLY (65 years and over): no dose adjustment is necessary, but regular monitoring of renal function is recommended. || HEPATIC IMPAIRMENT: severe - do not initiate (no data); moderate - no initial dose adjustment, consider additional serum potassium monitoring; mild - no initial dose adjustment. || BODY WEIGHT: no dose adjustment is necessary based on body weight. || CONCOMITANT MEDICINES: with moderate or weak CYP3A4 inhibitors, potassium supplements, trimethoprim, or trimethoprim/sulfamethoxazole, consider additional serum potassium monitoring; temporary discontinuation of finerenone may be necessary when trimethoprim or trimethoprim/sulfamethoxazole must be taken. || PAEDIATRIC: section 4.2 states 'The safety and efficacy of finerenone in children and adolescents aged under 18 years have not yet been established. No data are available.' No paediatric dose is published and paedDose is null - verify any under-18 use against a children's formulary. || SEPARATE INDICATION, NOT THIS PAGE'S PRIMARY ONE - heart failure with LVEF 40% or greater: target dose depends on eGFR at initiation (40 mg once daily if eGFR is 60 mL/min/1.73 m2 or above, 20 mg once daily if eGFR is 25 to under 60), maximum recommended dose 40 mg once daily, initiate only if serum potassium is 5.0 mmol/L or below, starting dose per Table 3 (eGFR 60 or above - 20 mg; 25 to under 60 - 10 mg; below 25 - not recommended), with dose adjustment per Table 4. These figures are recorded here for completeness and are deliberately excluded from every dose field on this page. || SOURCE COMPLETENESS: sections 4.1, 4.2, 4.3 and 4.6 were retrieved complete and are the basis of everything above. Some sections of the product information we used were incomplete — check the full SPC. Section 4.5 is not exposed by eMC as a separate heading and its text is absorbed into the section 4.4 material quoted here - it is not missing. Source product: Kerendia 10 mg film coated tablets (UK SPC via eMC, product 13437), bundle fetched 2026-09-10.

Dose adjustments

Renal

Initiation: do not initiate if eGFR is below 25 mL/min/1.73 m2, due to limited clinical data (sections 4.2, 4.4). The recommended starting dose is eGFR-based; UK SPC Table 1 for chronic kidney disease associated with type 2 diabetes gives 10 mg once daily for eGFR 25 to under 60 mL/min/1.73 m2 and 'not recommended' below 25, and prints no row for eGFR 60 or above in the text as fetched — no figure has been supplied for that band from any other source. Continuation: in patients with eGFR 15 mL/min/1.73 m2 or above, treatment can be continued with dose adjustment based on serum potassium; eGFR should be measured 4 weeks after initiation to determine whether the starting dose can be increased. Discontinue in patients who have progressed to end-stage renal disease (eGFR below 15 mL/min/1.73 m2), due to limited clinical data. If eGFR has decreased by more than 30% compared with the previous measurement, maintain 10 mg once daily rather than up-titrating (Table 2 footnote).

Hepatic

Section 4.2, verbatim in substance: severe hepatic impairment — finerenone should not be initiated (no data available); moderate hepatic impairment — no initial dose adjustment is required, consider additional serum potassium monitoring and adapt monitoring according to patient characteristics; mild hepatic impairment — no initial dose adjustment is required.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients listed in section 6.1 (section 4.3)
  • Concomitant treatment with strong inhibitors of CYP3A4 (section 4.3) — e.g. itraconazole, ketoconazole, ritonavir, nelfinavir, cobicistat, clarithromycin, telithromycin, nefazodone
  • Addison's disease (section 4.3)

Side effects

  • Hyperkalaemia — 'the most frequently reported adverse reaction under treatment with finerenone was hyperkalaemia (12.6%)'; VERY COMMON in chronic kidney disease with type 2 diabetes (section 4.8, Table 5)
  • Common in CKD with type 2 diabetes: hyponatraemia; hyperuricaemia (section 4.8, Table 5)
  • Common in CKD with type 2 diabetes: hypotension (section 4.8, Table 5)
  • Common in CKD with type 2 diabetes: pruritus (section 4.8, Table 5)
  • Common in CKD with type 2 diabetes: blood creatinine increased / glomerular filtration rate decreased (section 4.8, Table 5)
  • Uncommon in CKD with type 2 diabetes: haemoglobin decreased (section 4.8, Table 5)
  • Reported in the SEPARATE heart failure with LVEF 40% or greater column of Table 5, not the CKD-with-type-2-diabetes column: diarrhoea, constipation, renal impairment and acute kidney injury (all common)
  • In the pooled FIDELIO-DKD and FIGARO-DKD data, hyperkalaemia events were reported in 14.0% of finerenone-treated patients versus 6.9% on placebo; serious hyperkalaemia 1.1% versus 0.2%; serum potassium above 5.5 mmol/L in 16.8% versus 7.4% and above 6.0 mmol/L in 3.3% versus 1.3%; permanent discontinuation for hyperkalaemia 1.7% versus 0.6% (section 4.8)
  • PROVENANCE: section 4.8 of the Kerendia SPC, which ends at the source-fetch limit part-way through the hyperkalaemia narrative — this list is not guaranteed complete

Interactions

  • Strong CYP3A4 inhibitors (itraconazole, ketoconazole, ritonavir, nelfinavir, cobicistat, clarithromycin, telithromycin, nefazodone) — concomitant treatment is CONTRAINDICATED (section 4.3)
  • Moderate or weak CYP3A4 inhibitors — consider additional serum potassium monitoring and adapt monitoring to patient characteristics (section 4.2)
  • Grapefruit and grapefruit juice — tablets should not be taken with grapefruit or grapefruit juice (section 4.2)
  • Potassium-sparing diuretics (e.g. amiloride, triamterene) — finerenone should NOT be given concomitantly (section 4.4)
  • Other mineralocorticoid receptor antagonists (e.g. eplerenone, esaxerenone, spironolactone, canrenone) — finerenone should NOT be given concomitantly (section 4.4)
  • Potassium supplements or potassium-enriched salt substitutes — use with caution and monitor serum potassium (section 4.4)
  • Trimethoprim, or trimethoprim/sulfamethoxazole — use with caution and monitor serum potassium; temporary discontinuation of finerenone may be necessary (section 4.4)
  • Other medicinal products that may increase serum potassium — the risk of hyperkalaemia may increase (section 4.4)

Monitoring

  • Measure serum potassium and eGFR BEFORE initiation, both to determine whether treatment can be started and to determine the starting dose (section 4.2)
  • Remeasure serum potassium and eGFR 4 weeks after initiation, re-start or dose adjustment; thereafter remeasure potassium periodically and as needed based on patient characteristics and potassium levels (sections 4.2 and 4.4)
  • Consider more frequent monitoring in patients at higher risk of hyperkalaemia — risk factors are low eGFR, higher serum potassium and previous episodes of hyperkalaemia (section 4.4)
  • CKD with type 2 diabetes (section 4.4): do not initiate if serum potassium is above 5.0 mmol/L; withhold if potassium exceeds 5.5 mmol/L and follow local guidelines for the management of hyperkalaemia; restart at 10 mg once daily once potassium is 5.0 mmol/L or below
  • Printed within the HEART FAILURE (Table 4) block of section 4.2 and quoted here with that scope: 'If eGFR decreases by >= 40% compared to the previous measurement, consider reducing the dose or withholding finerenone. Once eGFR levels have stabilised... consider increasing the dose or restarting treatment.' In the CKD-with-type-2-diabetes tables the corresponding trigger is a fall in eGFR of more than 30%, which prevents up-titration rather than requiring a dose reduction
  • Monitor renal function periodically in heart failure with LVEF 40% or greater, where an increased incidence of worsening renal function has been reported — a section 4.4 statement scoped to that separate indication
  • Women of childbearing potential should use effective contraception during finerenone treatment (section 4.6)

Clinical monograph

How it works

It blocks mineralocorticoid receptor overactivation, reducing inflammatory and fibrotic signalling in the kidney and heart that drives renal and cardiovascular damage.

Prescribing in practice

  • Hyperkalaemia is the key risk, so potassium and renal function must be checked before and during treatment and the drug avoided when potassium is elevated.
  • It should not be co-prescribed with strong CYP3A4 inhibitors, and potassium-sparing diuretics or supplements increase the risk of high potassium.
  • Initiation depends on baseline potassium and renal function, with treatment adjusted accordingly.

Monitoring

Monitor serum potassium and renal function before starting, after initiation and periodically thereafter.

Counselling the patient

  • Attend for the blood tests needed to check potassium and kidney function.
  • Avoid potassium supplements or salt substitutes unless advised, and tell clinicians about all your medicines.
  • Report symptoms such as muscle weakness or palpitations that could suggest high potassium.

Evidence & guidelines

The FIDELIO-DKD trial demonstrated that finerenone reduces chronic kidney disease progression in type 2 diabetes, supporting its NICE-recommended use.

Reference: MHRA Approval Kerendia March 2022; NICE TA877 (2023); Bakris et al. NEJM 2020 (FIDELIO-DKD); Pitt et al. NEJM 2021 (FIGARO-DKD); FIDELITY pooled analysis EJHF 2022; SPC Kerendia; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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