Eplerenone

FDA label

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Titration Allow ~4 weeks for full effect before increasing 50 mg QD to 50 mg BID.

Renal Contraindicated at CrCl <=30 mL/min (all patients); for hypertension also contraindicated at CrCl <50 mL/min or serum Cr >2.0 mg/dL (M) / >1.8 mg/dL (F).

Hepatic Undefined

With a concomitant moderate CYP3A inhibitor (hypertension): initiate 25 mg QD; for inadequate BP response may increase to max 25 mg BID.

Instructions

• Measure serum potassium before starting, within the first week, at one month, then periodically
• Check serum potassium and creatinine within 3–7 days of starting a moderate CYP3A inhibitor, ARB, or NSAID

Contraindications

• Serum potassium >5.5 mEq/L at initiation
• CrCl <=30 mL/min (all indications)
• Concomitant strong CYP3A inhibitors
• Hypertension: type 2 diabetes with microalbuminuria
• Hypertension: concomitant potassium supplements or potassium-sparing diuretics (amiloride, spironolactone, triamterene)

Cautions

• Hyperkalemia — higher risk with renal impairment, proteinuria, diabetes, or concomitant ARBs/NSAIDs/moderate CYP3A inhibitors; monitor serum potassium

Adverse reactions

• Hyperkalemia
• Headache, dizziness
• Gynecomastia / abnormal vaginal bleeding
• Increased GGT

Pregnancy Insufficient human data; animal studies show no adverse developmental effects at 31–32× human exposure.

Lactation Undefined