From the Guidelines
Mineralocorticoid Receptor Antagonists (MRAs) include spironolactone, eplerenone, and finerenone as the main examples used in clinical practice. These medications work by blocking aldosterone's effects, which helps reduce sodium retention, potassium excretion, and pathological tissue remodeling.
- Spironolactone, the oldest MRA, is typically dosed at 25-100 mg daily and is commonly used for heart failure, resistant hypertension, and hyperaldosteronism, though it can cause gynecomastia and sexual dysfunction due to its anti-androgenic effects 1.
- Eplerenone, dosed at 25-50 mg daily, is more selective for the mineralocorticoid receptor with fewer hormonal side effects, making it preferable for men concerned about gynecomastia 1.
- Finerenone, the newest MRA (approved in 2021), is dosed at 10-20 mg daily and is specifically indicated for chronic kidney disease in type 2 diabetes patients 1. When starting any MRA, it's essential to monitor serum potassium and kidney function regularly, especially within 1-2 weeks of initiation, as hyperkalemia is a common side effect 1. These medications should be used cautiously in patients with reduced kidney function and are contraindicated in those with severe kidney impairment. The use of MRAs has been supported by several studies, including the RALES trial, which demonstrated a significant reduction in mortality and morbidity in patients with heart failure treated with spironolactone 1. Similarly, the EMPHASIS-HF trial showed that eplerenone reduced the risk of cardiovascular death and hospitalization in patients with mild symptoms of heart failure 1. Overall, MRAs are a valuable treatment option for patients with heart failure, resistant hypertension, and hyperaldosteronism, and their use should be considered in accordance with current guidelines and patient-specific factors.
From the FDA Drug Label
Eplerenone binds to the mineralocorticoid receptor and blocks the binding of aldosterone, a component of the renin-angiotensin-aldosterone-system (RAAS). Eplerenone selectively binds to human mineralocorticoid receptors relative to its binding to recombinant human glucocorticoid, progesterone, and androgen receptors.
Examples of MRAs (Mineralocorticoid Receptor Antagonists) include:
- Eplerenone 2, 2 Note that the provided drug labels only mention eplerenone as an example of an MRA. Other MRAs, such as finerenone 3, may exist but are not mentioned in the context of MRAs in the provided drug labels.
From the Research
Examples of Mineralocorticoid Receptor Antagonists (MRAs)
Characteristics of MRAs
- Steroidal MRAs (e.g. spironolactone, eplerenone) have a low safety profile and often lead to hyperkalemia complications 6
- Nonsteroidal MRAs (e.g. finerenone) have fewer side effects and may reduce the risk of hyperkalemia and renal dysfunction 5, 8
- MRAs can be used to treat various diseases, including heart failure, hypertension, and chronic kidney disease 4, 5, 6, 7