Formulary
Eplerenone: Indications, Dosing, Side Effects and Interactions
Eplerenone clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Eplerenone: Indications, Dosing, Side Effects and Interactions
Eplerenone clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Adjunct in stable patients with left ventricular ejection fraction 40% with evidence of heart failure, following myocardial infarction (start therapy within 3-14 days of event),Adjunct in chronic mild heart failure with left ventricular ejection fraction 30%**
- **Adult** (By Mouth): Initially 25 mg daily, then increased to 50 mg daily, increased within 4 weeks of initial treatment.
Cautions
Cautions, further information Elderly For mineralocorticoid receptor antagonists, Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate with concurrent potassium-conserving drugs without monitoring of serum potassium (risk of dangerous hyperkalaemia).
Contraindications
Hyperkalaemia
Side effects
Common or very common Arrhythmias; asthenia; constipation; cough; diarrhoea; dizziness; dyslipidaemia; electrolyte imbalance; headache; insomnia; muscle spasms; nausea; pain; renal impairment; skin reactions; syncope; vomiting Uncommon Angioedema; arterial thrombosis; cholecystitis; eosinophilia; flatulence; gynaecomastia; hyperhidrosis; hypothyroidism; increased risk of infection; malaise; numbness; postural hypotension
Interactions
**Severe interactions:**
- Warfarin No clinically significant pharmacokinetic interactions have been observed with warfarin.
- CYP3A4 substrates Results of pharmacokinetic studies with CYP3A4 probe-substrates, i.e.
- CYP3A4 inhibitors - Strong CYP3A4 inhibitors: Significant pharmacokinetic interactions may occur when eplerenone is co-administered with drugs that inhibit the CYP3A4 enzyme.
- Antacids Based on the results of a pharmacokinetic clinical study, no significant interaction is expected when antacids are co-administered with eplerenone.
**Other interactions (26):**
- Pharmacodynamic interactions Potassium-sparing diuretics and potassium supplements Due to increased risk of hyperkalaemia, eplerenone should not be administered to patients receiving other...
- Potassium-sparing diuretics may also potentiate the effect of antihypertensive agents and other diuretics.
- ACE inhibitors, ARBs The risk of hyperkalaemia may increase when eplerenone is used in combination with an ACE inhibitor and/or an ARB.
- The triple combination of an ACE inhibitor and an ARB with eplerenone should not be used (see sections 4.3 and 4.4).
- Lithium Drug interaction studies of eplerenone have not been conducted with lithium.
- However, lithium toxicity has been reported in patients receiving lithium concomitantly with diuretics and ACE inhibitors (see section 4.4).
Pregnancy
Manufacturer advises caution-no information available.
Breast feeding
Manufacturer advises use only if potential benefit outweighs risk.
Hepatic impairment
Manufacturer advises avoid in severe impairment (no information available).
Renal impairment
Avoid if creatinine clearance less than 30 mL/minute. M Dose adjustments Initially 25 mg on alternate days if creatinine clearance 30-60 mL/minute, adjust dose according to serum-potassium concentration (consult product literature). M See Prescribing in renal impairment .
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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