Can Kerendia (finerenone) tablets be split in half for dosing?

Can Kerendia (Finerenone) Tablets Be Split?

No, Kerendia tablets should not be split or cut in half—the medication should be swallowed whole as prescribed.

Dosing Strategy for Kerendia

Kerendia is available in two tablet strengths (10 mg and 20 mg) that are specifically designed to provide appropriate dosing based on kidney function and potassium levels, eliminating any need for tablet splitting 1.

Proper Dosing Algorithm

Initial dose selection is based on eGFR at screening:

• 10 mg once daily if eGFR is 25–60 mL/min/1.73 m² 1
• 20 mg once daily if eGFR is ≥60 mL/min/1.73 m² 1

Dose titration after 1 month:

• Increase from 10 mg to 20 mg daily if serum potassium is ≤4.8 mmol/L and eGFR remains stable 1

Why Tablet Splitting Is Inappropriate for Kerendia

Precision dosing requirements: Finerenone requires exact dosing based on kidney function and potassium monitoring, as the medication carries a significant risk of hyperkalemia (2.3% discontinuation rate in clinical trials) 1. Splitting tablets would compromise dose accuracy when precise control is essential for safety.

Pharmacokinetic considerations: Finerenone has a short half-life of 2-3 hours and undergoes extensive first-pass metabolism with 43.5% bioavailability 2. Any alteration to the tablet formulation could potentially affect drug release and absorption patterns, though the specific formulation details are not provided in the evidence.

Manufacturer design: The availability of both 10 mg and 20 mg strengths indicates the manufacturer specifically designed these doses to avoid any need for splitting 1.

Clinical Monitoring Requirements

Potassium monitoring is critical and follows a specific protocol:

• Check potassium at 1 month after initiation, then every 4 months 1
• Hold finerenone if K⁺ >5.5 mmol/L 1
• Continue if K⁺ is 4.9–5.5 mmol/L 1
• Only increase dose or restart if K⁺ ≤4.8 mmol/L (for dose increase) or ≤5.0 mmol/L (for restarting) 1

Common pitfall: Unlike some medications where tablet splitting might be considered for cost savings 3, 4, the safety profile of finerenone—particularly the hyperkalemia risk—makes precise dosing non-negotiable. The structured dose titration protocol based on laboratory values cannot accommodate the dose variability that would result from tablet splitting 1.