Mineralocorticoid receptor antagonists (MRAs)
- Block aldosterone signaling
- HFrEF: spironolactone/eplerenone improve survival
- Resistant HTN: spironolactone highly effective
- Finerenone: CKD/T2DM + HF indications
- Hyperkalemia + renal monitoring are central
- Spironolactone → gynecomastia/sexual AEs
- Eplerenone is more receptor-selective
Class at a glance
- Block aldosterone signaling
Clinical role
- HFrEF: spironolactone/eplerenone improve survival
- Eplerenone is more receptor-selective
Other clinical roles
- Resistant HTN: spironolactone highly effective
- Finerenone: CKD/T2DM + HF indications
- Spironolactone → gynecomastia/sexual AEs
Safety / monitoring
- Hyperkalemia + renal monitoring are central
Pearls
- Spironolactone and eplerenone similarly effective in HFrEF
- HFrEF: don't start if K ≥5.0 or eGFR <30
- HFrEF indication spans NYHA class II–IV
Self-check
- What are key clinical uses of finerenone?
CKD/T2DM and HF indications. - Which MRA causes gynecomastia/sexual adverse effects?
Spironolactone.
Drugs in this class (3)
Mineralocorticoid receptor antagonists (MRAs) prescription history
Animated chart of estimated U.S. prescriptions per year, Diuretics (1953–2026). Potassium sparing highlighted from 1960.
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