How It Works
Eplerenone works as a diuretic medication, classified as an aldosterone receptor antagonist or a mineralocorticoid. It blocks aldosterone receptors.
Aldosterone is a naturally occurring hormone that typically raises blood pressure by increasing the retention of sodium and water in the bloodstream. Eplerenone blocks aldosterone receptors, reducing the amount of sodium and fluid that the body retains. It does so without excessive potassium loss.
By reducing fluid buildup, eplerenone helps lower blood pressure and reduce strain on the heart.
| Quick Facts | |
|---|---|
| Common Brands | Inspra |
| Drug Class | Aldosterone receptor antagonist |
| Generic Status | Generic is available |
| Availability | Prescription only |
Dosing
Standard guidelines recommend that eplerenone tablets be taken once or twice daily, depending on the condition.
For high blood pressure, the typical starting dose is 50 mg once daily, with a maximum of 50 mg twice daily. Providers may adjust these doses based on regular blood test monitoring of potassium levels, or if the medication is being used alongside other drugs.
For heart failure after a heart attack, a typical starting dose is 25 mg taken by mouth once daily, with a maximum dose of 50 mg once daily.
Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs. Always follow your healthcare provider’s instructions for exact dosing.
Uses
FDA-Approved Uses
Eplerenone is FDA-approved to treat high blood pressure. It is also approved to improve heart function for patients who have heart failure after a recent heart attack.
Off-Label Uses
You may see eplerenone prescribed for uses that are not “FDA-approved.” This is a common and legal practice called “off-label” prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different (but well-researched) purpose.
Providers may sometimes use eplerenone for other health conditions based on their assessment of a specific patient’s circumstances.
Side Effects
Like all medications, eplerenone tablets can cause side effects. Some common side effects may improve over time as your body adjusts to the medication. Other side effects may be serious and require medical attention.
Common Side Effects
- Dizziness
- Fatigue
- Mild stomach discomfort and other digestive issues
- Nausea
- Skin problems
- Cough
- Shortness of breath
- Nervous system problems
- Urinary tract problems
Serious Side Effects
Serious side effects are rare, but it’s important to know what to look for if they do occur.
- High potassium levels (hyperkalemia): Eplerenone may cause too much potassium in the blood. This can lead to muscle weakness, unusual tiredness, nausea, numbness and tingling, or changes to your heart rhythm.
- Severe allergic reactions: Symptoms of a reaction to eplerenone may include a skin rash, itching, hives, trouble breathing, or notable swelling of the face, lips, mouth, tongue, or throat. See a doctor immediately if you have signs of an allergic reaction.
- Kidney injury: This issue can manifest as decreased urine production or swelling in the ankles, hands, or feet.
- Chest pain: When taking eplerenone, you may experience chest tightness or heaviness, or discomfort that spreads to the arms, jaw, back, or neck.
Call your doctor immediately if you experience any concerning or prolonged symptoms.
Pharmacist Tips
Maintain A Consistent Schedule
Providers recommend taking eplerenone at around the same time each day. It can be taken comfortably with or without food.
Avoid Potassium Supplements
Do not use any potassium supplements or potassium-containing salt substitutes while taking eplerenone, as this can increase your risk of developing dangerously high potassium levels.
Complete Routine Blood Work
Standard guidelines recommend performing blood tests to check potassium and creatinine levels before starting treatment, within the first week, at one month, and whenever your dosage is changed.
Avoid Grapefruit
Consuming grapefruit or grapefruit juice may increase eplerenone absorption, which can elevate the risk of side effects.
Be Patient With Results
Providers note that it typically takes about two weeks to notice a drop in blood pressure after starting eplerenone. The full effect of therapy may not be noticeable for several weeks.
Drug Interactions
Certain medications and substances can interact with eplerenone, potentially altering how it works or increasing the risk of side effects.
- Potassium supplements and potassium-sparing diuretics: Using these along with eplerenone can increase the risk of developing dangerously high blood potassium levels.
- Other blood pressure medications: Medications such as ACE inhibitors (like lisinopril), ARBs, and beta blockers may interact with eplerenone and require closer medical monitoring of your potassium levels and kidney function.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Taking common pain relievers such as ibuprofen and naproxen alongside eplerenone can increase the chance of developing high levels of potassium.
- Certain antibiotics: Clarithromycin and erythromycin interact with eplerenone and may require dose adjustments.
- Antifungal medications: Specific medications used for fungal infections, including ketoconazole and itraconazole, are generally not recommended for concurrent use with eplerenone.
- HIV or AIDS medications: Certain treatments for HIV or AIDS, such as ritonavir and indinavir, may have significant interactions with eplerenone.
- Lithium: This medication can interact with eplerenone.
- Grapefruit and grapefruit juice: Consuming these can increase eplerenone levels in your body and heighten the risk of side effects.
Always give your doctor and pharmacist a complete list of all your medications.
FAQs
What is the difference between eplerenone and older medications like spironolactone?
While both eplerenone and spironolactone are aldosterone antagonists used to lower blood pressure and manage heart failure, eplerenone is known to be highly selective. This means it is generally associated with fewer hormone-related side effects compared to spironolactone. For example, eplerenone carries a lower risk of breast enlargement in men (gynecomastia), low sex drive, and changes in menstruation.
Can taking eplerenone cause breast swelling in men?
Eplerenone can cause swelling of the breasts in men (gynecomastia), but this side effect is rare.
What should I do if I miss a daily dose of eplerenone?
If you miss a dose, providers typically recommend taking it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed one entirely and proceed with your regular daily schedule. Never take double or extra doses to make up for a missed tablet.
Why do doctors avoid prescribing eplerenone for those with type 2 diabetes?
Eplerenone is contraindicated for individuals with type 2 diabetes who also have abnormally high levels of protein in their urine (microalbuminuria). These patients have a higher risk of serious complications, such as high potassium levels, when taking eplerenone.
Does eplerenone interact with NSAIDs like ibuprofen or naproxen?
Yes, eplerenone can interact with drugs like ibuprofen and naproxen. When eplerenone is used in combination with these types of medications, there is an elevated risk of developing excess potassium in the bloodstream.
Is it safe to consume alcohol while taking a daily dose of eplerenone?
Alcohol can generally be consumed in moderation while taking eplerenone. While alcohol does not typically increase potassium levels, combining it with eplerenone may increase the risk of dizziness or lightheadedness, especially with heavier alcohol intake.
Can eplerenone cause menstrual irregularities or vaginal bleeding in women?
Although uncommon, irregular menstrual cycles, unexpected spotting, and abnormal vaginal bleeding have been reported as potential side effects of eplerenone.
Is eplerenone approved for use during pregnancy or while breastfeeding?
There is currently not enough clinical information to fully assess the safety of eplerenone during pregnancy, but risk cannot be ruled out. It is also unknown if eplerenone passes into breast milk. Consult your healthcare provider about the benefits and risks of eplerenone if you are pregnant, planning to become pregnant, or currently breastfeeding.
What are the symptoms of an eplerenone overdose, and how is it managed?
If there are any signs of a serious adverse reaction, seek prompt medical help. If you suspect an overdose has occurred, call 911 or contact a Poison Control center.
Comparable Medications
Eplerenone, Spironolactone (Aldactone), Hydrochlorothiazide, Furosemide, Lisinopril?
Spironolactone
From $26.99
This aldosterone antagonist is used to treat heart failure and high blood pressure, but it typically carries a higher risk of hormone-related side effects than eplerenone.
Hydrochlorothiazide
From $25.99
This medication is a diuretic frequently used in combination with other drugs to lower high blood pressure.
Furosemide
From $26.99
This diuretic is used to treat cardiovascular conditions.
Lisinopril
From $24.99
This prescription medication is an ACE inhibitor that lowers blood pressure and treats heart failure through a mechanism distinct from that of aldosterone receptor antagonists.
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Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions. Learn more about our editorial standards here.