Eplerenone Amiodarone

AMIODARONE POTASSIUM-SPARING DIURETICS Risk of T levels of eplerenone with amiodarone risk of hyperkalaemia directly related to serum levels Calcium channel blockers inhibit CYP3A4-mediated metabolism of eplerenone Restrict dose of eplerenone to 25mg/day. Monitor serum potassium concentrations closely watch for hyperkalaemia... 

Clinically important, potentially hazardous interactions with acebutolol, amiodarone, aspirin, atenolol, atorvastatin, betaxolol, carbamazepine, carteolol, celiprolol, donidine, dabigatran, dantrolene, digoxin, dofetilide, epirubicin, eplerenone, erythromycin, esmolol, eucalyptus, everolimus, lovastatin, metoprolol, mistletoe, nadolol, oxprenolol, penbutolol, pindolol, propranolol, quinidine, ranolazine, sibutramine, simvastatin, timolol, trabectedin... 

In the UK, the manufacturers recommend that the dose of eplerenone should not exceed 25 mg daily in patients taking mild to moderate CYP3A4 inhibitors such as amiodarone, diltiazem, erythromycin, fluconazole, saquinavir and verapamil. In the US, the manufacturer recommends that the starting dose for hypertension should be reduced to 25 mg daily for patients taking these drugs. This seems a sensible precaution. However, note that in many cases erythromycin appears to be a more potent inhibitor of CYP3A4 than clarithromycin (and certainly the other moderate CYP3A4 inhibitors listed above), and so extra caution is probably warranted with this combination. 

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