Eplerenone
- Class: Aldosterone antagonist
- Used for: heart failure
- Say it: eh-PLER-eh-nohn
- Forms: tablet
Both block the mineralocorticoid receptor. Spironolactone also hits androgen and progesterone receptors, causing gynaecomastia; eplerenone is selective, so it spares those and costs more.
Side effects
Common: high potassium, dizziness, diarrhea
Serious: dangerous hyperkalemia
Typical dose
25–50 mg once daily
Start at 25 mg and wait four weeks before increasing — the full effect is slow to appear.
Check yourself
Why might eplerenone be chosen instead of spironolactone?
- It is selective for the mineralocorticoid receptor, so it does not cause gynaecomastia
- It does not raise potassium
- It is a more powerful diuretic
- It can be used safely in renal failure
Show answer
A. It is selective for the mineralocorticoid receptor, so it does not cause gynaecomastia
Spironolactone's hormonal side effects come from blocking androgen and progesterone receptors as well. Eplerenone leaves those alone. The hyperkalaemia risk, however, is shared — that is the class effect, not a quirk.
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