Finerenone

 Finerenone – Full Introduction

Finerenone is a non‑steroidal, selective mineralocorticoid receptor antagonist (MRA) used primarily to protect the kidneys and heart in patients with chronic kidney disease (CKD) associated with type 2 diabetes mellitus (T2D) and to reduce cardiovascular risks. It represents a newer class of MRAs with improved selectivity and a potentially better side‑effect profile than older steroidal agents like spironolactone.

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Drug Class

• Non‑steroidal mineralocorticoid receptor antagonist (MRA)
  (Often called third‑generation MRA) 

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Mechanism of Action

Finerenone selectively blocks mineralocorticoid receptors (MRs), which are activated by aldosterone and can promote sodium retention, inflammation, fibrosis, and cardiovascular and renal damage. By antagonizing these receptors:

• It reduces renal inflammation and fibrosis

• Helps prevent progression of kidney disease

• Lowers cardiovascular risk
  Unlike traditional steroidal MRAs (e.g., spironolactone), finerenone has minimal activity at other steroid receptors, which reduces unwanted hormonal side effects.

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Therapeutic Uses

Finerenone is indicated to reduce the risk of:

• Sustained decline in kidney function (eGFR decline)

• End‑stage kidney disease

• Cardiovascular death

• Non‑fatal myocardial infarction

• Hospitalization for heart failure
  …in adults with chronic kidney disease associated with type 2 diabetes.

Finerenone may also be used to reduce heart failure‑related hospital events in patients with heart failure with preserved ejection fraction (HFpEF) or in similar cardiovascular risk contexts (based on recent indications). 

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Benefits

• Renoprotective: slows kidney function decline in CKD with T2D 

• Cardioprotective: reduces cardiovascular mortality and heart failure hospitalizations 

• More selective and potentially fewer hormonal side effects than older MRAs like spironolactone or eplerenone. 

• Oral once‑daily dosing with predictable pharmacokinetics. 

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Common Side Effects

• Hyperkalemia (high potassium; most significant risk) 

• Hypotension (low blood pressure) 

• Hyponatremia (low sodium) 

• Dizziness

• Headache

• Nausea or weakness 

Monitoring: Regular checks of serum potassium and kidney function (eGFR) are essential before and during treatment due to the risk of hyperkalemia. 

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Serious but Rare Risks

• Severe hyperkalemia leading to arrhythmias if unmonitored 

• Worsening kidney function in some heart failure patients 

• Hypersensitivity reactions

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Contraindications & Precautions

• Hypersensitivity to finerenone

• Concomitant use with strong CYP3A4 inhibitors (can raise finerenone levels and increase risk of adverse effects) 

• Adrenal insufficiency 

• Baseline serum potassium >5.0 mEq/L (initiation not recommended)

• Caution in moderate–severe hepatic impairment and patients at high risk for hyperkalemia 

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Pharmacokinetics (Key Points)

• Oral absorption: ~44% bioavailability

• Metabolism: Mainly by CYP3A4 enzyme 

• Half‑life: ~2–3 hours

• Excreted mostly as metabolites in urine and feces

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Conclusion

Finerenone is a novel, selective non‑steroidal MRA with renal and cardiovascular protective effects in adults with CKD associated with type 2 diabetes. Its targeted mechanism and favorable side effect profile compared to older MRAs make it a valuable option in modern cardiometabolic therapy, particularly when used with appropriate monitoring for hyperkalemia.