Selective mineralocorticoid receptor antagonist
ATC code: C03DA04 (Eplerenone)
Brand names
Inspra, Eplenor
A competitive selective mineralocorticoid receptor antagonist. Compared with spironolactone, 100-fold lower affinity for androgen and progesterone receptors – less gynecomastia, dysmenorrhea, and libido changes. Blocks aldosterone action on distal tubules – lowers sodium reabsorption and retains potassium. CYP3A4-metabolized.
First line
Foundation therapy in heart failure with reduced ejection fraction (HFrEF) per 2023 alongside spironolactone. Cuts mortality and cardiovascular hospitalization by 15% (EMPHASIS-HF, NYHA II). Starting dose 25 mg once daily, uptitrated to 50 mg over 4 weeks. Also indicated post-MI in patients with EF below 40% and HF symptoms or diabetes (EPHESUS).
Second line
Used in resistant hypertension as a fourth drug (ACEi/ARB + calcium channel blocker + thiazide) per 2024. Particularly effective in primary aldosteronism and low-renin hypertension. Dose 25–50 mg daily.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Eplerenone is a selective mineralocorticoid receptor antagonist. It is prescribed for heart failure after myocardial infarction and for resistant hypertension ( 2024). In anti-aging regimens, eplerenone is used as a selective anti-aldosterone heart protector. No clinical studies of prophylactic use outside these indications exist. The drug causes hyperkalemia (dangerous, can trigger arrhythmias), dizziness, and fatigue. If eplerenone was prescribed without heart failure or resistant hypertension, consider seeking a second opinion.
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Limited pregnancy data. In pregnant HF patients, combinations with more data are preferred under cardiologist supervision.
No data. Use during lactation only when indicated.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Eplerenone is evaluated for the following indications with varying evidence strength: Heart failure (evidence tier A), Hypertension (evidence tier B), Anti-aging and longevity (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Eplerenone (≥ 1 in 100): Hyperkalemia, Dizziness, Hypotension, Elevated creatinine, Hyponatremia, Cough. See the Safety section for uncommon and serious reactions.
FDA category B. Limited pregnancy data. In pregnant HF patients, combinations with more data are preferred under cardiologist supervision.
No data. Use during lactation only when indicated.
Eplerenone is contraindicated in: Eplerenone hypersensitivity; Serum potassium above 5.0 mmol/L; Severe renal impairment (eGFR under 30); Severe hepatic impairment (Child-Pugh C); Concomitant strong CYP3A4 inhibitors. Full list in the Safety section.