Finerenone and Larotrectinib: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Larotrectinib
No brand names on recordFinerenone
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased sensitive CYP3A4 substrate (finerenone) exposure and increase in the incidence or severity of adverse reactions
Interaction Deep Dive
Coadministration of larotrectinib (a CYP3A4 inhibitor) with a sensitive CYP3A4 substrate (finerenone) should be avoided. If concomitant use cannot be avoided, monitor for increased adverse reactions of the sensitive substrate. Concomitant use of larotrectinib (a CYP3A4 inhibitor) with a sensitive CYP3A4 substrate may increase plasma concentrations of the sensitive CYP3A4 substrate, which may increase the incidence or severity of adverse reactions. Coadministration of larotrectinib 100 mg twice daily with midazolam, a sensitive CYP3A4 substrate, increased both the AUC(0 to infinity) and Cmax of midazolam by 1.7-fold compared with midazolam administered alone2. Monitor serum potassium during drug initiation or dosage adjustment of either finerenone or the moderate or weak CYP3A4 inhibitor, and adjust finerenone dosage as appropriate. Concomitant use of finerenone, a CYP3A4 substrate, with erythromycin, a moderate CYP3A4 inhibitor, increased finerenone mean AUC by 248% and mean Cmax by 88% 1.
Why it happens (mechanism)
Inhibition of CYP3A4 substrate metabolism by larotrectinib
Literature reports
2 reports — tap to read
a) Coadministration of larotrectinib 100 mg twice daily with midazolam, a sensitive CYP3A4 substrate, increased both the AUC(0 to infinity) and Cmax of midazolam by 1.7-fold compared with midazolam administered alone. The AUC(0 to infinity) and Cmax of 1-hydroxymidazolam, the main metabolite of midazolam, were both increased 1.4-fold 2.
b) Concomitant use of erythromycin (moderate CYP3A4 inhibitor) increased finerenone mean AUC and Cmax by 248% and 88%, respectively 1.
Common questions
Can I take Finerenone and Larotrectinib together?
Increased sensitive CYP3A4 substrate (finerenone) exposure and increase in the incidence or severity of adverse reactions Always confirm with your pharmacist or prescriber before making any change.
How serious is the Finerenone and Larotrectinib interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Finerenone or Larotrectinib need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (2)
- Product Information: KERENDIA(R) oral tablets, finerenone oral tablets. Bayer HealthCare Pharmaceuticals Inc (per manufacturer), Whippany, NJ, 2021. DailyMed
- Product Information: VITRAKVI(R) oral capsules, oral solution, larotrectinib oral capsules, oral solution. Bayer HealthCare Pharmaceuticals Inc (per FDA), Whippany, NJ, 2022. DailyMed
Keep reading about Larotrectinib
Keep reading about Finerenone
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