Ciprofloxacin, Grapefruit Juice, and More: 10 Kerendia Interactions to Consider

Kerendia (finerenone) is an oral medication used to treat chronic kidney disease in adults with Type 2 diabetes. It was the first medication in its class to be FDA approved for this use. And it’s recommended by the American Diabetes Association for certain people to prevent worsening kidney disease and cardiovascular problems.

If you’re prescribed Kerendia, there are a few things to keep in mind, including its potential drug interactions. Below, we’ll detail 10 notable Kerendia interactions and how they’re typically managed. But be sure to also share a current medication list with your healthcare team so they can screen for potential interactions

1. Certain antibiotics, such as ciprofloxacin

Antibiotics treat various types of bacterial infections. But some of them also affect how the body breaks down medications.

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Certain antibiotics, such as ciprofloxacin (Cipro), block the action of liver enzymes (proteins) that are responsible for breaking down Kerendia. Other antibiotics that have this effect include erythromycin (Ery-Tab) and clarithromycin.

If you combine Kerendia with these antibiotics, it can lead to increased levels of Kerendia in the body. This may raise the risk of experiencing Kerendia side effects such as high potassium (hyperkalemia), low blood pressure (hypotension), and low sodium (hyponatremia).

Combining Kerendia with the antibiotic rifampin (Rifadin) can have the opposite effect. Rifampin enhances liver enzymes that break down Kerendia. So the combination can lower Kerendia levels in the body, potentially making Kerendia less effective.

It’s best to avoid these combinations, if possible. If you need an antibiotic, your healthcare team will help choose an effective medication that doesn’t interact with Kerendia.

2. Grapefruit juice

Certain foods are known for interacting with medications, and grapefruit juice is one of them. Grapefruit and grapefruit juice interact with many medications due to their effects on liver enzymes.

Grapefruit products block enzymes that break down Kerendia. This can raise Kerendia levels and increase the chance of side effects. So it’s safest to avoid consuming grapefruit products altogether while taking Kerendia.

EXPERT PICKS: WHAT TO READ NEXT

• More about Kerendia: Read a pharmacist’s guide to things you should know about Kerendia, including how it works.

• What causes drug interactions? Learn about why drug interactions happen and how medications can interact with dietary items.

• Drinks that impact kidney health: Experts list the best things to drink if you have kidney disease — plus, drinks you should avoid.

3. Paxlovid and other ritonavir-containing medications

Medications that contain the antiviral ritonavir (Norvir) treat conditions like COVID-19, HIV, and hepatitis C. Ritonavir blocks certain liver enzymes that break down Kerendia. So any medication that contains ritonavir could increase Kerendia levels in the body and raise the risk of side effects.

Some people take ritonavir as a separate pill along with other antivirals. But it’s also included in combination pills. Examples of ritonavir-containing combination pills include:

• Paxlovid (nirmatrelvir / ritonavir)

• Kaletra (lopinavir / ritonavir)

If you need to take a short-term medication, like Paxlovid, your prescriber may have you temporarily pause treatment with Kerendia. If you need long-term treatment with a ritonavir-containing medication, they may suggest an alternative to Kerendia.

4. Certain calcium channel blockers, such as diltiazem and verapamil

Calcium channel blockers are used to treat high blood pressure and other heart conditions. Some calcium channel blockers, like diltiazem (Cardizem) and verapamil, can interact with Kerendia. Similar to ritonavir, these calcium channel blockers can increase Kerendia levels, raising the risk of side effects.

If you take diltiazem or verapamil, your prescriber may recommend making changes to your medication regimen before you start Kerendia. You may be instructed to adjust your dosage or switch to a different blood pressure or heart medication that doesn’t interact with Kerendia.

5. Azole antifungals such as fluconazole

Azole antifungal medications, such as fluconazole (Diflucan) and ketoconazole, treat fungal infections. As with many of the above medications, azole antifungals block liver enzymes that break down Kerendia. So combining Kerendia with azole antifungals can increase your risk of side effects.

Some antifungal treatment courses are short — even as short as a single dose. But in some cases, antifungal medications are needed for several weeks or longer. In either case, it’s best to check with your prescriber to see if they suggest any medication or dosage changes.

Good to know: Kerendia primarily interacts with oral and injectable antifungals. Topical antifungals, such as creams or foams, are less likely to cause issues because very little of the medication reaches your bloodstream when applied to the skin. So interactions with topical antifungals aren’t typically a concern.

6. Amiodarone

Amiodarone (Pacerone) is an antiarrhythmic medication that’s used to treat irregular heartbeats. Amiodarone also blocks liver enzymes that break down Kerendia. This can result in higher levels of Kerendia and an increased risk of side effects when the medications are combined.

Your prescriber may adjust your medication regimen to avoid this interaction when you start treatment with Kerendia. Or if you need to take both medications, they may want to closely monitor you for Kerendia side effects.

7. St. John’s wort

St. John’s wort is an herbal supplement that people take for a variety of conditions, including depression. It’s known for interacting with many medications because it enhances certain liver enzymes. Unlike most of the interactions discussed above, St. John’s wort can lower Kerendia levels in the body, potentially making it less effective.

It’s recommended to avoid combining Kerendia with St. John’s wort, if possible. If you’re taking the supplement, your prescriber will likely recommend you stop taking it before starting treatment with Kerendia.

8. Seizure medications

Seizure medications are used to treat conditions such as epilepsy. Certain seizure medications, such as carbamazepine, phenytoin (Dilantin, Phenytek), and phenobarbital, enhance the action of some liver enzymes. This can cause a more rapid breakdown of Kerendia in the body, possibly lowering its effectiveness.

If you take one of these seizure medications, your prescriber may recommend adjusting to your treatment regimen before you start taking Kerendia. But if your seizures are well controlled with your current medication, they may instead suggest an alternative to Kerendia.

9. ACE inhibitors and ARBs

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are two types of blood pressure medications. Lisinopril (Zestril, Qbrelis) and benazepril (Lotensin) are examples of commonly prescribed ACE inhibitors. Losartan (Cozaar) and valsartan (Diovan) are two commonly prescribed ARBs. ACE inhibitors and ARBs work in similar ways, and they can both increase potassium levels in the body.

Kerendia can also raise potassium levels. So combining it with ACE inhibitors or ARBs can cause or contribute to hyperkalemia (elevated potassium levels). Hyperkalemia can cause symptoms such as abnormal heartbeats, muscle weakness, and nausea.

In some cases, people may need to take Kerendia with one of these blood pressure medications. If that’s the case for you, your prescriber will likely monitor your potassium closely to watch for signs of hyperkalemia.

10. Certain diuretics

Diuretics (“water pills”) help remove excess fluid from the body. This lowers blood pressure and helps with conditions such as heart failure. But some diuretics can also raise potassium levels. Examples include spironolactone (Aldactone), eplerenone (Inspra), and triamterene (Dyrenium). These diuretics can interact with Kerendia, increasing the risk of hyperkalemia.

As with an ACE inhibitor and ARB, your prescriber may determine you need to take both Kerendia and a diuretic. If there’s a risk for an interaction, your prescriber will likely keep a close eye on your potassium levels. But keep in mind that some diuretics don’t increase potassium levels, so this may not be an issue.

Can I drink alcohol while taking Kerendia?

Alcohol doesn’t directly interact with Kerendia. But Kerendia is approved for people living with Type 2 diabetes, and it’s typically recommended to limit or avoid alcohol with diabetes. Alcohol can increase the risk of hypoglycemia, or low blood glucose (sugar). Drinking alcohol can also make it hard to tell if you’re experiencing hypoglycemia symptoms.

If you plan to drink alcohol (even just an occasional drink) while taking Kerendia, talk with your prescriber. They can determine whether there is a safe amount for you to drink.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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