eplerenone
eplerenone
Pharmacologic class: Aldosterone receptor blocker
Therapeutic class: Antihypertensive
Pregnancy risk category B
Action
Binds to and blocks aldosterone receptors, disrupting normal sodium and water reabsorption and causing sodium and water excretion to increase. These actions reduce blood volume and blood pressure.
Availability
Tablets: 25 mg, 50 mg
Indications and dosages
➣ Hypertension
Adults: 50 mg/day P.O. as a single dose. After 4-week trial, may increase to 50 mg P.O. b.i.d. if necessary.
➣ Heart failure; post-myocardial infarction (MI)
Adults: Initially, 25 mg P.O. once daily. After 4 weeks, may increase to maximum dosage of 50 mg P.O. once daily.
Contraindications
• Hypersensitivity to drug
• Hyperkalemia
• Potassium supplements or potassium-sparing diuretics
• Type 2 diabetes mellitus with microalbuminuria
• Severe renal impairment
Precautions
Use cautiously in:
• hepatic impairment
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
Administration
• Give with or without food.
• Know that drug may be given alone or with other antihypertensives.
Adverse reactions
CNS: headache, dizziness, fatigue
CV: angina, MI
GI: diarrhea, abdominal pain
GU: albuminuria, vaginal bleeding, changes in sexual function, gynecomastia and breast pain (in men)
Metabolic: hypercholesterolemia, hyperkalemia
Respiratory: cough
Other: flulike symptoms
Interactions
Drug-drug. Angiotensin-converting enzyme inhibitors, potassium-sparing diuretics, potassium supplements: increased risk of hyperkalemia
CYP450-3A4 inhibitors: serious toxic effects
Lithium: increased risk of toxicity
Nonsteroidal antiinflammatory drugs: decreased hypertensive effect of eplerenone
Patient monitoring
• Monitor electrolyte levels, and watch for signs and symptoms of hyperkalemia.
• Check vital signs, and ask patient about chest pain.
• Monitor lipid panel.
• Assess for new onset of persistent dry cough or flulike symptoms.
Patient teaching
See Advise patient to immediately report chest pain, flulike symptoms, or persistent dry cough.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Inform patient that drug may affect sexual function. Encourage him to discuss this issue with prescriber.
• Advise female patient to discuss pregnancy or breastfeeding with prescriber before starting drug.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.
eplerenone
(e-ple-re-none) eplerenone,Inspra
(trade name)Classification
Therapeutic: antihypertensivesPharmacologic: aldosterone antagonists
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (antihypertensive effect)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | unknown | 4 wk | unknown |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- dizziness
- fatigue
Gastrointestinal
- abnormal liver function tests
- abdominal pain
- diarrhea
Genitourinary
- albuminuria
Endocrinologic
- abnormal vaginal bleeding
- gynecomastia
Fluid and Electrolyte
- hyperkalemia (life-threatening)
Metabolic
- hypercholesterolemia
- hypertriglyceridemia
Miscellaneous
- flu-like symptoms
Interactions
Drug-Drug interaction
Concurrent use of strong inhibitors of the CYP3A4 enzyme system (ketoconazole, itraconazole, nefazodone, clarithromycin, ritonavir, or nelfinavir ) significantly ↑ effects of eplerenone; concurrent use contraindicated. Concurrent use of weak inhibitors of the CYP3A4 enzyme system (erythromycin, saquinavir, fluconazole, verapamil ) may ↑ effects of eplerenone; initial dose of eplerenone should be ↓ by 50%.NSAIDs may ↓ antihypertensive effects.Concurrent use of ACE inhibitors or Angiotensin II receptor blockers may ↑ risk of hyperkalemia.Route/Dosage
Hypertension
HF Post-MI
Availability (generic available)
Nursing implications
Nursing assessment
- Monitor BP periodically during therapy.
- Monitor prescription refills to determine adherence.
- Lab Test Considerations: May cause hyperkalemia. Monitor serum potassium levels prior to starting therapy, within the first wk, at 1 mo following start of therapy or dose adjustment and periodically thereafter. Monitor serum potassium and serum creatinine in 3–7 days in patients who start taking a moderate CYP3A4 inhibitor.
- May cause ↓ serum sodium and ↑ serum triglyceride, cholesterol, ALT, GGT, creatinine, and uric acid levels.
Potential Nursing Diagnoses
Decreased cardiac output (Indications)Noncompliance (Patient/Family Teaching)
Implementation
- Do not confuse Inspra with Spiriva.
- PO: Administer once daily. May be increased to twice daily if response is inadequate.
Patient/Family Teaching
- Instruct patient to take medication as directed at the same time each day, even if feeling well.
- Encourage patient to comply with additional interventions for hypertension (weight reduction, discontinuation of smoking, moderation of alcohol consumption, regular exercise, stress management). Medication controls, but does not cure, hypertension.
- Instruct patient and family on correct technique for monitoring BP. Advise them to monitor BP at least weekly, and notify health care professional of significant changes.
- Inform patient not to use potassium supplements, salt substitutes containing potassium, or other Rx, OTC, or herbal products without consulting health care professional.
- May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
- Advise patient to notify health care professional if dizziness, diarrhea, vomiting, rapid or irregular heartbeat, lower extremity edema, or difficulty breathing occur.
- Advise patient to inform health care professional of treatment regimen prior to treatment or surgery.
- Advise patient to notify health care professional if pregnancy is planned or suspected. Advise patient to avoid breast feeding during therapy.
- Emphasize the importance of follow-up exams to check serum potassium.
Evaluation/Desired Outcomes
- Decrease in BP without appearance of side effects.
- Improvement in survival in patients with evidence of HF post-MI.