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SIDE EFFECTS
Eplerenone
Most Common
( e h - P L E H - r e h - n o n e )
Hyperkalemia, diarrhea, abdominal pain, diz-ziness, coughing, fatigue, flu-like symptoms.
Classification(s): Aldosterone receptor
Hyperkalemia is the primary risk; can result in de- creased renal function and serious, sometimes fa-
tal arrhythmias.
GI: Diarrhea, abdominal pain.
Pregnancy Category: B
GU: Mastodynia in males, abnormal vaginal
RX: Inspra.
bleeding, gynecomastia (males). Miscellaneous:
Dizziness, coughing, fatigue, flu-like symptoms.
INDICATIONS/USES
LABORATORY TEST CONSIDERATIONS
(1) Hypertension, alone or in combination withother antihypertensive drugs. (2) Improve survival e ALT, BUN, uric acid, serum creatinine. Hypo- of stable clients with left ventricular systolic dys- natremia, hypercholesterolemia, albuminuria, hy- function (ejection fraction of 40% or less) and clinical evidence of CHF after an acute MI. Inves- DRUG INTERACTIONS
tigational: Alone or in combination with an angio- ACE inhibitors / e Risk of hyperkalemia tensin-converting enzyme inhibitor for reducing Angiotensin II antagonists / e Risk of hyperkale- left ventricular hypertrophy. As adjunctive therapy in diabetic hypertension with microalbuminuria.
CYP3A4 inhibitors (itraconazole, ketoconazole) / ACTION/KINETICS
Up to a 5-fold increase in eplerenone exposureLithium / Potential lithium toxicity; monitor se- Binds to the mineralocorticoid receptor and NSAIDs / Potential a antihypertensive effect and blocks binding of aldosterone. Aldosterone in- creases BP through induction of sodium reabsorp- h St. John’s wort / About a 30% a in eplere- tion and other mechanisms. Thus, by blocking aldosterone binding, sodium is not reabsorbedand BP decreases.
HOW SUPPLIED
Pharmacokinetics
Peak plasma levels: About 1.5 hr. Steady state:
Reached in 2 days. Absorption not affected by
food. Metabolized primarily via CYP3A4 in theliver. About two-thirds excreted in the urine and one-third in the feces. t1/2, terminal: 4–6 hr. Plas-
ma protein binding: About 50%.
Initial: 50 mg once daily. If inadequate
response, increase dose to 50 mg twice a
CONTRAINDICATIONS
Serum potassium greater than 5.5 mEq/L at initi- ation, type 2 diabetes with microalbuminuria, se- rum creatinine greater than 2 mg/dL in males or 30 mL/min. Also, clients concurrently taking po- tassium supplements, potassium-sparing diuretics (e.g., amiloride, spironolactone, triamterene), or Left ventricular systolic dysfunction and clinical strong inhibitors of CYP3A4 drugs (clarithromy- evidence of conjestive heart failure after an cin, ketoconazole, itraconazole, nefazodone, nelfi- navir, ritonavir, troleandomycin). Lactation.
Initial: 25 mg once daily; titrate to tar-
get dose of 50 mg once daily, preferable
SPECIAL CONCERNS
Safety and efficacy not determined in children.
um. Less than 5 mEq/L potassium:
nine >2.0 mg/dL in males or >1.8 mg/dL in day to 25 mg daily to 50 mg daily; Se-
4. Assess BP, serum K+, renal and LFTs, and for
rum potassium from 5–5.4 mEq/L:
DM. With post-MI heart failure, note LV ejec- Maintain dosage; no adjustment; Se-
tion fraction and systolic dysfunction.
rum potassium, 5.5–5.9 mEq/L: De-
CLIENT/FAMILY TEACHING
1. Take as directed with or without food. Do not
take supplements containing potassium.
holding the drug; Serum potassium, 6
mEq/L or greater:
Withhold drug.
2. Avoid activities that require mental alertness
until drug effects realized. Sit or lie down if experiencing dizziness or lightheadedness NURSING IMPLICATIONS
when standing. Keep log of BP and HR.
3. Continue lifestyle changes that help control
IMPLEMENTATION/ADMINISTRATION/STORAGE
BP, i.e., maintain healthy diet and limit intake 1. Dosage adjustment is not necessary for mild
of caffeine, avoid alcohol, salt substitutes, or to moderate hepatic dysfunction. Should notbe used in those with severe hepatic dysfunc- high Na+ and high K+ foods, perform regular exercise, maintain weight, and stop smoking.
2. Store from 15–30°C (59–86°F).
4. Avoid OTC meds and ETOH.
5. Keep all F/U to assess response, labs, and
ASSESSMENT
1. Note reasons for therapy, symptom character-
OUTCOMES/EVALUATE
2. List drugs prescribed to ensure none interact.
3. With HTN, avoid drug use in type 2 diabetes
with microalbuminuria, and if serum creati-

Source: http://www.cengagesites.com/academic/assets/sites/5407/pdf/bonus-drugs-2013/Eplerenone.pdf

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