Eplerenone: Best New Thing in Heart Failure?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Less than half of folks diagnosed with heart failure today will be alive in 5 years. Those numbers are worse than most cancers. Management of symptoms and improving quality of life and survival with medications has been the promise, and beta blockers and ace inhibitors have delivered on this promise. But, the last few years brought a new player which showed such impressive results that a 2010 study was stopped early.

Meet eplerenone (brand name Inspra). This is a medication to know if you have heart failure. It works by blocking aldosterone which results in less sodium (salt) and water being retained by the body. Adding eplerenone to the “standard” heart failure meds showed significant reductions in death and hospitalization for most people with chronic heart failure. This compelling evidence has resulted in more docs and heart failure patients getting to know eplerenone and that’s a good thing.

What has taking a 25 to 50 mg eplerenone pill a day been shown to do (when added to your beta blocker and ace inhibitor)?

 Reduce death and hospitalization for heart failure patients.

  Reduce new onset atrial fibrillation/flutter in patients with chronic systolic heart failure

  Reductions in death and hospitalization were true for almost all heart failure patients: older patients >75 years, diabetics etc.

What’s the downside? Not much. Eplerenone can raise potassium levels, so that needs to be monitored. Cost however, is a huge issue because though it’s available as a generic, it’s still pricey. That stinks, but the rest is good.

Dr O.

Generic eplerenone may run from $50 to about $70 for 30 tablets of either the 25 mg or the 50 mg strength. Brand name Inspra is pricier at $175 or so minimum for the same quantity and dose. The good news is that generic eplerenone is covered as a Tier 1 drug under most insurance plans, meaning you should pay only your lowest co-pay. Inspra may not be covered under many  plans because there’s a generic option available.

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