As a novel non-steroidal mineralocorticoid receptor antagonist (nsMRA), finerenone demonstrates significant value in the treatment of chronic kidney disease complicated with type 2 diabetes mellitus, as well as heart failure with preserved ejection fraction.

Dosage and Administration, Recommended Dose of Finerenone

Administration Regimen

The standard administration method of finerenone is oral once daily, which can be taken with or without food without affecting drug absorption.

For patients with dysphagia, a special administration method is available: crush the tablet immediately and mix it with water or soft food such as applesauce before oral administration.

If a dose is missed, the patient should take the missed dose as soon as possible on the same day when remembered. If it cannot be supplemented on the same day, the missed dose should be skipped and the next dose should be taken as originally scheduled.

Initial Dose Selection

The determination of the initial dose must be strictly based on the patient's baseline renal function status (as measured by the estimated glomerular filtration rate, eGFR).

For patients with eGFR ≥ 60 mL/min/1.73 m², the recommended initial dose is 20 mg once daily.

For patients with eGFR between 25 and 60 mL/min/1.73 m², the recommended initial dose is 10 mg once daily.

For patients with eGFR < 25 mL/min/1.73 m², initiation of treatment is not recommended.

Serum potassium level must be measured before starting treatment. If the serum potassium concentration exceeds 5.0 mEq/L, treatment should not be initiated.

Dose Adjustment of Finerenone

Dose Management in Patients with Chronic Kidney Disease Complicated with Type 2 Diabetes Mellitus

The target dose for such patients is 20 mg orally once daily.

Serum potassium level should be monitored 4 weeks after the initiation of treatment, and the dose should be adjusted according to the following regimen.

For patients currently taking 10 mg once daily: the dose can be increased to 20 mg once daily when serum potassium ≤ 4.8 mEq/L; maintain 10 mg once daily when serum potassium is > 4.8–5.5 mEq/L; suspend administration when serum potassium > 5.5 mEq/L, and consider restarting treatment at 10 mg once daily when serum potassium ≤ 5.0 mEq/L.

For patients currently taking 20 mg once daily: suspend administration when serum potassium > 5.5 mEq/L, and restart treatment at 10 mg once daily when serum potassium ≤ 5.0 mEq/L.

If eGFR decreases by more than 30% compared with the previous measurement, maintain the dose at 10 mg and do not increase the dose.

Patients with Heart Failure

For patients with baseline eGFR ≥ 60 mL/min/1.73 m², the target dose is 40 mg once daily.

For patients with baseline eGFR between 25 and 60 mL/min/1.73 m², the target dose is 20 mg once daily.

Administration in Special Populations

Patients with Hepatic Impairment

No dose adjustment is required for patients with mild to moderate hepatic impairment, but enhanced monitoring of serum potassium should be considered for patients with moderate hepatic impairment.

Patients with severe hepatic impairment should avoid using finerenone.

Pregnant and Lactating Women

Regarding the use of finerenone during pregnancy, human data are limited. Animal studies have shown developmental toxicity at exposures approximately twice the human exposure level.

Lactating women should avoid breastfeeding during treatment and within 1 day after discontinuation of the drug.