Selective Mineralocorticoid Receptor Antagonist Pregnancy: Avoid — insufficient safety data

Eplerenone

Brand names: Inspra

Adult dose

Dose: Post-MI HF: 25 mg OD, increasing to 50 mg OD after 4 weeks. Chronic HF: 25 mg OD → 50 mg OD

Route: Oral

Frequency: Once daily

Max: 50 mg OD

EPHESUS and EMPHASIS-HF trials. Preferred over spironolactone to minimise gynaecomastia/breast pain.

Paediatric dose

Route: N/A

Frequency: N/A

Max: Not licensed in children

No established paediatric dosing

Dose adjustments

Renal

Avoid if eGFR <30 (post-MI indication) or <50 (HF indication). High risk of hyperkalaemia.

Hepatic

Caution in hepatic impairment; no dose adjustment typically needed for mild-moderate

Clinical pearls

Selective MRA — less gynaecomastia/anti-androgenic effects than spironolactone
EPHESUS: reduced mortality post-MI with HF/LV dysfunction
EMPHASIS-HF: NYHA II HFrEF — reduced HF hospitalisation and death
Check K+ and renal function at 1 and 4 weeks after starting or dose increase

Contraindications

Hyperkalaemia (K+ >5 mmol/L)
Severe renal impairment (eGFR <30)
Concomitant potassium-sparing diuretics or strong CYP3A4 inhibitors
Type 2 diabetes with microalbuminuria (relative)

Side effects

Hyperkalaemia
Dizziness
Headache
Diarrhoea
Gynaecomastia (rare — selective MRA advantage)
Renal impairment

Interactions

ACEi/ARBs — hyperkalaemia risk
Potassium supplements — avoid
Strong CYP3A4 inhibitors (itraconazole, ritonavir) — contraindicated
NSAIDs — reduced efficacy and renal risk
Lithium — increased toxicity

Monitoring

Serum potassium (1 week, 4 weeks, then 3-monthly)
Renal function (eGFR)
Blood pressure
Signs of fluid overload

Reference: BNFc; EPHESUS (Pitt et al, NEJM 2003); EMPHASIS-HF (Zannad et al, NEJM 2011); BNF. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Myasthenia Gravis Activities of Daily Living (MG-ADL) Scale · Neuromuscular

Pathways