Recommended dose: 20 mg once a day; maximum dose: 20 mg once a day, orally, independent of food, not together with grapefruit or grapefruit juice! Forgotten dose: make up as soon as possible, but only on the same day; do not take a double dose!
Before starting treatment: it is mandatory to determine potassium and eGFR.
Decision to start treatment: only if potassium ≤4 .8 mmol/l.
if serum potassium ≥ 4.8- 5.0 mmol/l treatment may be considered taking into account the clinical situation and additional monitoring of the potassium level over 4 weeks.
Do not start treatment if potassium ≥5 mmol/l!
Monitoring: regular determination of eGFR and potassium obligatory during treatment! and, if necessary, additionally on the basis of patient characteristics.
Suspend ongoing treatmentif potassium ≥ 5.5 mmol/l! Follow guidelines for the treatment of hyperkalemia,
if potassium ≤ 5 mmol/l treatment can be continued under close monitoring, reduce dose if necessary.
Dose determination (starting dose) based on eGFR:
eGFR (ml/min/1.73 m2) Starting dose (once daily)
≥ 60 20 mg
≥ 25 to < 60 10 mg
< 25 Treatment with finerenone not recommended
Continuation of treatment in case of worsening of renal function impairment: at eGFR of ≥ 15 ml/min, treatment can be continued with dose adjustment according to potassium value and patient characteristics (dose regimens according to specialist information).
Current finerenone dose (once daily)
10 mg 20 mg
Current
potassium value
(mmol/l)≤ 4.8 increase to 20 mg once a day* maintain 20 mg once a day
> 4.8 to 5.5 Maintain 10 mg once a day Maintain 20 mg once a day
> 5.5 Discontinue finerenone Discontinue finerenone
If necessary, consider restarting with 10 mg once a day
if potassium ≤ 5.0 mmol/l.
(* Maintain 10 mg once daily if eGFR falls by > 30 % compared to the previous measurement)
In case of progression to terminal renal failure (eGFR < 15 ml/min/1.73 m2), discontinue treatment (insufficient clinical data).
Liver function impairment:
mild and moderate: no initial dose adjustment necessary; monitoring esp. serum potassium according to patient characteristics.
severe hepatic impairment: no use (no data available).
with concomitant medication that can lead to hyperkalemia : dose adjustment may also be necessary here! Close monitoring of potassium levels is also mandatory in this case!
Consider risk factors for increased risk of hyperkalemia: low eGFR, elevated serum potassium levels and previous episodes of hyperkalemia.