Eplerenone Drug Interactions
Also known as: Inspra
Eplerenone is a selective aldosterone receptor antagonist (potassium-sparing diuretic) used to treat heart failure after myocardial infarction and hypertension. It is more selective than spironolactone and has fewer hormonal side effects.Eplerenone has 1 documented drug interaction in our database, including 0 contraindicated, 1 major, 0 moderate, and 0 minor interactions.
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Contraindicated
1
Major
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Moderate
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Minor
Concurrent use of losartan and eplerenone significantly increases the risk of hyperkalemia. Both drugs reduce renal potassium excretion through complementary RAAS-blocking mechanisms. Eplerenone is a selective aldosterone antagonist with a lower risk of hormonal side effects than spironolactone, but the hyperkalemia risk with ARB co-administration is equivalent.
Mechanism
Losartan blocks AT1 receptors, reducing angiotensin II-stimulated aldosterone secretion and thereby decreasing renal potassium excretion. Eplerenone selectively blocks mineralocorticoid receptors in the kidney collecting duct, further reducing potassium excretion. The additive potassium-retaining effect can cause clinically significant hyperkalemia.
Clinical Management
Avoid in patients with eGFR <30 mL/min/1.73m², diabetes with microalbuminuria (eplerenone is contraindicated), or baseline potassium >5.0 mEq/L. Monitor serum potassium and creatinine within 1–2 weeks of initiating the combination and every 3 months thereafter. Reduce eplerenone dose or discontinue if potassium exceeds 5.5 mEq/L. Avoid potassium supplements and salt substitutes.
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