What is the use of Inspra (Eplerenone)?

From the Guidelines

Inspra (eplerenone) is recommended for patients with heart failure with reduced ejection fraction (HFrEF) and NYHA class II to IV symptoms to reduce morbidity and mortality, with a starting dose of 25 mg orally daily, increased to 50 mg daily orally after a month, as long as eGFR is >30 mL/min/1.73 m2 and serum potassium is <5.0 mEq/L 1.

Key Points

• Inspra (eplerenone) is an aldosterone receptor antagonist used to treat heart failure and high blood pressure.
• The medication works by blocking the action of aldosterone, a hormone that can increase blood pressure by causing the body to retain salt and water.
• For heart failure patients, treatment usually begins at 25 mg once daily, potentially increasing to 50 mg daily after a month based on potassium levels and kidney function 1.
• Regular monitoring of potassium levels is essential as hyperkalemia (high potassium) is a significant risk, especially in patients with kidney problems.
• The medication should be taken at the same time each day with or without food.
• Common side effects include dizziness, headache, and increased potassium levels.
• Inspra differs from spironolactone (another aldosterone antagonist) by having fewer hormonal side effects like gynecomastia.
• It's particularly beneficial for heart failure patients after heart attacks as it has been shown to reduce mortality and hospitalization rates by addressing harmful neurohormonal activation that contributes to cardiac remodeling 1.

Dosage and Administration

• Starting dose: 25 mg orally daily
• Target dose: 50 mg daily orally
• Dose adjustment: reduce by half for eGFR 31 to 49 mL/min/1.73 m2
• Monitoring: regular checks of serum potassium levels and renal function should be performed according to clinical status, approximately 1 week, then 4 weeks, then every 6 months after initiating or intensifying MRA, with more frequent testing for clinical instability 1.

Benefits and Risks

• Benefits: reduces morbidity and mortality in patients with HFrEF and NYHA class II to IV symptoms
• Risks: hyperkalemia, renal insufficiency, and other side effects such as dizziness, headache, and increased potassium levels
• Value statement: MRA therapy provides high economic value with a cost per QALY of under $1000 1.

From the FDA Drug Label

Eplerenone tablets are indicated to improve survival of stable patients with symptomatic heart failure with reduced ejection fraction (≤40%) (HFrEF) after an acute myocardial infarction (MI). Eplerenone tablets are indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular (CV) events, primarily strokes and MI.

The use of Inspra (Eplerenone) is for:

• Improving survival of stable patients with symptomatic heart failure with reduced ejection fraction (HFrEF) after an acute myocardial infarction (MI) 2
• Treatment of hypertension, to lower blood pressure and reduce the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions 2, 2, 2

From the Research

Uses of Inspra (Eplerenone)

• Eplerenone (Inspra) is a selective aldosterone blocker used in patients with left ventricular (LV) systolic dysfunction and clinical evidence of heart failure following acute myocardial infarction (MI) 3.
• It is also used as adjunctive therapy to reduce mortality for heart failure patients with New York Heart Association (NYHA) class II systolic chronic heart failure and left ventricular systolic dysfunction 4.
• Additionally, eplerenone is indicated for the treatment of mild and moderate essential hypertension for patients who cannot be treated adequately with other agents 4, 5.
• The medication has been shown to lower blood pressure in people with primary hypertension by 9.21 mmHg systolic and 4.18 mmHg diastolic compared to placebo 4.
• Eplerenone has demonstrated some renoprotective effects in diabetic patients with hypertension 5.
• It has also been shown to significantly reduce mortality and cardiovascular morbidity in post-myocardial infarction patients with systolic heart failure currently taking standard heart failure medications 3, 5, 6.

Benefits and Side Effects

• The addition of eplerenone to standard medical therapy significantly improved mortality and morbidity in patients with LV systolic dysfunction and clinical evidence of heart failure following acute MI 3.
• Eplerenone was generally well tolerated, although hyperkalemia with this agent is of some concern 3, 5, 6.
• The incidence of hypokalaemia was significantly lower with eplerenone treatment compared to placebo 3.
• Adverse effects such as gynecomastia and vaginal bleeding seem to be less likely in patients who take eplerenone than in those who take spironolactone 6.