Finerenone

How it works

It selectively antagonises the mineralocorticoid receptor to attenuate aldosterone-mediated inflammation and fibrosis in renal and cardiac tissue, with a lower impact on serum electrolytes than steroidal MRAs.

Prescribing in practice

• Serum potassium must be checked before starting and monitored throughout, with initiation withheld if potassium exceeds the SPC limit because of hyperkalaemia risk.
• Co-administration with strong CYP3A4 inhibitors is contraindicated due to markedly increased drug levels.
• Do not use in Addison's disease, and avoid combining with potassium supplements or other potassium-sparing diuretics without careful review.

Monitoring

Check potassium and renal function before treatment and periodically thereafter, modifying dose or pausing therapy based on potassium levels.

Counselling the patient

• You will need ongoing blood tests to keep potassium and kidney function safe.
• Avoid salt substitutes containing potassium and disclose all concurrent medicines and supplements.
• Seek advice if you develop weakness, an irregular heartbeat or unusual tiredness.

Evidence & guidelines

FIDELIO-DKD and FIGARO-DKD established the renal and cardiovascular benefits of finerenone in diabetic CKD.