ALDOSTERONE ANTAGONISTS








DRUGS IN CLASS



MECHANISM OF ACTION



FDA-APPROVED INDICATIONS



EFFECTIVENESS

  • Spir = spironolactone
  • Study lengths ranged from 6 - 12 weeks
  • Reference [8]
Spironolactone (Spir) in placebo-controlled trials
Spir 25 mg/day
(N=24)
Spir 100 mg/day
(N=24)
Spir 150 mg/day
(N=50)
Spir 200 mg/day
(N=24)
Systolic BP (mmHg)
(spir minus placebo)
10 23 19 20
Diastolic BP (mmHg)
(spir minus placebo)
2.4 7.2 8 6.2

  • Epl = eplerenone
  • Baseline BP across groups ∼ 149/95
  • Reference [13]
Eplerenone (Epl) for hypertension
Randomized placebo-controlled 12 week trial
Placebo

(N=70)
Epl 25 mg/day
(N=34)
Epl 50 mg/day
(N=63)
Epl 100 mg/day
(N=73)
Epl 200 mg/day
(N=73)
Systolic BP (mmHg)
(change from baseline in daytime ambulatory BP)
-1.5 -6.3 -6.6 -8.4 -10.1
Diastolic BP (mmHg)
(change from baseline in daytime ambulatory BP)
-1.0 -3.8 -4.0 -5.3 -5.8


SIDE EFFECTS


  • Measure serum potassium before initiating eplerenone therapy, within the first week, and at one month after the start of treatment or dose adjustment. Assess serum potassium periodically thereafter.
  • Reference [Inspra PI]
Eplerenone dose adjustments in heart failure based on serum potassium
Serum Potassium (mEq/L) Dose Adjustment
< 5.0
  • 25 mg every other day to 25 mg once daily
  • 25 mg once daily to 50 mg once daily
5.0 - 5.4
  • No adjustment
5.5 - 5.9
  • 50 mg once daily to 25 mg once daily
  • 25 mg once daily to 25 mg every other day
  • 25 mg every other day to withhold
≥ 6.0
  • Withhold and restart at 25 mg every other day when potassium levels fall to <5.5 mEq/L

CONTRAINDICATIONS



PRECAUTIONS



DRUG INTERACTIONS



DOSING



LONG-TERM SAFETY



GENERIC AVAILABILITY



DIFFERENCES BETWEEN DRUGS



BIBLIOGRAPHY