Finerenone is a novel non-steroidal mineralocorticoid receptor antagonist (nsMRA) that exhibits significant clinical value in the treatment of chronic kidney disease associated with type 2 diabetes mellitus and heart failure. To ensure medication safety, both healthcare professionals and patients need a comprehensive understanding of the precautions and monitoring requirements for this drug.

What Are the Precautions for Finerenone Administration?

Contraindication Screening

Before initiating finerenone treatment, the patient’s contraindications must be carefully evaluated.

This drug is absolutely contraindicated in patients receiving potent CYP3A4 inhibitors, as concomitant use can significantly increase the plasma concentration of finerenone, thereby elevating the risk of adverse reactions.

Patients with adrenal insufficiency and those hypersensitive to any component of this product should also not use finerenone.

Patients should avoid concurrent consumption of grapefruit or grapefruit juice, as these foods may interfere with drug metabolism.

Key Points of Baseline Assessment

A comprehensive baseline assessment must be performed prior to treatment initiation.

Critical laboratory tests include measurement of serum potassium level and estimated glomerular filtration rate (eGFR).

Finerenone treatment should not be initiated if the patient’s serum potassium concentration exceeds 5.0 mEq/L.

For heart failure patients, initiation of this drug is not recommended if eGFR is below 25 mL/min/1.73 m².

Precautions for Special Populations

Patients with severe hepatic impairment (Child-Pugh Class C) should avoid using finerenone.

Patients with moderate hepatic impairment may require more frequent monitoring of serum potassium levels.

The efficacy of this drug has not been established in children under 18 years of age, and thus its use is not recommended for this population.

Data on finerenone use in pregnant women are limited. Animal studies have shown developmental toxicity at exposures approximately twice the expected human exposure level.

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

Monitoring During Finerenone Treatment

Serum Potassium Monitoring

Hyperkalemia is the primary safety concern with finerenone, and the risk is particularly pronounced in patients with reduced renal function and elevated baseline potassium levels.

Serum potassium must be tested 4 weeks after treatment initiation, followed by regular monitoring 4 weeks after each dose adjustment and throughout the entire course of treatment.

For patients with risk factors for hyperkalemia—including those taking drugs that affect potassium excretion or increase serum potassium levels—a more frequent monitoring schedule should be implemented to promptly detect and manage potential electrolyte disturbances.

Renal Function Monitoring

In addition to serum potassium, renal function also requires regular assessment.

Finerenone may cause worsening renal function in heart failure patients, and severe events requiring hospitalization may occur in rare cases.

Long-term Monitoring Strategy

During maintenance treatment, healthcare providers should develop an individualized long-term monitoring plan based on the patient’s clinical condition.

For patients with clinically significant deterioration of renal function, consideration should be given to delaying dose escalation or discontinuing treatment.