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Selective Mineralocorticoid Receptor Antagonist

Eplerenone

Brand names: Inspra

Used in: Heart Failure

Eplerenone is a selective mineralocorticoid-receptor antagonist used in heart failure after myocardial infarction and in chronic heart failure with reduced ejection fraction.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

HFrEF Post-MI: Initiate treatment with 25 mg once daily. Titrate to maximum of 50 mg once daily within 4 weeks, as tolerated. Dose adjustments may be required based on potassium levels. ( 2.1 ) Hypertension: 50 mg once daily, alone or combined with other antihypertensive agents. For inadequate response, increase to 50 mg twice daily. Higher dosages are not recommended. ( 2.2 ) For all patients: Measure serum potassium before starting INSPRA and periodically thereafter. ( 2.3 ) 2.1 Heart Failure Post-Myocardial Infarction Initiate treatment at 25 mg once daily and titrate to the recommended dose of 50 mg once daily, preferably within 4 weeks as tolerated by the patient. Once treatment with …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-06-23. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It selectively blocks the mineralocorticoid (aldosterone) receptor, reducing adverse cardiac remodelling and promoting modest sodium loss with potassium retention.

Prescribing in practice

  • Hyperkalaemia is the key risk — check renal function and potassium before and after starting or up-titrating, and avoid in significant renal impairment or pre-existing hyperkalaemia.
  • It is more selective than spironolactone, so it causes less gynaecomastia.
  • Risk rises with ACE inhibitors/ARBs, potassium supplements and strong CYP3A4 inhibitors.

Monitoring

Monitor potassium and renal function at baseline, after initiation/titration, and periodically.

Counselling the patient

  • Avoid potassium-based salt substitutes and over-the-counter potassium.
  • Report marked tiredness or palpitations.

Evidence & guidelines

Improves outcomes in post-MI heart failure and HFrEF (e.g. EPHESUS, EMPHASIS-HF); part of guideline-directed therapy (NICE NG106).

Reference: EPHESUS (Pitt et al, NEJM 2003); EMPHASIS-HF (Zannad et al, NEJM 2011); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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