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Finerenone Dosage

Medically reviewed by Drugs.com. Last updated on Aug 9, 2021.

Applies to the following strengths: 10 mg; 20 mg

Usual Adult Dose for Chronic Kidney Disease

Initial dose:

  • For estimated glomerular filtration rate (eGFR) at least 60 mL/min/1.73 m2: 20 mg orally once a day
  • For eGFR 25 to less than 60 mL/min/1.73 m2: 10 mg orally once a day
Target dose: 20 mg orally once a day

Comments:
  • Initiation of therapy is not recommended if serum potassium is greater than 5 mEq/L; if serum potassium levels are greater than 4.8 to 5 mEq/L, initiation of therapy may be considered with additional serum potassium monitoring within the first 4 weeks based on clinical judgment and serum potassium levels.
  • Initiation of therapy is not recommended in patients with eGFR less than 25 mL/min/1.73 m2.

Use: To reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure in patients with chronic kidney disease associated with type 2 diabetes

Renal Dose Adjustments

Initial dose:

  • For eGFR at least 60 mL/min/1.73 m2: 20 mg orally once a day
  • For eGFR 25 to less than 60 mL/min/1.73 m2: 10 mg orally once a day
  • For eGFR less than 25 mL/min/1.73 m2: Not recommended.

Liver Dose Adjustments

Mild or moderate liver dysfunction (Child-Pugh A or B): No adjustment recommended.
Severe liver dysfunction (Child-Pugh C): Not recommended.

Comments:

  • In patients with moderate liver dysfunction, additional serum potassium monitoring should be considered.

Dose Adjustments

Serum potassium should be measured 4 weeks after initiating treatment and dose should be adjusted; serum potassium should be monitored 4 weeks after dose adjustment and throughout therapy, and dose should be adjusted as needed.

Dose Adjustment Based on Current Serum Potassium Level and Current Dose:
Dose: 10 mg orally once a day

  • Serum potassium 4.8 mEq/L or less: Dose should be increased to 20 mg orally once a day.
  • If eGFR has decreased by more than 30% compared to prior measurement: Dose should be maintained at 10 mg orally once a day.
  • Serum potassium greater than 4.8 to 5.5 mEq/L: Dose should be maintained at 10 mg orally once a day.
  • Serum potassium greater than 5.5 mEq/L: This drug should be withheld.
  • If serum potassium 5 mEq/L or less: Restarting at 10 mg orally once a day should be considered.

Dose: 20 mg orally once a day
  • Serum potassium 5.5 mEq/L or less: Dose should be maintained at 20 mg orally once a day.
  • Serum potassium greater than 5.5 mEq/L: This drug should be withheld.
  • If serum potassium 5 mEq/L or less: This drug should be restarted at 10 mg orally once a day.

Precautions

CONTRAINDICATIONS:

  • Concomitant treatment with strong CYP450 3A4 inhibitors
  • Adrenal insufficiency

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Comments:

  • This drug is highly bound to plasma proteins; efficient removal via hemodialysis is unlikely.

Other Comments

Administration advice:

  • Measure serum potassium levels and eGFR before treatment initiation.
  • If serum potassium is greater than 5 mEq/L, do not initiate therapy.
  • For patients unable to swallow whole tablets, the tablet may be crushed and mixed with water or soft foods (e.g., applesauce) immediately before use and administered orally.

Storage requirements:
  • Store at 20C to 25C (68F to 77F); excursions permitted to 15C to 30C (59F to 86F).

Monitoring:
  • General: Serum potassium (prior to and 4 weeks after initiation, 4 weeks after dose adjustment, and throughout therapy)
  • Renal: Estimated GFR (prior to and during therapy, as appropriate)

Patient advice:
  • If a dose is missed, take it as soon as you remember but only on the same day, otherwise skip the missed dose and take the next dose as scheduled.
  • Periodic monitoring of serum potassium levels is necessary; consult physician before using potassium supplements or salt substitutes containing potassium.
  • Avoid grapefruit and grapefruit juice while taking this drug.
  • Do not breastfeed during therapy and for 1 day after treatment.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.