Finerenone is an oral non-steroidal mineralocorticoid receptor antagonist indicated to reduce the risk of sustained estimated glomerular filtration rate (eGFR) decline, end-stage kidney disease (ESKD), cardiovascular (CV) death, non-fatal myocardial infarction (MI), and hospitalization for heart failure in adults with chronic kidney disease (CKD) associated with type 2 diabetes mellitus (T2DM). In a randomized, double-blind, placebo-controlled, multicenter study in adult patients with CKD associated with T2DM (FIDELIO-DKD; n = 5,674), finerenone reduced the incidence of the primary composite endpoint of a sustained decline in eGFR of 40% or more, kidney failure, or renal death (HR 0.82, 95% CI 0.73 to 0.93, p = 0.001). The treatment effect reflected a reduction in a sustained decline in eGFR of 40% or more and progression to kidney failure. Finerenone also reduced the incidence of the secondary composite endpoint of CV death, non-fatal MI, non-fatal stroke or hospitalization for heart failure (HR 0.86, 95% CI 0.75 to 0.99, p = 0.034). In another randomized, double-blind, placebo-controlled, multicenter study in adult patients with CKD associated with T2DM (FIGARO DKD; n = 7,352), finerenone reduced the incidence of the primary composite endpoint of CV death, non-fatal MI, non-fatal stroke or hospitalization for heart failure (HR 0.87, 95% CI 0.76 to 0.98, p = 0.026). The treatment effect was mainly driven by an effect on hospitalization for heart failure, though CV death also contributed to the treatment effect. Guidelines recommend the use of finerenone in patients with T2DM and CKD who are at increased risk for CV events or CKD progression or who are unable to use a sodium-glucose co-transporter 2 (SGLT2) inhibitor. Finerenone is metabolized by CYP3A4 and is subject to many drug interactions that increase the likelihood of developing hyperkalemia, the principal risk associated with finerenone.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
Route-Specific Administration
Oral Administration
Oral Solid Formulations
-May administer without regard to food.
-For patients who are unable to swallow whole tablets, the tablets may be crushed and mixed with water or soft foods such as applesauce immediately prior to use.
-Missed dose: If a dose is missed, administer as soon as possible on the same day. If this is not possible, skip the missed dose and continue with the next dose as prescribed.
Initiation of finerenone treatment may cause an initial small decrease in estimated glomerular filtration rate (eGFR) that occurs within the first 4 weeks of starting therapy, and then stabilizes. In a study that included patients with chronic kidney disease associated with type 2 diabetes, this decrease was reversible after treatment discontinuation. Initiation of finerenone may also cause a small increase in serum uric acid. This increase appears to attenuate over time.
In 2 randomized, double-blind, placebo-controlled clinical studies, in which 6,510 patients received finerenone 10 mg or 20 mg once daily, the most commonly reported adverse reactions reported with finerenone and occurring more frequently than placebo were hyperkalemia (14% vs. 7%), hypotension (5% vs. 4%), and hyponatremia (1.3% vs. 0.7%). Hyperkalemia led to permanent discontinuation in 1.7% of patients receiving finerenone compared to 0.6% of patients receiving placebo. Hospitalization due to hyperkalemia occurred in 0.9% in the finerenone group vs. 0.2% in the placebo group. Monitor serum potassium before initiation of finerenone therapy and 4 weeks after the start of treatment or a dose adjustment. Do not initiate finerenone treatment if serum potassium is more than 5 mEq/L. Withhold finerenone if serum potassium increases to more than 5.5 mEq/L during treatment.
Finerenone is a CYP3A4 substrate and concomitant use with a strong CYP3A4 inhibitor increases finerenone exposure very significantly, which may increase the risk of adverse reactions due to the drug. Concomitant use of finerenone with strong CYP3A4 inhibitors is contraindicated.
Finerenone is contraindicated in patients with adrenal insufficiency. Finerenone is potassium-sparing and these patients are predisposed to elevated potasium concentrations.
Finerenone can cause hyperkalemia. The risk for developing hyperkalemia increases with decreasing kidney function and is greater in patients with higher baseline potassium concentrations or other risk factors for hyperkalemia. Initiation of finerenone is not recommended in patients with severe renal impairment or renal failure (eGFR less than 25 mL/minute/1.73 m2). Measure serum potassium concentration and estimated glomerular filtration rate (eGFR) before initiation; do not initiate finerenone treatment if serum potassium is more than 5 mEq/L. If serum potassium concentration is more than 4.8 to 5 mEq/L, initiation of finerenone treatment may be considered with additional serum potassium monitoring within the first 4 weeks based on clinical judgement and serum potassium concentrations. Monitor serum potassium 4 weeks after initiation of treatment or a dose adjustment and throughout treatment, and adjust the dose as needed. Withhold finerenone if serum potassium increases to more than 5.5 mEq/L during treatment. More frequent monitoring may be necessary for patients at risk for hyperkalemia, including those on concomitant medications that impair potassium excretion or increase serum potassium.
Avoid use of finerenone in patients with severe hepatic disease or impairment (Child Pugh C). No dosage adjustment is recommended in patients with mild or moderate hepatic impairment (Child Pugh A or B); however, consider more frequent serum potassium monitoring in patients with moderate hepatic impairment (Child Pugh B).
There are no available data on finerenone use in human pregnancy to evaluate for a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. Animal studies have shown developmental toxicity at exposures about 4 times those expected in humans, but the clinical implications of those findings in humans are unclear.
Avoid breast-feeding during finerenone treatment and for 1 day after treatment due to the potential risk to breastfed infants from exposure to finerenone. Although there are no data on the presence of finerenone or its metabolite in human milk, the effects on the breastfed infant, or the effects of the drug on milk production, a pre- and postnatal developmental toxicity study in rats has shown increased pup mortality and lower pup weight at about 4 times the AUCunbound expected in humans. These findings suggest that finerenone is present in rat milk. When a drug is present in animal milk, it is likely that the drug will be present in human milk.
For the treatment of chronic kidney disease associated with type 2 diabetes mellitus (diabetic nephropathy) to reduce the risk of sustained eGFR decline and end-stage kidney disease, non-fatal myocardial infarction, reduction of cardiovascular mortality, and reduction of heart failure hospitalizations:
Oral dosage:
Adults: 20 mg PO once daily. Adjust dose based on serum potassium concentrations every 4 weeks as needed. Dose range: 10 to 20 mg PO once daily.
Therapeutic Drug Monitoring:
Dosage adjustments in adults based on serum potassium concentration
Serum potassium 4.8 mEq/L or less:
-Current dose 10 mg/day: Increase dose to 20 mg PO once daily; if eGFR has decreased by more than 30% compared to previous measurement, maintain 10 mg/day dose.
-Current dose 20 mg/day: Maintain current dose.
Serum potassium more than 4.8 and up to 5.5 mEq/L: Maintain current dose. Do NOT initiate therapy in a patient not taking the drug currently if serum potassium is more than 5 mEq/L.
Serum potassium more than 5.5 mEq/L:
-Current dose 10 mg/day: Hold dose; consider 10 mg PO once daily when serum potassium concentration is less than 5 mEq/L.
-Current dose 20 mg/day: Hold dose; restart 10 mg PO once daily when serum potassium concentration is less than 5 mEq/L.
Maximum Dosage Limits:
-Adults
20 mg/day PO.
-Geriatric
20 mg/day PO.
-Adolescents
Safety and efficacy have not been established.
-Children
Safety and efficacy have not been established.
-Infants
Safety and efficacy have not been established.
-Neonates
Safety and efficacy have not been established.
Patients with Hepatic Impairment Dosing
Mild or moderate hepatic impairment (Child Pugh A or B): No dosage adjustment necessary.
Severe hepatic impairment (Child Pugh C): Avoid use.
Patients with Renal Impairment Dosing
eGFR 60 mL/minute/1.73 m2 or more: No dosage adjustment necessary.
eGFR 25 to 59 mL/minute/1.73 m2: 10 mg PO once daily initially; may increase to 20 mg PO once daily after 4 weeks if serum potassium concentration is 4.8 mEq/L or less and eGFR has not decreased by more than 30% compared to previous measurement.
eGFR less than 25 mL/minute/1.73 m2: Initiation is not recommended.
Intermittent hemodialysis
Use not recommended. Finerenone is unlikely to be efficiently removed by hemodialysis given its high plasma protein binding of approximately 90%.
*non-FDA-approved indication
Adagrasib: (Contraindicated) Concomitant use of finerenone and adagrasib is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and adagrasib is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Amiloride: (Moderate) Monitor serum potassium concentrations closely if finerenone and potassium-sparing diuretics are used together. Concomitant use may increase the risk of hyperkalemia.
Amiloride; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and potassium-sparing diuretics are used together. Concomitant use may increase the risk of hyperkalemia.
Amiodarone: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or amiodarone; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and amiodarone is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Amlodipine: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or amlodipine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Amlodipine; Atorvastatin: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or amlodipine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Amlodipine; Benazepril: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia. (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or amlodipine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Amlodipine; Celecoxib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or amlodipine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Amlodipine; Olmesartan: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or amlodipine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Amlodipine; Valsartan: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or amlodipine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or amlodipine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Amobarbital: (Major) Avoid concurrent use of finerenone and amobarbital due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and amobarbital is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Amoxicillin; Clarithromycin; Omeprazole: (Contraindicated) Concomitant use of finerenone and clarithromycin is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and clarithromycin is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Angiotensin II receptor antagonists: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Angiotensin-converting enzyme inhibitors: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Apalutamide: (Major) Avoid concurrent use of finerenone and apalutamide due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and apalutamide is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased overall exposure to finerenone by 90%.
Aprepitant, Fosaprepitant: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or aprepitant, fosaprepitant; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and aprepitant, fosaprepitant is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Asciminib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or asciminib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and asciminib is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Aspirin, ASA; Butalbital; Caffeine: (Major) Avoid concurrent use of finerenone and butalbital due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and butalbital is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Atazanavir: (Contraindicated) Concomitant use of finerenone and atazanavir is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and atazanavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Atazanavir; Cobicistat: (Contraindicated) Concomitant use of finerenone and atazanavir is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and atazanavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%. (Contraindicated) Concomitant use of finerenone and cobicistat is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and cobicistat is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Avacopan: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or avacopan; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and avacopan is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Azilsartan: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Azilsartan; Chlorthalidone: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Belumosudil: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or belumosudil; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and belumosudil is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Benazepril: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Benazepril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Berotralstat: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or berotralstat; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and berotralstat is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Bexarotene: (Major) Avoid concurrent use of finerenone and bexarotene due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and bexarotene is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Bicalutamide: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or bicalutamide; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and bicalutamide is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Bosentan: (Major) Avoid concurrent use of finerenone and bosentan due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and bosentan is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Butalbital; Acetaminophen: (Major) Avoid concurrent use of finerenone and butalbital due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and butalbital is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Butalbital; Acetaminophen; Caffeine: (Major) Avoid concurrent use of finerenone and butalbital due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and butalbital is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Butalbital; Acetaminophen; Caffeine; Codeine: (Major) Avoid concurrent use of finerenone and butalbital due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and butalbital is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Butalbital; Aspirin; Caffeine; Codeine: (Major) Avoid concurrent use of finerenone and butalbital due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and butalbital is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Candesartan: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Candesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Capivasertib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or capivasertib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and capivasertib is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Captopril: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Captopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Carbamazepine: (Major) Avoid concurrent use of finerenone and carbamazepine due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and carbamazepine is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased overall exposure to finerenone by 90%.
Cenobamate: (Major) Avoid concurrent use of finerenone and cenobamate due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and cenobamate is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Ceritinib: (Contraindicated) Concomitant use of finerenone and ceritinib is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and ceritinib is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Chloramphenicol: (Contraindicated) Concomitant use of finerenone and chloramphenicol is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and chloramphenicol is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Cimetidine: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or cimetidine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and cimetidine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Ciprofloxacin: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or ciprofloxacin; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and ciprofloxacin is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Citric Acid; Potassium Citrate; Sodium Citrate: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and finerenone are used together. Concomitant use may increase the risk of hyperkalemia.
Clarithromycin: (Contraindicated) Concomitant use of finerenone and clarithromycin is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and clarithromycin is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Clofazimine: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or clofazimine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and clofazimine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Cobicistat: (Contraindicated) Concomitant use of finerenone and cobicistat is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and cobicistat is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Conivaptan: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or conivaptan; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and conivaptan is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Crizotinib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or crizotinib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and crizotinib is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Cyclosporine: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or cyclosporine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and cyclosporine is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Dabrafenib: (Major) Avoid concurrent use of finerenone and dabrafenib due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and dabrafenib is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Dalfopristin; Quinupristin: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or dalfopristin; quinupristin; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and dalfopristin; quinupristin is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Danazol: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or danazol; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and danazol is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Daridorexant: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or daridorexant; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and daridorexant is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Darunavir: (Contraindicated) Concomitant use of finerenone and darunavir is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and darunavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Darunavir; Cobicistat: (Contraindicated) Concomitant use of finerenone and cobicistat is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and cobicistat is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%. (Contraindicated) Concomitant use of finerenone and darunavir is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and darunavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: (Contraindicated) Concomitant use of finerenone and cobicistat is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and cobicistat is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%. (Contraindicated) Concomitant use of finerenone and darunavir is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and darunavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Delavirdine: (Contraindicated) Concomitant use of finerenone and delavirdine is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and delavirdine is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Diltiazem: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or diltiazem; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and diltiazem is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Dronedarone: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or dronedarone; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia.
Drospirenone: (Moderate) Monitor serum potassium concentrations closely if finerenone and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone.
Drospirenone; Estetrol: (Moderate) Monitor serum potassium concentrations closely if finerenone and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone.
Drospirenone; Estradiol: (Moderate) Monitor serum potassium concentrations closely if finerenone and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone.
Drospirenone; Ethinyl Estradiol: (Moderate) Monitor serum potassium concentrations closely if finerenone and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone.
Drospirenone; Ethinyl Estradiol; Levomefolate: (Moderate) Monitor serum potassium concentrations closely if finerenone and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone.
Duvelisib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or duvelisib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and duvelisib is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Efavirenz: (Major) Avoid concurrent use of finerenone and efavirenz due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and efavirenz is a moderate CYP3A inducer. Coadministration with efavirenz decreased overall exposure to finerenone by 80%.
Efavirenz; Emtricitabine; Tenofovir Disoproxil Fumarate: (Major) Avoid concurrent use of finerenone and efavirenz due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and efavirenz is a moderate CYP3A inducer. Coadministration with efavirenz decreased overall exposure to finerenone by 80%.
Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: (Major) Avoid concurrent use of finerenone and efavirenz due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and efavirenz is a moderate CYP3A inducer. Coadministration with efavirenz decreased overall exposure to finerenone by 80%.
Elagolix: (Major) Avoid concurrent use of finerenone and elagolix due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and elagolix is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Elagolix; Estradiol; Norethindrone acetate: (Major) Avoid concurrent use of finerenone and elagolix due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and elagolix is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Elbasvir; Grazoprevir: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or grazoprevir; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and grazoprevir is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Elexacaftor; tezacaftor; ivacaftor: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or ivacaftor; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and ivacaftor is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: (Contraindicated) Concomitant use of finerenone and cobicistat is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and cobicistat is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Contraindicated) Concomitant use of finerenone and cobicistat is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and cobicistat is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Enalapril, Enalaprilat: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Encorafenib: (Major) Avoid concurrent use of finerenone and encorafenib due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and encorafenib is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased overall exposure to finerenone by 90%.
Enzalutamide: (Major) Avoid concurrent use of finerenone and enzalutamide due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and enzalutamide is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased overall exposure to finerenone by 90%.
Eplerenone: (Moderate) Monitor serum potassium concentrations closely if finerenone and eplerenone are used together. Concomitant use may increase the risk of hyperkalemia.
Eprosartan: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Eprosartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Erythromycin: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or erythromycin; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and erythromycin is a moderate CYP3A inhibitor. Coadministration with erythromycin increased overall exposure to finerenone by 248%.
Eslicarbazepine: (Major) Avoid concurrent use of finerenone and eslicarbazepine due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and eslicarbazepine is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Etravirine: (Major) Avoid concurrent use of finerenone and etravirine due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and etravirine is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Everolimus: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or everolimus; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and everolimus is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Fedratinib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or fedratinib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and fedratinib is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Fexinidazole: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or fexinidazole; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and fexinidazole is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Fluconazole: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or fluconazole; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and fluconazole is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Fluvoxamine: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or fluvoxamine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and fluvoxamine is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Fosamprenavir: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or fosamprenavir; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and fosamprenavir is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Fosinopril: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Fosphenytoin: (Major) Avoid concurrent use of finerenone and phenytoin/fosphenytoin due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and phenytoin and fosphenytoin are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased overall exposure to finerenone by 90%.
Fostamatinib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or fostamatinib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and fostamatinib is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Grapefruit juice: (Major) Advise patients to avoid grapefruit and grapefruit juice during finerenone treatment due to the risk of increased finerenone exposure and adverse reactions. Finerenone is a CYP3A substrate and grapefruit juice is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Hydrochlorothiazide, HCTZ; Moexipril: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Ibritumomab Tiuxetan: (Moderate) Monitor serum potassium concentrations closely if finerenone and potassium supplements are used together. Concomitant use may increase the risk of hyperkalemia. (Moderate) Monitor serum potassium concentrations closely if potassium supplements and finerenone are used together. Concomitant use may increase the risk of hyperkalemia.
Idelalisib: (Contraindicated) Concomitant use of finerenone and idelalisib is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and idelalisib is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Imatinib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or imatinib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and imatinib is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Indinavir: (Contraindicated) Concomitant use of finerenone and indinavir is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and indinavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Iodine; Potassium Iodide, KI: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and finerenone are used together. Concomitant use may increase the risk of hyperkalemia.
Irbesartan: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Irbesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Isavuconazonium: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or isavuconazole; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and isavuconazole is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Isoniazid, INH: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or isoniazid; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and isoniazid is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Isoniazid, INH; Pyrazinamide, PZA; Rifampin: (Major) Avoid concurrent use of finerenone and rifampin due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and rifampin is a strong CYP3A inducer. Coadministration with rifampin decreased overall exposure to finerenone by 90%. (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or isoniazid; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and isoniazid is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Isoniazid, INH; Rifampin: (Major) Avoid concurrent use of finerenone and rifampin due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and rifampin is a strong CYP3A inducer. Coadministration with rifampin decreased overall exposure to finerenone by 90%. (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or isoniazid; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and isoniazid is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Istradefylline: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or istradefylline; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and istradefylline is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Itraconazole: (Contraindicated) Concomitant use of finerenone and itraconazole is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and itraconazole is a strong CYP3A inhibitor. Coadministration with itraconazole increased overall exposure to finerenone by more than 400%.
Ivacaftor: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or ivacaftor; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and ivacaftor is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Ketoconazole: (Contraindicated) Concomitant use of finerenone and ketoconazole is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and ketoconazole is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Lansoprazole; Amoxicillin; Clarithromycin: (Contraindicated) Concomitant use of finerenone and clarithromycin is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and clarithromycin is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Lapatinib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or lapatinib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and lapatinib is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Larotrectinib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or larotrectinib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and larotrectinib is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Lefamulin: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or oral lefamulin; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and oral lefamulin is a moderate CYP3A inhibitor; an interaction is not expected with intravenous lefamulin. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Lenacapavir: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or lenacapavir; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and lenacapavir is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Letermovir: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or letermovir; a finerenone dosage reduction may be necessary. This combination is contraindicated if the patient is also receiving cyclosporine because the magnitude of the interaction may be amplified. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate. Letermovir is a moderate CYP3A inhibitor; however, when given with cyclosporine, the combined effect on CYP3A substrates is similar to a strong CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%; a strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Levamlodipine: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or amlodipine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Levoketoconazole: (Contraindicated) Concomitant use of finerenone and ketoconazole is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and ketoconazole is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Lisinopril: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Lisinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Lonafarnib: (Contraindicated) Concomitant use of finerenone and lonafarnib is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and lonafarnib is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Lopinavir; Ritonavir: (Contraindicated) Concomitant use of finerenone and ritonavir is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and ritonavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Lorlatinib: (Major) Avoid concurrent use of finerenone and lorlatinib due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and lorlatinib is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Losartan: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Losartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Lumacaftor; Ivacaftor: (Major) Avoid concurrent use of finerenone and lumacaftor; ivacaftor due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and lumacaftor; ivacaftor is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased overall exposure to finerenone by 90%. (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or ivacaftor; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and ivacaftor is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Lumacaftor; Ivacaftor: (Major) Avoid concurrent use of finerenone and lumacaftor; ivacaftor due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and lumacaftor; ivacaftor is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased overall exposure to finerenone by 90%.
Maribavir: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or maribavir; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and maribavir is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Mavacamten: (Major) Avoid concurrent use of finerenone and mavacamten due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and mavacamten is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Methohexital: (Major) Avoid concurrent use of finerenone and methohexital due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and methohexital is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Mifepristone: (Contraindicated) Concomitant use of finerenone and mifepristone is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and mifepristone is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Mitotane: (Major) Avoid concurrent use of finerenone and mitotane due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and mitotane is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased overall exposure to finerenone by 90%.
Moexipril: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Nafcillin: (Major) Avoid concurrent use of finerenone and nafcillin due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and nafcillin is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Nebivolol; Valsartan: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Nefazodone: (Contraindicated) Concomitant use of finerenone and nefazodone is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and nefazodone is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Nelfinavir: (Contraindicated) Concomitant use of finerenone and nelfinavir is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and nelfinavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Netupitant, Fosnetupitant; Palonosetron: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or netupitant; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and netupitant is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Nilotinib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or nilotinib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and nilotinib is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Nirmatrelvir; Ritonavir: (Contraindicated) Concomitant use of finerenone and ritonavir is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and ritonavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%. (Contraindicated) Concomitant use of ritonavir-boosted nirmatrelvir and finerenone is contraindicated due to the potential for serious adverse reactions including hyperkalemia, hypotension, and hyponatremia; consider an alternative COVID-19 therapy. Coadministration may increase finerenone exposure resulting in increased toxicity. Finerenone is a CYP3A4 substrate and nirmatrelvir is a CYP3A inhibitor.
Nirogacestat: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or nirogacestat; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and nirogacestat is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Olmesartan: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or amlodipine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Olmesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Omeprazole; Amoxicillin; Rifabutin: (Major) Avoid concurrent use of finerenone and rifabutin due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and rifabutin is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Osilodrostat: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or osilodrostat; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and osilodrostat is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Pacritinib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or pacritinib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and pacritinib is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Palbociclib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or palbociclib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and palbociclib is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Pazopanib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or pazopanib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and pazopanib is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Penicillin G: (Moderate) Monitor serum potassium concentrations closely if finerenone and penicillin G potassium are used together. Concomitant use may increase the risk of hyperkalemia. Penicillin G potassium contains 1.7 mEq of potassium per million units of penicillin G activity.
Perindopril: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Perindopril; Amlodipine: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia. (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or amlodipine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Pexidartinib: (Major) Avoid concurrent use of finerenone and pexidartinib due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and pexidartinib is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Phenobarbital: (Major) Avoid concurrent use of finerenone and phenobarbital due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and phenobarbital is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased overall exposure to finerenone by 90%.
Phenobarbital; Hyoscyamine; Atropine; Scopolamine: (Major) Avoid concurrent use of finerenone and phenobarbital due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and phenobarbital is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased overall exposure to finerenone by 90%.
Phenytoin: (Major) Avoid concurrent use of finerenone and phenytoin/fosphenytoin due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and phenytoin and fosphenytoin are strong CYP3A inducers. Coadministration with another strong CYP3A inducer decreased overall exposure to finerenone by 90%.
Pirtobrutinib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or pirtobrutinib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and pirtobrutinib is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Posaconazole: (Contraindicated) Concomitant use of finerenone and posaconazole is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and posaconazole is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Potassium Acetate: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and finerenone are used together. Concomitant use may increase the risk of hyperkalemia.
Potassium Bicarbonate: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and finerenone are used together. Concomitant use may increase the risk of hyperkalemia.
Potassium Chloride: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and finerenone are used together. Concomitant use may increase the risk of hyperkalemia.
Potassium Citrate: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and finerenone are used together. Concomitant use may increase the risk of hyperkalemia.
Potassium Citrate; Citric Acid: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and finerenone are used together. Concomitant use may increase the risk of hyperkalemia.
Potassium Gluconate: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and finerenone are used together. Concomitant use may increase the risk of hyperkalemia.
Potassium Iodide, KI: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and finerenone are used together. Concomitant use may increase the risk of hyperkalemia.
Potassium Phosphate: (Moderate) Monitor serum potassium concentrations closely if finerenone and potassium supplements are used together. Concomitant use may increase the risk of hyperkalemia.
Potassium Phosphate; Sodium Phosphate: (Moderate) Monitor serum potassium concentrations closely if finerenone and potassium supplements are used together. Concomitant use may increase the risk of hyperkalemia.
Potassium: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and finerenone are used together. Concomitant use may increase the risk of hyperkalemia.
Primidone: (Major) Avoid concurrent use of finerenone and primidone due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and primidone is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased overall exposure to finerenone by 90%.
Quinapril: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Quinapril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Quinine: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or quinine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and quinine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Ramipril: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Ranolazine: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or ranolazine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and ranolazine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Repotrectinib: (Major) Avoid concurrent use of finerenone and repotrectinib due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and repotrectinib is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Ribociclib: (Contraindicated) Concomitant use of finerenone and ribociclib is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and ribociclib is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Ribociclib; Letrozole: (Contraindicated) Concomitant use of finerenone and ribociclib is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and ribociclib is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Rifabutin: (Major) Avoid concurrent use of finerenone and rifabutin due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and rifabutin is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Rifampin: (Major) Avoid concurrent use of finerenone and rifampin due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and rifampin is a strong CYP3A inducer. Coadministration with rifampin decreased overall exposure to finerenone by 90%.
Rifapentine: (Major) Avoid concurrent use of finerenone and rifapentine due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and rifapentine is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased overall exposure to finerenone by 90%.
Ritlecitinib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or ritlecitinib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and ritlecitinib is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Ritonavir: (Contraindicated) Concomitant use of finerenone and ritonavir is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and ritonavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Rucaparib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or rucaparib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and rucaparib is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Sacubitril; Valsartan: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Saquinavir: (Contraindicated) Concomitant use of finerenone and saquinavir is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and saquinavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Secobarbital: (Major) Avoid concurrent use of finerenone and secobarbital due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and secobarbital is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Selpercatinib: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or selpercatinib; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and selpercatinib is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Sodium Sulfate; Magnesium Sulfate; Potassium Chloride: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and finerenone are used together. Concomitant use may increase the risk of hyperkalemia.
Sotorasib: (Major) Avoid concurrent use of finerenone and sotorasib due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and sotorasib is a moderate CYP3A inducer. Coadministration with another moderate CYP3A inducer decreased overall exposure to finerenone by 80%.
Spironolactone: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or spironolactone; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and spironolactone is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Spironolactone; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or spironolactone; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and spironolactone is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
St. John's Wort, Hypericum perforatum: (Major) Avoid concurrent use of finerenone and St. John's Wort due to the risk for decreased finerenone exposure which may reduce its efficacy. Finerenone is a CYP3A substrate and St. John's Wort is a strong CYP3A inducer. Coadministration with another strong CYP3A inducer decreased overall exposure to finerenone by 90%.
Streptogramins: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or dalfopristin; quinupristin; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and dalfopristin; quinupristin is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole: (Moderate) Monitor serum potassium concentrations closely if finerenone and trimethoprim are used together. Concomitant use may increase the risk of hyperkalemia. High doses of trimethoprim may increase the risk for hyperkalemia especially in patients with additional risk factors such as renal insufficiency.
Telmisartan: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Telmisartan; Amlodipine: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or amlodipine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and amlodipine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Telmisartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Tezacaftor; Ivacaftor: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or ivacaftor; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and ivacaftor is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Ticagrelor: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or ticagrelor; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and ticagrelor is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Tipranavir: (Contraindicated) Concomitant use of finerenone and tipranavir is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and tipranavir is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Tolvaptan: (Moderate) Monitor serum potassium concentrations closely if finerenone and tolvaptan are used together. Concomitant use may increase the risk of hyperkalemia. The risk for hyperkalemia may be greatest during and immediately following tolvaptan's peak aquaretic effect as a result of an acute reduction in extracellular fluid volume.
Trandolapril: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia.
Trandolapril; Verapamil: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors (ACEI) are used together. Concomitant use may increase the risk of hyperkalemia. (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or verapamil; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and verapamil is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Triamterene: (Moderate) Monitor serum potassium concentrations closely if finerenone and potassium-sparing diuretics are used together. Concomitant use may increase the risk of hyperkalemia.
Triamterene; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and potassium-sparing diuretics are used together. Concomitant use may increase the risk of hyperkalemia.
Trimethoprim: (Moderate) Monitor serum potassium concentrations closely if finerenone and trimethoprim are used together. Concomitant use may increase the risk of hyperkalemia. High doses of trimethoprim may increase the risk for hyperkalemia especially in patients with additional risk factors such as renal insufficiency.
Trofinetide: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or trofinetide; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and trofinetide is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Tucatinib: (Contraindicated) Concomitant use of finerenone and tucatinib is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and tucatinib is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Valsartan: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if finerenone and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Verapamil: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or verapamil; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and verapamil is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Viloxazine: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or viloxazine; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and viloxazine is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Vonoprazan: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or vonoprazan; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and vonoprazan is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Vonoprazan; Amoxicillin: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or vonoprazan; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and vonoprazan is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Vonoprazan; Amoxicillin; Clarithromycin: (Contraindicated) Concomitant use of finerenone and clarithromycin is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and clarithromycin is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%. (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or vonoprazan; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and vonoprazan is a weak CYP3A inhibitor. Coadministration with another weak CYP3A inhibitor increased overall exposure to finerenone by 21%.
Voriconazole: (Contraindicated) Concomitant use of finerenone and voriconazole is contraindicated. Concomitant use may increase finerenone exposure and the risk for finerenone-related adverse reactions. Finerenone is a CYP3A substrate and voriconazole is a strong CYP3A inhibitor. Coadministration with another strong CYP3A inhibitor increased overall exposure to finerenone by more than 400%.
Voxelotor: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or voxelotor; a finerenone dosage reduction may be necessary. Concomitant use may increase finerenone exposure and the risk of hyperkalemia. Finerenone is a CYP3A substrate and voxelotor is a moderate CYP3A inhibitor. Coadministration with another moderate CYP3A inhibitor increased overall exposure to finerenone by 248%.
Finerenone is a nonsteroidal, selective antagonist of the mineralocorticoid receptor (MR), which is activated by aldosterone and cortisol and regulates gene transcription. Finerenone has a high potency and selectivity for the MR and has no relevant affinity for androgen, progesterone, estrogen, and glucocorticoid receptors. Finerenone blocks MR-mediated sodium reabsorption and MR overactivation in both epithelial (e.g., kidney) and nonepithelial (e.g., heart, and blood vessels) tissues; MR overactivation is thought to contribute to fibrosis and inflammation.
In 2 randomized, double-blind, placebo-controlled, multicenter studies in adult patients with chronic kidney disease (CKD) associated with type 2 diabetes (FIDELIO-DKD and FIGARO-DKD), the placebo-corrected relative reduction in urinary albumin-to-creatinine ratio (UACR) in patients randomized to finerenone was 31% (95% CI, 29% to 34%) and 32% (95% CI, 30% to 35%), respectively at month 4 and remained stable for the duration of the trial. In another randomized, double-blind, placebo-controlled, multicenter dose finding study (ARTS DN) in adults with CKD and type 2 diabetes, the placebo-controlled relative reduction in UACR at day 90 was 25% and 38% in patients treated with finerenone 10 mg and 20 mg once daily, respectively.
In patients treated with finerenone, the mean systolic blood pressure decreased by 3 mmHg and the mean diastolic blood pressure decreased by 1 to 2 mmHg at month 1, remaining stable thereafter. At a dose 4 times the maximum approved recommended dose, finerenone did not prolong the QT interval to any clinically relevant extent.
Finerenone is administered orally. Plasma protein binding of finerenone is 92%, primarily to serum albumin in vitro. The volume of distribution at steady-state (Vss) of finerenone is 52.6 L. Finerenone is primarily metabolized by CYP3A4 (90%) and to a lesser extent by CYP2C8 (10%) to inactive metabolites. About 80% of the administered dose is excreted in urine (less than 1% as unchanged) and approximately 20% in feces (less than 0.2% as unchanged). The terminal half-life of finerenone is approximately 2 to 3 hours, and the systemic blood clearance is approximately 25 L/hour.
Affected cytochrome P450 isoenzymes and drug transporters: CYP3A4
Finerenone is primarily metabolized by CYP3A4 (90%) and to a lesser extent by CYP2C8 (10%) to inactive metabolites. Inhibitors and inducers of CYP3A4 may increase and decrease the exposure of finerenone, respectively. Coadministration with strong CYP3A4 inhibitors is contraindicated and use is not recommended with strong or moderate CYP3A4 inducers.
-Route-Specific Pharmacokinetics
Oral Route
Finerenone is completely absorbed after oral administration but undergoes metabolism resulting in an absolute bioavailability of 44%. Finerenone maximum concentration (Cmax) was achieved between 0.5 and 1.25 hours after dosing. There was no clinically significant effect on finerenone AUC following administration with high fat, high calorie food.
-Special Populations
Hepatic Impairment
There was no clinically significant effect on finerenone exposure in patients with mild hepatic impairment (Child Pugh A). Finerenone mean AUC was increased by 38% and Cmax was unchanged in cirrhotic patients with moderate hepatic impairment (Child Pugh B) compared to healthy control subjects. The effect of severe hepatic impairment (Child Pugh C) on finerenone exposure was not studied.
Renal Impairment
There were no clinically relevant differences in finerenone AUC or Cmax values in patients with renal impairment (eGFR 15 to 89 mL/min/1.73 m2) compared to patients with an eGFR of 90 mL/min/1.73 m2 or more. However, reduced renal function can impact serum potassium and for those adults with an eGFR less than 25 mL/minute/1.73 m2, use of finerenone is not recommended
Geriatric
There are no clinically significant effects of age (up to 79 years) on the pharmacokinetics of finerenone. No dose adjustment is required in geriatric patients.
Gender Differences
There are no clinically significant effects of sex on the pharmacokinetics of finerenone.
Ethnic Differences
There are no clinically significant effects of race or ethnicity on the pharmacokinetics of finerenone.
Obesity
There are no clinically significant effects of weight (up to 121 kg) on the pharmacokinetics of finerenone.