Kerendia (finerenone) will be a new Rx for patients with chronic kidney disease (CKD) due to type 2 diabetes.
Kerendia is thought to limit inflammation and scarring in the kidneys and heart...which may slow kidney disease progression and reduce risk of cardiovascular events (heart attack, etc).
But expect Kerendia to be a "niche" med.
Other steps...such as controlling blood pressure and blood sugar...should be taken first to help slow progression of kidney disease.
Plus some meds for diabetes already help protect the kidneys and improve CV outcomes...such as Jardiance (empagliflozin) or Victoza (liraglutide). These also lower blood sugar...Kerendia doesn't.
And Kerendia costs about $570/month. Expect prior auths.
If you dispense Kerendia, watch for look-alike/sound-alike mix-ups. Finerenone can be mistaken for eplerenone...or finasteride.
Expect patients getting Kerendia to start with one 10 mg tablet by mouth once daily with or without food...and titrate up to 20 mg once daily depending on potassium blood levels and kidney function.
Watch for e-Rx notes asking patients to get labs...and consider adding these to the Rx label. Monitoring is needed to ensure potassium blood levels don't go too high.
Don't override drug interactions. Patients who get Kerendia will likely also be on an ACE inhibitor (lisinopril, etc) or ARB (losartan, etc)...which also raises potassium.
Apply an "Avoid grapefruit" auxiliary label to Kerendia Rxs. Grapefruit can increase Kerendia blood levels.
Ensure patients getting Kerendia receive pharmacist counseling.
For instance, Kerendia tabs can be crushed and mixed in water or soft foods (applesauce, etc) if the patient has trouble swallowing.
See our Kidneys: What Are They Good For? tech tutorial to learn more about how to prevent issues with kidney meds.
- N Engl J Med 2020;383(23):2219-29
- N Engl J Med Published online Aug 28, 2021; doi:10.1056/NEJMoa2110956
- Diabetes Care 2021;44(Suppl 1):S151-S167
- Medication pricing by Elsevier, accessed Sep 2021
- Chart: Slowing Progression of Kidney Disease in Patients with Diabetes
- Technician Tutorial: Kidneys: What Are They Good For?