Eplerenone adverse effects

Eplerenone 25 mg once 50 mg once baseline and within 1 week of initiation and dose titration Adverse effects gynecomastia or breast tenderness, menstrual changes, hirsutism... 

To reduce mortality, administration of an aldosterone antagonist, either eplerenone or spironolactone, should be considered within the first 2 weeks following MI in all patients who are already receiving an ACE inhibitor (or ARB) and have an EF of equal to or less than 40% and either heart failure symptoms or diagnosis of diabetes mellitus.3 Aldosterone plays an important role in heart failure and in MI because it promotes vascular and myocardial fibrosis, endothelial dysfunction, hypertension, left ventricular hypertrophy, sodium retention, potassium and magnesium loss, and arrhythmias. Aldosterone antagonists have been shown in experimental and human studies to attenuate these adverse effects.70 Spironolactone decreases all-cause mortality in patients with stable, severe heart failure.71... 

Primary advantage of eplerenone over spironolactone is a potentially decreased incidence of endocrine-related adverse effects, such as gynecomastia or sexual dysfunction... 

Eplerenone is a spironolactone analog with much greater selectivity for the mineralocorticoid receptor. It is several hundred-fold less active on androgen and progesterone receptors than spironolactone, and therefore eplerenone has considerably fewer adverse effects. 

POTASSIUM-SPARING DIURETICS ANTIVIRALS-PROTEASE INHIBITORS Possibly t adverse effects of eplerenone with nelfinavir, ritonavir (with or without lopinavir) and saquinavir Inhibition of CYP3A4-mediated metabolism of eplerenone Avoid concomitant use... 

Although troublesome, these adverse effects are reversible and dose-related. The advent of selective aldosterone receptor antagonists, such as eplerenone, should reduce these adverse effects and thereby improve patient compliance. In EPHESUS there was no increase in the incidence of gynecomastia, breast pain, or impotence in men or menstrual irregularities in women who took eplerenone. 

Cardiovascular System In a prospective study assessing the eplerenone (50 mg per day) effect on 117 patients with uncontrolled HTN on at least two anti-HTN drugs showed wi drawal of four patients from the study due to cardiovascular adverse events (like myocardial infarction, two patients hypertensive urgency, one patient orthostatic hypotension, one patient). The authors suspected these may be unrelated to the use of eplerenone [44]. 

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