Finerenone

KERENDIA

Open Finerenone in the interactive console ↗

Pronunciation: fin-ER-e-noen

Finerenone ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Finerenone ballicule

Finerenone KERENDIA mascot mnemonic cartoon — Visual mnemonic: Finerenone mascot
**“Finer renal K-renderer”**
Approved for CKD in type 2 diabetes
Bananas in bunches → ↑ serum potassium
“Finer” = nonsteroidal, highly selective for mineralocorticoid receptors
No relevant affinity for androgen, progesterone, estrogen, or glucocorticoid receptors
More cardio-renal benefit than other MRAs

What it isNonsteroidal mineralocorticoid receptor antagonist; CKD with type 2 diabetes, and heart failure with mildly reduced or preserved EF.

Why this oneCardiovascular and renal outcome benefit without the gynecomastia of spironolactone, because it is non-steroidal.

What limits itHyperkalemia is the limiting toxicity and needs a potassium check before and during. CYP3A4-dependent.

Pearls

Start 20 mg if eGFR ≥60, 10 mg if 25–59; avoid below 25.
Recheck potassium at 4 weeks; withhold above 5.5.

Finerenone molecular structure (skeletal formula) — Molecular structure: Finerenone

Finerenone prescription history

Animated chart of estimated U.S. prescriptions per year, Diuretics (1953–2026). Finerenone enters in 2021 (estimated).

FDA-approved for

chronic kidney disease in type 2 diabetes (2021)

Off-label

heart failure with preserved ejection fraction

Principal riskHyperkalemia

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryNot assigned — PLLR-era drug

Defining liabilityHyperkalemia and kidney dysfunction, especially with RAAS blockers or impaired renal function.

FDA label

Read the full label on DailyMed ↗

NO BOXED WARNINGS

FDA dosing	Population	Start	Target	Max
CKD associated with T2DM	adult	10–20 mg QD (by eGFR)	20 mg QD	20 mg QD
Heart failure with LVEF ≥40%	adult	10–20 mg QD (by eGFR)	20–40 mg QD	40 mg QD

Titration Up-titrate after 4 weeks based on serum potassium and eGFR.

Renal eGFR ≥60: start 20 mg QD; eGFR 25 to <60: start 10 mg QD; eGFR <25: initiation not recommended.

Hepatic Undefined

Instructions

Take with or without food.
May crush and mix with water or soft food (e.g., applesauce) if unable to swallow whole.
Measure serum potassium and eGFR before initiation; do not start if potassium >5.0 mEq/L.
Measure serum potassium 4 weeks after initiation/adjustment and periodically.

Available strengths

tab 10, 20, 40 mg

Contraindications

Concomitant use with strong CYP3A4 inhibitors
Adrenal insufficiency

Cautions

Hyperkalemia (greater with decreased kidney function/higher baseline potassium) — monitor
Worsening of renal function in patients with heart failure

Adverse reactions

Hyperkalemia
Hypotension
Hyponatremia

Pregnancy No human data; animal developmental toxicity at ~2x expected human exposure.

Lactation No data; avoid breastfeeding during treatment and for 1 day after.

Cost

Finerenone (KERENDIA)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	brand $/mo	CostPlus
10 mg	tab	30 qd	—	$685.67	not offered
20 mg	tab	30 qd	—	$685.55	not offered
40 mg	tab	30 qd	—	$685.93	not offered

Generic entry2035 est.

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Memory aids: interaction avatars

CYP3A4 substrate

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Self-check

Which spironolactone adverse effect does finerenone avoid?
Gynecomastia.
Which electrolyte needs checks before and during finerenone?
Potassium.