Finerenone
Potassium-sparing diuretics
Potassium-sparing diuretics
A non-steroidal tablet that blocks the aldosterone (mineralocorticoid) receptor. It protects kidneys and heart in diabetic kidney disease.
Quick facts
- Group
- Potassium-sparing diuretics
- Target
- Mineralocorticoid receptor (NR3C2)
- Used for
- Chronic kidney disease
- Key effects
- Hyperkalaemia · Dizziness or feeling faint
- Monitor
- Serum potassium · Blood pressure
- ATC
- C03DA05
No doses: the clinician sets them by the current guideline.
Mechanism of action
Finerenone is a non-steroidal antagonist of the mineralocorticoid receptor. Overactivation of this receptor by aldosterone and cortisol drives inflammation and fibrosis in the kidney and heart. Blocking it slows the loss of kidney function and lowers cardiovascular events in people with type 2 diabetes and chronic kidney disease. Unlike spironolactone it binds androgen and progesterone receptors much less, and it causes somewhat less (but still significant) hyperkalaemia.
- Finerenone blocks the mineralocorticoid receptor
- Aldosterone-driven inflammation and fibrosis are reduced
- Albuminuria falls and kidney decline slows
- Potassium is retained, so serum potassium can rise
Indications
- Chronic kidney disease with type 2 diabetes, to slow kidney decline and lower cardiovascular death, heart attack and heart failure hospitalisation Diabetic kidney disease →
Adverse effects
Common
- Hyperkalaemia
- Dizziness or feeling faint (low blood pressure)
Contraindications
- Use with strong CYP3A4 inhibitors (such as ketoconazole, itraconazole, clarithromycin, ritonavir)
- Adrenal insufficiency
- High serum potassium before starting
Key interactions
- Strong CYP3A4 inhibitors (ketoconazole, itraconazole, voriconazole, clarithromycin, ritonavir)
- Much higher finerenone levels and hyperkalaemia; the combination is avoided
- Grapefruit juice
- Raises finerenone levels; avoided
- St John's wort and other CYP3A4 inducers
- Lower finerenone levels and less effect
- Potassium supplements and potassium-containing salt substitutes
- Additive rise in serum potassium
What is monitored
- Serum potassium and eGFR before starting and during treatment
- Blood pressure
- Urine albumin-creatinine ratio
Administration and safety
- Tablets may be crushed and mixed with water or soft food for people who cannot swallow them
- Medication history is checked for CYP3A4 inhibitors before each new prescription
- Look-alike risk with other mineralocorticoid antagonists (spironolactone, eplerenone): they are not interchangeable
Pregnancy and breastfeeding
Data in pregnancy are limited; it is not used unless clearly needed. Breastfeeding is avoided during treatment and for a day after the last dose.
Nursing care
- Check potassium and kidney function results before giving
- Teach the signs of high potassium: muscle weakness, cramps, palpitations
- Advise avoiding grapefruit and potassium-containing salt substitutes
- Rise slowly if dizzy
Pharmacokinetics
- Absorption
- Taken by mouth, with or without food
- Metabolism
- Metabolised by CYP3A4, so strong CYP3A4 inhibitors and inducers change its levels
Test yourself
Think of the answer, then tap the question to see it.
How does finerenone differ chemically and clinically from spironolactone?
It is non-steroidal, binds androgen and progesterone receptors much less (little gynaecomastia), and causes somewhat less hyperkalaemia.
What is the main laboratory risk of finerenone?
Hyperkalaemia; potassium and eGFR are checked before and during treatment.
Why are strong CYP3A4 inhibitors avoided with finerenone?
Finerenone is cleared by CYP3A4, so inhibitors raise its levels sharply and with them the risk of hyperkalaemia.
In which patients does finerenone slow kidney disease?
Adults with chronic kidney disease and type 2 diabetes.
Connections
← Back to the class: Potassium-sparing diuretics
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Finerenone: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.