Finerenone

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.