Eplerenone

Potassium-sparing Diuretic·Cardiovascular - Diuretics

HFrEF, left ventricular dysfunction post-MI

Authority requiredPBSMRAInspra25 mg tablet+2

Max Dose

50 mg/day

Half-life

4–6 h

Hyperkalemia

HIGH RISK

Gynecomastia

RARE

Rapid Summary

Overview

Highly selective Mineralocorticoid Receptor Antagonist (MRA). Retains the heart failure mortality benefits of Spironolactone but completely eliminates the hormonal side effects.

Maximum Dose

Max 50 mg/day

Clinical Focus

Potassium monitoring is absolutely mandatory, especially when combined with ACEi/ARBs.

Bottom Line

Eplerenone is the selective MRA of choice post-MI and in heart failure with proven mortality benefit, but hyperkalaemia risk mandates strict potassium monitoring.

Formulation & Access

Brand Names

Inspra

Oral Routes

Tablets (25 mg, 50 mg).

Prescribing & PBS

Authority Required (PBS) for heart failure.

Indications & Use

Primary

PBSTGA

HFrEF, left ventricular dysfunction post-MI.

Clinical Place

Direct replacement for Spironolactone in males who develop painful gynecomastia or sexual dysfunction.

Quick reference

Class & Role

Potassium-sparing Diuretic — Highly selective Mineralocorticoid Receptor Antagonist (MRA).

Route / Formulation

Tablets (25 mg, 50 mg). (Inspra)

Usual Dose & Max

PO 25 mg OD. Titrate up after 4 weeks to Max 50 mg OD (dependent on K+ levels).

Key Indication Doses

Heart Failure (Post-MI or Chronic): PO 25 mg OD. Titrate up after 4 weeks to Max 50 mg OD (dependent on K+ levels). Renal Impairment: If eGFR 30-50, Max 25 mg OD.

Best Uses

Eplerenone is the selective MRA of choice post-MI and in heart failure with proven mortality benefit, but hyperkalaemia risk mandates strict potassium monitoring.

Avoid / Cautions

Baseline K+ > 5.0 mmol/L, severe renal impairment (eGFR < 30). Pregnancy Category B3.

Key Risks

Electrolytes: Hyperkalemia (K+ > 5.5 mmol/L). Renal: Acute renal impairment/AKI. Endocrine: Gynecomastia and menstrual issues are practically zero (highly selective, no affinity for androgen/progesterone receptors).

Key Interactions

Strong CYP3A4 inhibitors (clarithromycin, itraconazole) massively increase eplerenone levels. Use is contraindicated. Potassium supplements, ACEi, ARBs (Hyperkalemia).

Monitoring

U&E check at day 3, 1 week, 1 month, then 3-monthly. Adjust dose if K+ hits 5.0, withhold if K+ > 5.5. Monitor BP and assess for heart failure symptoms.

Clinical Pearl

Unlike Spironolactone, Eplerenone is a very weak blood pressure lowering agent. It is used almost exclusively for its anti-fibrotic, mortality-reducing properties in the heart.

Access

Authority requiredInspra25 mg tablet

Brand: Inspra
PBS status: Authority required
Formulation: Tablets (25 mg, 50 mg)

Eplerenone

Potassium-sparing Diuretic·Cardiovascular - Diuretics

HFrEF, left ventricular dysfunction post-MI

Authority requiredPBSMRAInspra25 mg tablet+2

Max Dose

50 mg/day

Half-life

4–6 h

Hyperkalemia

HIGH RISK

Gynecomastia

RARE

Rapid Summary

Overview

Highly selective Mineralocorticoid Receptor Antagonist (MRA). Retains the heart failure mortality benefits of Spironolactone but completely eliminates the hormonal side effects.

Maximum Dose

Max 50 mg/day

Clinical Focus

Potassium monitoring is absolutely mandatory, especially when combined with ACEi/ARBs.

Bottom Line

Eplerenone is the selective MRA of choice post-MI and in heart failure with proven mortality benefit, but hyperkalaemia risk mandates strict potassium monitoring.

Formulation & Access

Brand Names

Inspra

Oral Routes

Tablets (25 mg, 50 mg).

Prescribing & PBS

Authority Required (PBS) for heart failure.

Indications & Use

Primary

PBSTGA

HFrEF, left ventricular dysfunction post-MI.

Clinical Place

Direct replacement for Spironolactone in males who develop painful gynecomastia or sexual dysfunction.

Quick reference

Class & Role

Potassium-sparing Diuretic — Highly selective Mineralocorticoid Receptor Antagonist (MRA).

Route / Formulation

Tablets (25 mg, 50 mg). (Inspra)

Usual Dose & Max

PO 25 mg OD. Titrate up after 4 weeks to Max 50 mg OD (dependent on K+ levels).

Key Indication Doses

Heart Failure (Post-MI or Chronic): PO 25 mg OD. Titrate up after 4 weeks to Max 50 mg OD (dependent on K+ levels). Renal Impairment: If eGFR 30-50, Max 25 mg OD.

Best Uses

Eplerenone is the selective MRA of choice post-MI and in heart failure with proven mortality benefit, but hyperkalaemia risk mandates strict potassium monitoring.

Avoid / Cautions

Baseline K+ > 5.0 mmol/L, severe renal impairment (eGFR < 30). Pregnancy Category B3.

Key Risks

Key Interactions

Strong CYP3A4 inhibitors (clarithromycin, itraconazole) massively increase eplerenone levels. Use is contraindicated. Potassium supplements, ACEi, ARBs (Hyperkalemia).

Monitoring

U&E check at day 3, 1 week, 1 month, then 3-monthly. Adjust dose if K+ hits 5.0, withhold if K+ > 5.5. Monitor BP and assess for heart failure symptoms.

Clinical Pearl

Unlike Spironolactone, Eplerenone is a very weak blood pressure lowering agent. It is used almost exclusively for its anti-fibrotic, mortality-reducing properties in the heart.

Access

Authority requiredInspra25 mg tablet

Brand: Inspra
PBS status: Authority required
Formulation: Tablets (25 mg, 50 mg)