Drug reference
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% ▶BY MOUTH ▶Adult: Initially 25 mg daily, then increased to 50 mg daily, increased within 4 weeks of initial treatment
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DUE TO INTERACTIONS ▶Manufacturer advises max. dose 25 mg daily with concurrent use of amiodarone or moderate inhibitors of CYP3A4.
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Hyperkalaemia
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Elderly CAUTIONS, FURTHER INFORMATION ▶Elderly For aldosterone antagonists, prescription potentially inappropriate (STOPP criteria) with concurrent potassium-conserving drugs without monitoring of serum potassium (risk of dangerous hyperkalaemia). See also Prescribing in the elderly p. 33.
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→Appendix 1: aldosterone antagonists
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▶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. Cardiovascular system hyperhidrosis. hypothyroidism. increased risk of infection . malaise. numbness. postural hypotension
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Manufacturer advises caution—no information available.
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Manufacturer advises use only if potential benefit outweighs risk.
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Manufacturer advises avoid in severe impairment (no information available).
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Avoid if eGFR less than 30 mL/minute/1.73 m2. Dose adjustments Initially 25 mg on alternate days if eGFR 30–60 mL/minute/1.73 m2, adjust dose according to serum-potassium concentration—consult product literature. Monitoring Increased risk of hyperkalaemia in renal impairment—close monitoring required.
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Monitor plasma-potassium concentration before treatment, during initiation, and when dose changed.
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There can be variation in the licensing of different medicines containing the same drug. Tablet ▶Eplerenone (Non-proprietary) Eplerenone 25 mg Eplerenone 25mg tablets | 28 tablet P £42.72 DT = £4.43 | 30 tablet P £24.95 Eplerenone 50 mg Eplerenone 50mg tablets | 28 tablet P £42.72 DT = £5.87 | 30 tablet P £24.95 ▶Inspra (Upjohn UK Ltd) Eplerenone 25 mg Inspra 25mg tablets | 28 tablet P £42.72 DT = £4.43 Eplerenone 50 mg Inspra 50mg tablets | 28 tablet P £42.72 DT = £5.87
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Initially 25 mg daily, then increased to 50 mg
First-line fragment. Read the complete Indications and Dose section above.
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