From the Guidelines
Eplerenone can cause erectile dysfunction, though it occurs less frequently than with other similar medications, such as spironolactone, with an estimated incidence of around 1-2% of male patients. Eplerenone is an aldosterone antagonist primarily used to treat high blood pressure and heart failure, and sexual dysfunction is listed as a potential side effect 1. The difference in the incidence of erectile dysfunction between eplerenone and spironolactone occurs because eplerenone is more selective for mineralocorticoid receptors and has less anti-androgenic activity than spironolactone.
Key Considerations
- Eplerenone's selectivity for mineralocorticoid receptors reduces its potential for causing sexual side effects compared to spironolactone.
- The incidence of erectile dysfunction with eplerenone is significantly lower than with spironolactone, which can cause sexual side effects in up to 10% of men.
- If a patient experiences erectile dysfunction while taking eplerenone, they should discuss this with their healthcare provider, as dosage adjustments or alternative medications might be considered.
Clinical Guidance
Patients should never stop taking eplerenone without medical consultation, as the benefits for cardiovascular health often outweigh the potential sexual side effects. The American College of Physicians does not recommend for or against routine use of hormonal blood tests or hormonal treatment in the management of patients with erectile dysfunction due to insufficient evidence 1. However, in the context of eplerenone use, the focus should remain on managing the cardiovascular condition while monitoring for and addressing any sexual side effects that may arise.
From the Research
Eplerenone and Erectile Dysfunction
- Eplerenone is a selective aldosterone receptor antagonist used to treat hypertension and heart failure 2, 3.
- Compared to spironolactone, another aldosterone antagonist, eplerenone has a lower incidence of sexual impotence due to its higher selectivity for the aldosterone receptor 2.
- The available evidence suggests that eplerenone may cause fewer sexual side effects, including erectile dysfunction, compared to spironolactone 4, 5.
- However, it is essential to note that eplerenone can still cause hyperkalemia, and its use requires close monitoring of potassium levels and renal function 3, 6.
Comparison with Spironolactone
- Spironolactone is a non-selective aldosterone receptor antagonist that can cause sex hormone-related adverse effects, including gynecomastia and erectile dysfunction 3, 4.
- Eplerenone, on the other hand, is a selective aldosterone receptor antagonist with minimal effects on other steroid receptors, resulting in fewer hormonal side effects 2, 3.
- While spironolactone has been established as an effective treatment for resistant hypertension, eplerenone may be a preferred choice for patients who experience anti-androgenic side effects with spironolactone 4.
Clinical Implications
- Eplerenone is a valuable treatment option for patients with hypertension and heart failure, offering cardiovascular therapeutic and prognostic benefits with fewer side effects compared to spironolactone 5.
- However, patients taking eplerenone require close monitoring of potassium levels and renal function to minimize the risk of hyperkalemia 3, 6.