Eplerenone (Inspra) is a medication that’s used to treat high blood pressure and improve survival among people with heart failure after a heart attack. It comes as an oral tablet that can be taken alone or in combination with other medications. Look out for side effects including dizziness, nausea, cough, and shortness of breath. Eplerenone (Inspra) is available as a generic tablet and also under the brand name Inspra.
Heart failure after a heart attack
High blood pressure
Eplerenone (Inspra) is a mineralocorticoid (aldosterone) antagonist. Aldosterone is a natural hormone in the body that normally raises your blood pressure by increasing the amount of salt and water in your bloodstream. So by blocking aldosterone, eplerenone (Inspra) helps your body get rid of extra salt and water, which then lowers your blood pressure.
It’s unclear how exactly eplerenone (Inspra) helps with heart failure. But it’s thought that the medication helps protect the heart. This will help reduce the risk of death in people with heart failure.
Source: DailyMed
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Incidence not known
Abdominal or stomach pain
arm, back, or jaw pain
chest pain or discomfort
chest tightness or heaviness
confusion
difficulty with breathing
dizziness
fast or irregular heartbeat
headache
irregular heartbeat
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
nervousness
numbness or tingling in the hands, feet, or lips
pain or discomfort in the arms, jaw, back, or neck
rash
shortness of breath
sweating
vomiting
weakness or heaviness of the legs
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Improves survival for people with heart failure after a heart attack
Fewer side effects than spironolactone
Typically once daily dosing
Have to get regular blood tests while taking the medication to check for high potassium levels
Not safe to use with severe kidney problems
Isn’t a first-choice medication for high blood pressure or heart failure
Eplerenone (Inspra) can be taken with or without food, and it’s best to take it around the same time every day.
Following a low sodium diet while using eplerenone (Inspra) is a good option to help lower blood pressure. If you’re using salt substitutes, be sure to choose salt substitutes that don’t have potassium to lower the chance of having high potassium levels with eplerenone (Inspra). Also, don’t use any potassium supplements while taking this medication since this can also lead to high potassium levels
To prevent high potassium levels, you’ll need regular blood work to check your potassium levels while taking eplerenone (Inspra). Typically, you’ll get blood work done before starting this medication, within the first week, at one month, or whenever the dose is changed. If you start taking certain medications (e.g., ACE inhibitors, ARBS, or NSAIDs) you’ll also need to have your potassium and creatinine levels checked within 1 week.
When eplerenone (Inspra) is used in combination with certain blood pressure medications (e.g., ACE inhibitors, ARBs, and NSAIDs), there is a greater risk for high levels of potassium in your blood. So it’s important to tell your healthcare provider if you’re also taking any of these medications.
Though rare, eplerenone (Inspra) can cause an increase in breast tenderness and size in men. If this becomes bothersome, speak to your healthcare provider.
Eplerenone (Inspra) doesn’t work immediately. In fact, you might notice a drop in your blood pressure in as soon as 2 weeks. But it does take about 4 weeks to see the full effect of this medication. So it’s important to keep taking this medication even if you don’t feel any changes. You might want to monitor your blood pressure at home while using this medication.
Eplerenone (Inspra) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: Current kidney problems | Diabetes | Taking other medications that can increase potassium | Taking other medications that interact with eplerenone (Inspra)
Eplerenone (Inspra) can cause high potassium levels in the blood. Very high potassium levels can cause changes in heart rhythm. In emergency situations, it can cause the heart to stop beating. Your risk is higher if you have kidney problems, have diabetes, or are taking other medications that interact with eplerenone (Inspra) (e.g., ACE inhibitors, ARBs, NSAIDs). It’s important to report any sudden changes in numbness or tingling, nausea, or muscle weakness. If this is something that you experience, call your healthcare provider to let them know, they might suggest lowering your dose.
Heart failure after a heart attack: The typical starting dose is 25 mg by mouth once daily. The max dose is 50 mg by mouth once daily.
High blood pressure: The typical starting dose is 50 mg by mouth once daily. The max dose is 50 mg by mouth twice a day.
Your dose might differ depending on your potassium levels and if you’re also taking other medications such as amiodarone (Pacerone), fluconazole (Diflucan), diltiazem (Cardizem), or verapamil.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
For all people:
Very high potassium levels
Severe kidney problems
Taking certain medications like ketoconazole, ritonavir (Norvir), or clarithromycin
For people with high blood pressure:
Type 2 diabetes with abnormally high protein in the urine (microalbuminuria)
Moderate to severe kidney problems
Use along with potassium supplements or potassium-sparing diuretics (e.g., spironolactone (Aldactone), amiloride (Midamor), triamterene (Dyrenium)
Heart failure after a heart attack
High blood pressure
Swelling due to liver damage (cirrhosis)
Swelling due to nephrotic syndrome (a rare kidney condition) - tablets only
Primary aldosteronism (a hormone imbalance) - tablets only
To prevent low potassium levels in the blood when used with certain diuretic medications that treat high blood pressure and heart failure
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Brown, N. J. (2003). Eplerenone. Circulation.
Dickson, G. (2012). Gynecomastia. American Family Physician.
Heidenreich, P. A., et al. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation.
Kartha Pharmaceuticals, Inc. (2022). Eplerenone tablet, film coated [package insert]. DailyMed.
National Kidney Foundation. (n.d.). Albuminuria (proteinuria).
National Kidney Foundation. (n.d.). Creatinine.
Pitt, B., et al. (2003). Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. The New England Journal of Medicine.
Rubenfire, M. (2018). 2017 guideline for high blood pressure in adults. American College of Cardiology.
Unger, T., et al. (2020). 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension.
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