Home Drug Guide Eplerenone

Drug Guide

Generic Name

Eplerenone

Brand Names Inspra

Classification

Therapeutic: Antihypertensive, Diuretic

Pharmacological: Mineralocorticoid receptor antagonist

FDA Approved Indications

  • Hypertension
  • Heart failure post myocardial infarction with left ventricular systolic dysfunction

Mechanism of Action

Eplerenone selectively blocks mineralocorticoid receptors, reducing sodium retention and potassium excretion, leading to decreased blood pressure and fluid retention.

Dosage and Administration

Adult: Initially 25 mg once daily; can be increased to 50 mg once daily based on response and serum potassium levels.

Pediatric: Not typically used in pediatric patients; safety and efficacy not established.

Geriatric: Start at lower end of dosing range; monitor closely.

Renal Impairment: Reduce dose in patients with serum creatinine >2.0 mg/dL or eGFR <50 mL/min/1.73 m².

Hepatic Impairment: No specific adjustment; use with caution.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Extensively bound to plasma proteins.

Metabolism: Primarily metabolized by CYP3A4.

Excretion: Excreted in urine and feces.

Half Life: Approximately 4-6 hours.

Contraindications

  • Type 2 diabetes and elevated fasting serum glucose levels (due to risk of hyperkalemia)

Precautions

  • Hyperkalemia, renal impairment, concomitant use of strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin).

Adverse Reactions - Common

  • Hyperkalemia (Common)
  • Dizziness (Common)
  • Hypotension (Common)

Adverse Reactions - Serious

  • Serious hyperkalemia leading to arrhythmias (Uncommon)
  • Renal impairment worsening (Uncommon)

Drug-Drug Interactions

  • Potassium-sparing diuretics, ACE inhibitors, NSAIDs, CYP3A4 inhibitors like ketoconazole, clarithromycin.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, serum potassium, renal function.

Diagnoses:

  • Risk for hyperkalemia
  • Risk for decreased cardiac output

Implementation: Administer with food to enhance absorption; monitor labs regularly.

Evaluation: Assess blood pressure response and serum potassium levels periodically.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Avoid potassium-containing salt substitutes.
  • Report muscle weakness, fatigue, or irregular heartbeat.
  • Stay hydrated and avoid excessive potassium intake.

Special Considerations

Black Box Warnings:

  • Hyperkalemia risk, especially in patients with renal impairment or on other potassium-sparing drugs.

Genetic Factors: Consider pharmacogenomics for CYP3A4 metabolism affecting drug levels.

Lab Test Interference: May affect serum potassium and renal function tests.

Overdose Management

Signs/Symptoms: Hyperkalemia, hypotension.

Treatment: Discontinue medication, monitor electrolytes, supportive care, and manage hyperkalemia per protocols.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable up to the expiration date when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.