Eplerenone for Heart Failure - Heart Disease and Eplerenone

How does Eplerenone help, and who should take it?

Aldosterone is produced by the adrenal glands, and it makes the body hold on to sodium and water. As a result, the amount of fluid in your body increases, and blood pressure increases too. By keeping body tissue from receiving aldosterone, eplerenone lowers blood pressure and helps the heart pump blood more effectively with less effort.

Eplerenone is widely accepted as a useful treatment for high blood pressure and heart failure partly because its action is very specific: it only blocks the receptors for aldosterone. Another medication, spironolactone, is more effective at blocking aldosterone and is usually less expensive, but it also blocks other essential hormones, such as androgen and progesterone.

Most people tolerate eplerenone very well. Studies in those older than age 65 have found eplerenone to be safe and effective; no studies in young children or pregnant or breastfeeding women have been completed. Eplerenone isn't recommended if you have type 2 diabetes and microalbuminuria (high levels of the protein albumin in the urine).

Eplerenone increases how much potassium is in the blood. This can lead to a serious and potentially fatal condition known as hyperkalemia. Those with diabetes are more likely to become "hyperkalemic." If you take eplerenone, you should have your potassium level tested often.

Other possible side effects of eplerenone include diarrhea, nausea, headaches, dizziness and flu-like symptoms -- chills, fever, muscle aches. Rarely, eplerenone can cause abnormal vaginal bleeding, chest pain, changes in mood or mental state and gynecomastia (swelling of breast tissue in males).

Make sure your doctor is aware of all your medications. Eplerenone interacts with many, including angiotensin-converting enzyme (ACE) inhibitors, amiloride (Midamor), amiloride and hydrochlorothiazide (Moduretic), itraconazole (Sporanox), ketoconazole (Nizoral), spironolactone (AldactoneAldactone), spironolactone and hydrochlorothiazide (Aldactazide), triamterene (Dyrenium), triamterene and hydrochlorothiazide (Dyazide, Maxzide) and potassium supplements  (salt substitutes).

If you take eplerenone, avoid grapefruit juice and St. John's wort. They can change how much eplerenone is in your blood, so the drug either acts more strongly or weakly than your doctor intended.

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