Inspra

In·spra (nspr)

A trademark for the drug eplerenone.

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eplerenone

Inspra

Pharmacologic class: Aldosterone receptor blocker

Therapeutic class: Antihypertensive

Pregnancy risk category B

Action

Binds to and blocks aldosterone receptors, disrupting normal sodium and water reabsorption and causing sodium and water excretion to increase. These actions reduce blood volume and blood pressure.

Availability

Tablets: 25 mg, 50 mg, 100 mg

⊘Indications and dosages

➣ Hypertension

Adults: 50 mg/day P.O. as a single dose. After 4-week trial, may increase to 50 mg P.O. b.i.d. if necessary.

➣ Heart failure; postmyocardial infarction (MI)

Adults: Initially, 25 mg P.O. once daily. After 1 month, may increase to maximum dosage of 50 mg P.O. once daily.

Contraindications

• Hypersensitivity to drug
• Hyperkalemia
• Type 2 diabetes mellitus with microalbuminuria
• Severe renal impairment

Precautions

Use cautiously in:
• hepatic impairment
• pregnant or breastfeeding patients
• children (safety and efficacy not established).

Administration

• Give with or without food.
• Know that drug may be given alone or with other antihypertensives.

Route	Onset	Peak	Duration
P.O.	Slow	1.5 hr	Unknown

Adverse reactions

CNS: headache, dizziness, fatigue

CV: angina, MI

GI: diarrhea, abdominal pain

GU: albuminuria, vaginal bleeding, changes in sexual function, gynecomastia and breast pain (in men)

Metabolic: hypercholesterolemia, hyperkalemia

Respiratory: cough

Other: flulike symptoms

Interactions

Drug-drug. Angiotensin-converting enzyme inhibitors: increased risk of hyperkalemia

CYP450-3A4 inhibitors: serious toxic effects

Lithium: increased risk of toxicity

Nonsteroidal anti-inflammatory drugs: decreased hypertensive effect of eplerenone

Patient monitoring

• Monitor electrolyte levels, and watch for signs and symptoms of hyperkalemia.
• Check vital signs, and ask patient about chest pain.
• Monitor lipid panel.
• Assess for new onset of persistent dry cough or flulike symptoms.

Patient teaching

☞ Advise patient to immediately report chest pain, flulike symptoms, or persistent dry cough.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Inform patient that drug may affect sexual function. Encourage him to discuss this issue with prescriber.
• Advise female patient to discuss pregnancy or breastfeeding with prescriber before starting drug.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.