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Related to Inspra: Altoprev



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

• Hyperkalemia

• 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.

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


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

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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved


(e-ple-re-none) ,


(trade name)


Therapeutic: antihypertensives
Pharmacologic: aldosterone antagonists
Pregnancy Category: B


Hypertension (alone, or with other agents).LV systolic dysfunction and evidence of HF post-MI.


Blocks the effects of aldosterone by attaching to mineralocorticoid receptors.

Therapeutic effects

Lowering of BP.
Improves survival in patients with evidence of HF post-MI.


Absorption: Well absorbed following oral administration.
Distribution: Unknown.
Metabolism and Excretion: Mostly metabolized by the liver (CYP3A4 enzyme system); <5% excreted unchanged by the kidneys.
Half-life: 4–6 hr.

Time/action profile (antihypertensive effect)

POunknown4 wkunknown


Contraindicated in: Serum potassium >5.5 mEq/L;Type 2 diabetes with microalbuminuria (for patients with HTN; ↑ risk of hyperkalemia);Serum creatinine >2 mg/dL in males or > 1.8 mg/dL in females (for patients with HTN);CCr ≤30 mL/min (for all patients); CCr <50 mL/min (for patients with HTN);Concurrent use of potassium supplements or potassium-sparing diuretics (for patients with HTN);Concurrent use of strong inhibitors of the CYP3A4 enzyme system (ketoconazole, itraconazole, nefazodone, clarithromycin, ritonavir, or nelfinavir); Lactation: Lactation.
Use Cautiously in: Severe hepatic impairment; Obstetric: Use only if clearly needed; Pediatric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • fatigue


  • abnormal liver function tests
  • abdominal pain
  • diarrhea


  • albuminuria


  • abnormal vaginal bleeding
  • gynecomastia

Fluid and Electrolyte

  • hyperkalemia (life-threatening)


  • hypercholesterolemia
  • hypertriglyceridemia


  • flu-like symptoms


Drug-Drug interaction

Concurrent 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.



Oral (Adults) 50 mg daily initially; may be ↑ to 50 mg twice daily; Patients receiving concurrent moderate CYP3A4 inhibitors (erythromycin, saquinavir, verapamil, fluconazole)—25 mg once daily initially.

HF Post-MI

Oral (Adults) 25 mg daily initially; ↑ in 4 wk to 50 mg daily; subsequent dose adjustments may need to be made based on serum potassium concentrations.

Availability (generic available)

Tablets: 25 mg, 50 mg

Nursing implications

Nursing assessment

  • 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 Diagnoses

Decreased 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.

Patient/Family Teaching

  • 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.

Evaluation/Desired Outcomes

  • Decrease in BP without appearance of side effects.
  • Improvement in survival in patients with evidence of HF post-MI.
Drug Guide, © 2015 Farlex and Partners


A trademark for the drug eplerenone.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.
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One is Inspra, a selective aldosterone receptor antagonist that is approved for the treatment of hypertension and heart failure.
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He is a consultant to Pfizer Inc., which markets eplerenone (Inspra).