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Eplerenone
💊 About
Always check the BNF link here for up-to-date prescribing guidance.
- Eplerenone is a selective aldosterone receptor antagonist used in heart failure management.
- It has similar actions to spironolactone but fewer anti-androgenic side effects (e.g. gynaecomastia).
⚙️ Mode of Action
- Competitively binds to aldosterone receptors in the distal nephron.
- Reduces sodium and water retention, lowers preload/afterload, and prevents myocardial remodelling.
📌 Indications
- Licensed: Adjunct in chronic heart failure, especially post-MI with LV dysfunction or CCF Class III–IV.
- Off-label: Sometimes used in resistant hypertension (consult specialist guidance).
💊 Dose
- Start: 25 mg OD.
- Titrate up to 50 mg OD depending on potassium & renal function.
- Monitor U&E at baseline, 1 week, and 1 month, then regularly.
⚠️ Interactions
🚨 Avoid co-administration with other potassium-sparing drugs → risk of severe hyperkalaemia.
- Drugs increasing K⁺: Trimethoprim, Ciclosporin, Tacrolimus.
- Antiarrhythmics: Amiodarone, Diltiazem, Verapamil.
- Antimicrobials (CYP3A4 inhibitors): Ketoconazole, Itraconazole, Clarithromycin, Erythromycin, Ritonavir.
- Other: Digoxin (↑ toxicity), Lithium, Rifampicin, Carbamazepine, Phenytoin.
⛔ Contraindications & Cautions
- Severe renal impairment (eGFR <30 mL/min/1.73m²).
- Baseline serum potassium >5.0 mmol/L.
- Concomitant use with potassium supplements or strong CYP3A4 inhibitors.
- Caution in pregnancy & breastfeeding.
💥 Side Effects
- Hyperkalaemia ⚡ – most serious (requires monitoring).
- Dizziness & hypotension.
- GI upset: diarrhoea, nausea.
- Skin rash (rare).
💡 Clinical Pearls
- Eplerenone is preferred over spironolactone if patients develop gynaecomastia. - Always check renal function & potassium before starting and during therapy. - Improves survival in patients post-MI with LV systolic dysfunction when added to ACEi + beta-blocker.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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