How to manage joint pain and swelling in patients taking finerenone (Mineralocorticoid receptor antagonist) with chronic kidney disease or heart failure?

From the Guidelines

To manage joint pain and swelling in patients taking finerenone who have chronic kidney disease or heart failure, first assess whether the symptoms are related to the medication or have another cause, and consider acetaminophen as the safest first-line option for symptomatic relief. Finerenone itself is not commonly associated with joint symptoms, so consider other potential causes such as gout, which is prevalent in these patient populations 1. For symptomatic relief, the following options can be considered:

• Acetaminophen at doses of 500-1000 mg every 6 hours, not exceeding 3000 mg daily in patients with kidney or liver impairment
• Topical analgesics such as diclofenac gel 1% or lidocaine patches for localized relief without systemic effects
• Short-term low-dose opioids under close supervision for moderate to severe pain
• Colchicine (0.6 mg once or twice daily with dose reduction in kidney disease) or low-dose corticosteroids if gout is suspected
• Physical therapy, gentle exercise, and hot/cold compresses for non-pharmacological relief Always monitor kidney function regularly, as both the underlying conditions and pain management strategies can impact renal status 1. If joint symptoms persist or worsen, refer to a rheumatologist for specialized evaluation.

From the Research

Joint Pain and Swelling with Finerenone

• Joint pain and swelling are not explicitly mentioned as common side effects of finerenone in the provided studies 2, 3, 4, 5, 6.
• However, finerenone is a mineralocorticoid receptor antagonist, and mineralocorticoid receptor antagonists can have various side effects, including hyperkalemia, which may lead to muscle weakness, fatigue, and other symptoms 2, 5, 6.
• The studies focus on the efficacy and safety of finerenone in patients with chronic kidney disease (CKD) and type 2 diabetes, as well as its effects on cardiovascular outcomes 3, 4, 5, 6.
• To manage joint pain and swelling in patients taking finerenone, it is essential to monitor their overall health and adjust their treatment plan as needed, considering the potential benefits and risks of finerenone therapy 2, 5, 6.

Management of Joint Pain and Swelling

• Patients experiencing joint pain and swelling while taking finerenone should consult their healthcare provider to determine the best course of action 2, 5, 6.
• The healthcare provider may recommend adjusting the finerenone dosage, adding other medications to manage joint pain and swelling, or switching to a different treatment plan if necessary 2, 5, 6.
• Regular monitoring of patients' kidney function, blood pressure, and cardiovascular health is crucial when taking finerenone, as it can help identify potential issues and prevent complications 3, 4, 5, 6.

Considerations for Patients with CKD or Heart Failure

• Patients with CKD or heart failure taking finerenone should be closely monitored for signs of hyperkalemia, as it can increase the risk of cardiovascular events 2, 5, 6.
• Finerenone has been shown to reduce the risk of cardiovascular events and slow CKD progression in patients with type 2 diabetes and CKD 5, 6.
• Healthcare providers should weigh the benefits and risks of finerenone therapy in patients with CKD or heart failure and adjust their treatment plan accordingly 2, 3, 4, 5, 6.