Eplerenone vs Spironolactone – Comparison of Uses & Side Effects blood pressure

Eplerenone

It is the generic name of a brand name drug called Inspra. It belongs to a group of drugs known as mineralocorticoid receptor blockers.

Mechanism of Action

This medication works by blocking the action of aldosterone, a natural substance in the body which increases the amount of water and sodium you retain, leading to high blood pressure and scarring of the organ tissues.

It is produced by Pfizer, Inc., a research-based global biopharmaceutical company. The US Food and Drug Administration originally approved it in 2002.

Uses

This prescription medication is typically used to help the heart function after a heart attack. It is also used to treat high blood pressure.

Dosage

For high blood pressure, the usual recommended dose is 50 mg orally once per day. For congestive heart failure post-myocardial infarction, the usual initial recommended dose is 25 mg orally once per day. This dose should be increased to 50 mg once per day in about one month.

Note – it may take one month or longer before you experience the full benefits of this medication.

Side Effects and Precautions

Common side effects may include:

  • increased potassium levels;
  • flu-like symptoms;
  • dizziness;
  • fatigue;
  • coughing;
  • diarrhea.

Rare side effects may include:

  • severe diarrhea;
  • chest pain;
  • loss of muscle tone;
  • fast or irregular heartbeat;
  • severe lack of energy;
  • enlarged or sore breasts in men;
  • confusion;
  • abnormal vaginal bleeding in women;
  • cold, gray skin;
  • severe dizziness;
  • swelling of the face, mouth, lips, tongue, legs, feet, or ankles;
  • tightness in the chest;
  • difficulty breathing;
  • heaviness in the legs;
  • tingling in the arms or legs;
  • vomiting.

Alcoholalcohol

Drinking alcoholic beverages may worsen certain side effects of this medication.

Drug Interactionspills drugs

It may negatively interact with other medications, especially:

  • Danazol;
  • angiotensin-converting enzyme (ACE) inhibitors, including – Capoten (captopril), Lotrel (benazepril), Zestoretic (lisinopril), Vaseretic (enalapril), or Quinaretic (quinapril);
  • E-Mycin or Erythrocin (erythromycin);
  • angiotensin II receptor antagonists, including – Atacand HCT (candesartan), Edarbyclor (azilsartan), Hyzaar (losartan), Avalide (irbesartan), Twynsta (telmisartan), Benicar HCT (olmesartan), and Exforge (valsartan);
  • Luvox (fluvoxamine);
  • nonsteroidal anti-inflammatory drugs, including – Motrin (ibuprofen) and Naprosyn (naproxen);
  • Prozac or Selfemra (fluoxetine);
  • Tagamet (cimetidine);
  • accutane;
  • Lithobid (lithium);
  • Biaxin (clarithromycin);
  • Nefazodone;
  • Rescriptor (delavirdine);
  • Accolate (zafirlukast);
  • Cardizem or Tiazac (diltiazem);
  • St. John’s Wort;
  • Diflucan (fluconazole);
  • Calan or Tarka (verapamil);
  • Flagyl (metronidazole);
  • Laniazid or Rifater (isoniazid);
  • HIV protease inhibitors, including – Norvir (ritonavir), Crixivan (indinavir), and Invirase (saquinavir).

Pregnancy & Breastfeeding

It is not known exactly whether this medication passes into breast milk. Do not breastfeed a baby while using this mineralocorticoid receptor blocker.

Also, there are no well-done studies to determine whether this medication may harm an unborn baby. Tell your healthcare provider if you’re pregnant or plan to fall pregnant before starting on this mineralocorticoid receptor blocker.

Spironolactone

It is the generic name of a brand name drug called aldactone. It belongs to a group of drugs called diuretics.

Mechanism of Action

This medication blocks aldosterone and helps the body get rid of excess fluid by increasing the amount of water and salt the kidneys remove from the blood.

It was originally approved by the US Food and Drug Administration in 1985. It is produced by Pfizer.

Uses

This prescription medication is typically used to treat:

  • certain forms of heart failure;
  • primary hyperaldosteronism, a medical condition wherein too much aldosterone is produced by the adrenal glands;
  • low potassium levels;
  • fluid retention;
  • high blood pressure.

In addition, it is occasionally used off-label to treat women with persistent adult acne due to increased androgen levels.

Dosage

For high blood pressure, the usual recommended dose is 50–100 mg taken by mouth each day.

Side Effects and Precautions

Common side effects may include:

  • deepening of the voice and increased hair growth;
  • stomach pain or cramps;
  • tiredness, drowsiness, and restlessness;
  • erectile dysfunction;
  • diarrhea;
  • post-menopausal vaginal bleeding;
  • vomiting;
  • irregular menstrual periods;
  • dry mouth;
  • breast pain in women;
  • headaches;
  • gynecomastia (enlarged breast tissue) in men;
  • unsteadiness;
  • dizziness.

Rare side effects may include:

  • unusual bleeding or bruising;
  • muscle pain or weakness;
  • decreased urination;
  • numbness or tingling;
  • difficulty breathing or swallowing;
  • paralysis of the arms or legs;
  • bloody stools;
  • arrhythmia;
  • vomiting blood;
  • extreme tiredness;
  • loss of appetite;
  • confusion;
  • pain in the upper right abdomen.

Alcohol

Drinking alcoholic beverages may worsen certain side effects of this medication.

Drug Interactions

It may negatively interact with other medications, especially:

  • ibuprofen (Advil) and other non-steroidal anti-inflammatory drugs;
  • Lithium (Eskalith);
  • skeletal muscle relaxers, such as – cyclobenzaprine (Flexeril);
  • norepinephrine;
  • ACE inhibitors, like – benazepril (Lotensin);
  • potassium supplements;
  • fluocinonide;
  • angiotensin II receptor blockers, like – azilsartan (Edarbi);
  • other diuretics, like – amiloride (Midamor);
  • digoxin (Lanoxin);
  • Heparin (Hemochron, Hep-Lock);
  • aldosterone receptor antagonists, such as – Inspra (Eplerenone);
  • steroids like prednisone;
  • Cholestyramine (Cholybar).

Pregnancy & Breastfeedingpregnant

It is not known exactly whether this medication passes into breast milk. Do not breastfeed a baby while using this mineralocorticoid receptor blocker.

Also, there are no well-done studies to determine whether this medication may harm an unborn baby. Tell your healthcare provider if you’re pregnant or plan to fall pregnant before starting on this mineralocorticoid receptor blocker.

Bottom Line – Eplerenone vs Spironolactone

Eplerenone (brand name – Inspra) is a prescription medication which is given to improve the chances of survival in certain people with congestive heart failure who have had a heart attack. In addition, it is used to treat high blood pressure.

Spironolactone (brand name – Aldactone) is a potassium-sparing diuretic that is used to treat fluid retention in people with congestive heart failure. It is also used to treat heart failure, hypokalemia (low potassium levels in the blood), and high blood pressure (hypertension).

According to a 2008 study that was done at the Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, United Kingdom, both medications produce dose-dependent increases in potassium concentrations, although the effect with spironolactone appears to be greater.

Also, it was established that eplerenone was as effective as spironolactone in reducing blood pressure in sufferers with bilateral idiopathic hyperaldosteronism.

References

http://www.nejm.org/doi/full/10.1056/NEJMoa1009492
https://academic.oup.com/eurheartj/article/36/34/2310/2398253
http://www.nejm.org/doi/full/10.1056/NEJMoa030207

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