eplerenone: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
eplerenone: clinical details
Prescribing considerations
- Confirm a licensed heart-failure indication and review concurrent renin–angiotensin–aldosterone system therapy.
- Assess hyperkalaemia risk in older people and those with diabetes, renal impairment or mild-to-moderate hepatic impairment.
- Review prescribed, non-prescribed and herbal products for potassium effects and CYP3A4 interactions.
- Safety and efficacy in children and adolescents are not established.
Contraindications and cautions
- Hypersensitivity to eplerenone or a formulation excipient.
- Serum potassium above the product initiation threshold.
- Severe renal impairment.
- Severe hepatic impairment.
- Concurrent potassium-sparing diuretic or strong CYP3A4 inhibitor.
- Concurrent triple combination of eplerenone, an ACE inhibitor and an angiotensin-receptor blocker.
Monitoring
- Check potassium, renal function and electrolytes before treatment, after initiation or treatment changes, and periodically thereafter.
- Monitor more closely with renal impairment, diabetes, older age or interacting medicines.
- Monitor blood pressure and assess for symptomatic hypotension.
- During vomiting, diarrhoea, fever or heavy sweating, reassess hydration, renal function and potassium promptly.
Clinical pharmacology
Eplerenone is a relatively selective mineralocorticoid-receptor antagonist. Oral absorption is unaffected by food; metabolism is mainly through CYP3A4, no active human plasma metabolites have been identified, and it is not removed by haemodialysis.
Formulation and product differences
- Both selected products are lactose-containing yellow film-coated tablets.
- The selected Inspra tablet carries manufacturer-specific letter and number markings; the selected Krka tablet is smaller and marked numerically on one side.
- Excipient quantities and tablet appearance differ, so check the individual product information where intolerance or identification matters.
eplerenone preparations and strengths
Tablet
Route: Oral
Strengths: 25 mg, 50 mg
eplerenone interactions
A prescriber or pharmacist should review all medicines, supplements and herbal products.
Potassium supplements, potassium salt substitutes and potassium-sparing diuretics
These can cause dangerously high potassium. Concurrent potassium-sparing diuretics are contraindicated.
ACE inhibitors and angiotensin-receptor blockers
Either can increase high-potassium risk; using both classes together with eplerenone is contraindicated.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.