Eplerenone Administration with Food
Eplerenone does not need to be taken with food—absorption is not affected by food, so it can be taken with or without meals based on patient preference. 1
Key Administration Facts
- The FDA label explicitly states that "absorption is not affected by food," meaning eplerenone can be administered at any time regardless of meals 1
- The absolute bioavailability of eplerenone is 69% following oral administration, and this remains consistent whether taken with or without food 1
- Peak plasma concentrations are reached approximately 1.5 to 2 hours after oral administration, independent of food intake 1
Practical Dosing Guidance
Initial dosing should start at 25 mg once daily, with the option to take it at any time of day that promotes adherence. 2, 3
- For heart failure patients, the typical starting dose is 25 mg daily, increasing to 50 mg daily after 4 weeks if potassium remains ≤5.0 mEq/L 2, 3
- For hypertension, doses of 50-200 mg/day are effective, with no clinically important dose-response difference within this range 4
- Steady state is reached within 2 days of consistent dosing 1
Critical Monitoring (Unrelated to Food Timing)
Potassium and renal function must be checked within 3 days and again at 7 days after initiation, regardless of when the medication is taken during the day. 2, 3
- Do not initiate eplerenone if baseline potassium is >5.0 mEq/L 2, 3
- Monitor potassium monthly for the first 3 months, then every 3 months thereafter 2
- Discontinue potassium supplements when starting eplerenone and counsel patients to avoid high-potassium foods 2, 3
Common Pitfall to Avoid
The most important consideration is not food timing but rather avoiding medications that interact with CYP3A4, as eplerenone is cleared predominantly by this pathway. 1 Potent CYP3A4 inhibitors (like ketoconazole) significantly increase eplerenone blood levels and should be avoided. 2, 1