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Related to eplerenone: Amiloride
Pharmacologic class: Aldosterone receptor blocker
Therapeutic class: Antihypertensive
Pregnancy risk category B
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.
Tablets: 25 mg, 50 mg
⊘Indications and dosages
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; post-myocardial infarction (MI)
Adults: Initially, 25 mg P.O. once daily. After 4 weeks, may increase to maximum dosage of 50 mg P.O. once daily.
• Hypersensitivity to drug
• Potassium supplements or potassium-sparing diuretics
• Type 2 diabetes mellitus with microalbuminuria
• Severe renal impairment
Use cautiously in:
• hepatic impairment
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
• Give with or without food.
• Know that drug may be given alone or with other antihypertensives.
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
Other: flulike symptoms
Drug-drug.Angiotensin-converting enzyme inhibitors, potassium-sparing diuretics, potassium supplements: increased risk of hyperkalemia
CYP450-3A4 inhibitors: serious toxic effects
Lithium: increased risk of toxicity
Nonsteroidal antiinflammatory drugs: decreased hypertensive effect of eplerenone
• 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.
☞ 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.
Pharmacologic: aldosterone antagonists
Time/action profile (antihypertensive effect)
Adverse Reactions/Side Effects
Central nervous system
- abnormal liver function tests
- abdominal pain
- abnormal vaginal bleeding
Fluid and Electrolyte
- hyperkalemia (life-threatening)
- flu-like symptoms
Drug-Drug interactionConcurrent use of strong inhibitors of the CYP3A4 enzyme system (ketoconazole, itraconazole, nefazodone, clarithromycin, ritonavir, or nelfinavir ) significantly ↑ effects of eplerenone; concurrent use contraindicated. Concurrent use of weak inhibitors of the CYP3A4 enzyme system (erythromycin, saquinavir, fluconazole, verapamil ) may ↑ effects of eplerenone; initial dose of eplerenone should be ↓ by 50%.NSAIDs may ↓ antihypertensive effects.Concurrent use of ACE inhibitors or Angiotensin II receptor blockers may ↑ risk of hyperkalemia.
Availability (generic available)
- Monitor BP periodically during therapy.
- Monitor prescription refills to determine adherence.
- Lab Test Considerations: May cause hyperkalemia. Monitor serum potassium levels prior to starting therapy, within the first wk, at 1 mo following start of therapy or dose adjustment and periodically thereafter. Monitor serum potassium and serum creatinine in 3–7 days in patients who start taking a moderate CYP3A4 inhibitor.
- May cause ↓ serum sodium and ↑ serum triglyceride, cholesterol, ALT, GGT, creatinine, and uric acid levels.
Potential Nursing DiagnosesDecreased cardiac output (Indications)
Noncompliance (Patient/Family Teaching)
- Do not confuse Inspra with Spiriva.
- PO: Administer once daily. May be increased to twice daily if response is inadequate.
- Instruct patient to take medication as directed at the same time each day, even if feeling well.
- Encourage patient to comply with additional interventions for hypertension (weight reduction, discontinuation of smoking, moderation of alcohol consumption, regular exercise, stress management). Medication controls, but does not cure, hypertension.
- Instruct patient and family on correct technique for monitoring BP. Advise them to monitor BP at least weekly, and notify health care professional of significant changes.
- Inform patient not to use potassium supplements, salt substitutes containing potassium, or other Rx, OTC, or herbal products without consulting health care professional.
- May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
- Advise patient to notify health care professional if dizziness, diarrhea, vomiting, rapid or irregular heartbeat, lower extremity edema, or difficulty breathing occur.
- Advise patient to inform health care professional of treatment regimen prior to treatment or surgery.
- Advise patient to notify health care professional if pregnancy is planned or suspected. Advise patient to avoid breast feeding during therapy.
- Emphasize the importance of follow-up exams to check serum potassium.
- Decrease in BP without appearance of side effects.
- Improvement in survival in patients with evidence of HF post-MI.