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Selective aldosterone receptor antagonist used to treat hypertension and to improve survival in heart failure after a recent heart attack.
Reviewed by:
Dr. Steve Malen, PharmD
Dr. Steven Blikstein, PharmD
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Eplerenone selectively blocks aldosterone receptors, reducing sodium retention and blood pressure while sparing the potassium-sparing benefit typical of this drug class, with less antiandrogenic effect (gynecomastia) than spironolactone. It is FDA-approved for hypertension, alone or with other agents, and to reduce the risk of cardiovascular death and hospitalization in patients with heart failure following an acute myocardial infarction with left ventricular dysfunction. Common side effects include hyperkalemia, dizziness, and diarrhea. It should not be used with strong CYP3A4 inhibitors (such as ketoconazole or certain HIV protease inhibitors), and requires periodic monitoring of serum potassium, especially when starting therapy or adjusting the dose, or in patients with renal impairment or diabetes.
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Eplerenone is a selective aldosterone receptor antagonist that lowers blood pressure and reduces cardiac remodeling by blocking the effects of aldosterone, with a lower risk of antiandrogenic side effects (such as gynecomastia) compared to spironolactone.
Common side effects include hyperkalemia (elevated potassium), dizziness, and diarrhea.
Precautions: Serum potassium should be checked before starting therapy, within the first week, and periodically thereafter, especially in patients with renal impairment, diabetes, or those taking other potassium-raising medications (ACE inhibitors, ARBs, potassium supplements). Eplerenone should not be combined with strong CYP3A4 inhibitors, and should be used with caution in patients with hepatic impairment.