Eplerenone

Description
A potassium-sparing diuretic, an aldosterone receptor antagonist.
Indications
Heart failure and impaired left ventricular function (LVEF ≤ 40%) after a recent MI in stable condition: to reduce cardiovascular mortality and morbidity; chronic heart failure of NYHA class II in adults with impaired left ventricular systolic function (LVEF ≤ 30%): to reduce cardiovascular mortality and morbidity (in addition to standard therapy).
Contraindications
Hypersensitivity to eplerenone or any excipient; initial serum potassium concentration > 5 mmol/l; severe renal impairment (GFR < 30 ml/min./1.73 m2); severe hepatic impairment (Child-Pugh class C); concomitant use with potassium-sparing diuretics, potassium supplements, strong CYP3A4 isoenzyme inhibitors, ACE inhibitors, or angiotensin receptor blockers. Dosage Adults. Oral administration. Initially, 25 mg once daily, increase to 50 mg once daily after 4 weeks (considering potassium concentration). Start after 3-14 days post-acute MI. Adjust dose based on serum potassium concentration. Children. Data not available. Elderly. No dose adjustment needed. Mild renal impairment: no need to adjust initial doses, later adjust based on serum potassium concentration. Moderate renal impairment: initially 25 mg every other day, later adjust based on serum potassium concentration. Mild or moderate hepatic impairment: no need to adjust initial doses, later adjust based on serum potassium concentration. Adverse reactions Most common: hyperkalemia, hyponatremia; dehydration; hypercholesterolemia, hypertriglyceridemia; dizziness, hypotension; diarrhea, nausea; renal impairment. Others: eosinophilia; insomnia; headache; atrial fibrillation, myocardial infarction, left heart failure; orthostatic hypotension, leg artery thrombosis; pharyngitis; flatulence, vomiting; itching, increased sweating; back pain, leg cramps; asthenia, malaise; pyelonephritis; increased blood urea nitrogen concentration, increased creatinine concentration. Pregnancy Use with caution. Breastfeeding not recommended. Warnings When starting treatment with the drug and adjusting its dose, all patients should have their serum potassium concentration monitored. It is recommended to monitor it regularly, especially in the elderly and patients with renal insufficiency or diabetes. Avoid using potassium supplements when starting treatment. The drug is not removed by hemodialysis.

Source | Drug Guide | Lithuanian University of Health Sciences | Institute of Physiology and Pharmacology | Doctor of Medical Sciences Rimas Jankūnas, Doctor of Medical Sciences Arvydas Milašius | Clinic of Internal Diseases | Doctor of Medical Sciences Palmira Leišytė