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Kerendia®▼ (finerenone) Dosing: Initiating, continuing & adjusting the dose for your patients
Please refer to the SmPC for full information on prescribing considerations
Please refer to the 'prescribing considerations' tab for further important information to take into account prior to treatment consideration.
Initiating treatment with Kerendia 10 mg once daily
Serum potassium and eGFR must be measured to determine if Kerendia can be initiated.
In patients with an eGFR between ≥25 mL/min/1.73 m2 and <60 mL/min/1.73 m2, Kerendia may be initiated depending on serum potassium. Treatment should not be initiated in patients with eGFR <25 mL/min/1.73 m2.
Kerendia Dosing: Initiation
Serum potassium | Dose |
|---|---|
≤4.8 mmol/L | Initiate Kerendia 10 mg once daily |
>4.8 mmol/L to 5.0 mmol/L | Initiating Kerendia 10 mg once daily may be considered with additional serum potassium monitoring within the first 4 weeks based on patient characteristics and serum potassium levels |
>5.0 mmol/L | Kerendia should not be initiated |
4 weeks after Kerendia initiation, serum potassium and eGFR must be remeasured
This will determine whether the starting dose can be increased to the recommended dose of 20 mg once daily
Adapted from Kerendia SmPC
Hepatic Impairment
Kerendia should not be initiated in patients with severe hepatic impairment. No initial dose adjustment is required in mild or moderate hepatic impairment, but in moderate hepatic impairment additional serum potassium monitoring should be considered and monitoring adapted according to patient characteristics.
Concomitant medications: When Kerendia is not recommended or contraindicated
Kerendia should not be used in patients taking:
- Moderate or strong CYP3A4 inducers (see SmPC for full details) since these are expected to markedly decrease Kerendia plasma concentration and result in reduced therapeutic effect
- Potassium-sparing diuretics (e.g., amiloride, triamterene)
- Other MRAs (e.g., eplerenone, spironolactone)
Kerendia is contraindicated in patients taking strong CYP3A4 inhibitors (see SmPC for full details) since a marked increase in Kerendia exposure is expected.
Grapefruit or grapefruit juice should not be consumed during finerenone treatment, as it is expected to increase the plasma concentrations of finerenone through inhibition of CYP3A4.
How to administer Kerendia
Kerendia is a film-coated tablet that may be taken with a glass of water, with or without food.
-Kerendia should not be taken with grapefruit or grapefruit juice
Crushing of tablets
For patients who are unable to swallow whole tablets, Kerendia tablets may be crushed and mixed with water or soft foods, such as apples sauce, directly before oral use.
Missed dose
A missed dose should be taken as soon as your patients notice, but only on the same day; they should not take two doses to make up for a missed dose.
Continuing treatment and adjusting the dose with Kerendia
Serum potassium and eGFR must be remeasured 4 weeks after initiation or re-start of Kerendia treatment or increase in dose
In patients with eGFR ≥15 ml/min/1.73 m2, Kerendia treatment can be continued with dose adjustment based on serum potassium*.
Serum potassium | Dose |
|---|---|
≤4.8 mmol/L | If your patient is on 10 mg: Increase to 20 mg once daily if eGFR has not decreased >30% compared with the previous measurement If your patient is on 20 mg: maintain their dose |
>4.8 mmol/L to 5.5 mmol/L | Maintain current dose (10 mg or 20 mg once daily) |
>5.5 mmol/L | Withhold Kerendia† lf your patient was on 10 mg:consider restarting at 10 mg once daily when serum potassium is ≤5 mmol/L lf your patient was on 20mg: restart at 10 mg once daily when serum potassium is ≤5mmol/L |
4 weeks after
- dose increase to 20 mg, or
- re-starting a patient on 10mg Kerendia
serum potassium and eGFR must be remeasured.
Thereafter, serum potassium has to be remeasured periodically and as needed based on patient characteristics and serum potassium levels.
*Treatment should be discontinued in patients who have progressed to End-stage renal disease (ESRD) (eGFR <15 ml/min/1.73 m2)
†Local guidelines for the management of hyperkalaemia have to be followed.
PP-KER-GB-0475 | March 2024
- Referencesexpand_more
- 1GB Kerendia SmPC, NI Kerendia SmPC