Finerenone is a novel non-steroidal mineralocorticoid receptor antagonist that plays an important role in the treatment of patients with chronic kidney disease complicated by type 2 diabetes mellitus and specific heart failure.
Adverse Effects of Finerenone
Risk of Hyperkalemia
Hyperkalemia is one of the most noteworthy adverse effects of finerenone.
Clinical data show that approximately 14% of patients taking the drug will experience elevated serum potassium levels, i.e., serum potassium exceeding the normal range.
Regular monitoring of serum potassium concentration is required during medication, especially in the initial stage of treatment and dose adjustment phase.
Impact on Blood Pressure Fluctuations
A subset of patients may experience hypotension, with an incidence rate of approximately 4.6%.
Regular monitoring of blood pressure changes is recommended during medication, and extra caution should be exercised especially when combined with other antihypertensive drugs.
Electrolyte Disturbances
Approximately 1.3% of patients may develop hyponatremia, characterized by decreased serum sodium levels.
Laboratory tests may reveal a slight increase in serum creatinine and a temporary decrease in estimated glomerular filtration rate (eGFR). These changes usually occur in the initial stage of treatment and then tend to stabilize.
Severe Adverse Effects of Finerenone
Life-threatening Hyperkalemia
When the serum potassium concentration exceeds 5.5 mEq/L, medication must be suspended and intervention measures should be taken immediately.
For patients with persistently elevated serum potassium (≥5.5 mEq/L), treatment should be restarted at a dose of 10 mg.
It is particularly noteworthy that patients with reduced renal function and high baseline serum potassium levels have a significantly increased risk of developing severe hyperkalemia.
Deterioration of Renal Function in Heart Failure Patients
In patients with heart failure, finerenone may cause further deterioration of renal function, which may even require hospitalization in severe cases.
Renal function must be evaluated before medication initiation. Treatment is not recommended if the estimated glomerular filtration rate (eGFR) is below 25 mL/min/1.73 m².
Allergic Reactions
Although relatively rare, post-marketing surveillance has reported allergic reactions including angioedema, skin rashes, and urticaria.
Medical attention should be sought immediately once relevant symptoms appear.
Precautions for Finerenone Administration
Pre-treatment Assessment and Monitoring
Serum potassium level and estimated glomerular filtration rate (eGFR) must be measured before the initiation of treatment.
Treatment should not be initiated if the serum potassium concentration is higher than 5.0 mEq/L.
A standardized monitoring plan should be established during treatment, with regular re-examinations conducted 4 weeks after initial treatment, 4 weeks after dose adjustment, and throughout the entire course of treatment.
Risks Associated with Enzyme Inhibitors
Potent CYP3A4 inhibitors can significantly increase the plasma concentration of finerenone and are therefore contraindicated for concomitant use.
Moderate and weak CYP3A4 inhibitors can also increase drug exposure, necessitating enhanced monitoring of serum potassium levels.
Food Interactions
Concurrent consumption of grapefruit or grapefruit juice should be avoided, as these foods may increase the plasma concentration of finerenone and raise the risk of adverse reactions.
Synergistic Effects with Other Drugs
When used in combination with drugs or supplements that affect serum potassium levels, more frequent monitoring of serum potassium is required.
In particular, when administered at a dose of 40 mg, finerenone can slightly inhibit CYP2C8, which may increase the exposure of relevant substrate drugs.
