Eplerenone (Inspra) is a selective aldosterone receptor antagonist, primarily indicated for improving survival in patients with heart failure following acute myocardial infarction and treating hypertension in adults. Although this medication demonstrates significant efficacy in the cardiovascular field, its potential risks require strict management and control.

Side Effects of Eplerenone (Inspra)

In Patients with Heart Failure after Myocardial Infarction

(1) Hyperkalemia: The incidence rate is 3.4%.

(2) Elevated serum creatinine: The incidence rate is 2.4%.

(3) The treatment discontinuation rate due to adverse reactions is 4.4%, with the main causes of discontinuation being hyperkalemia, myocardial infarction, and renal dysfunction.

In Hypertensive Patients

(1) The overall incidence of adverse events is 47%.(2) The rate of treatment discontinuation due to adverse reactions is 3%.(3) Specific reactions include gynecomastia and abnormal vaginal bleeding, and their incidence increases with the prolongation of treatment duration.

Severe Side Effects of Eplerenone (Inspra)

Hyperkalemia

(1) The incidence of serum potassium > 5.5 mEq/L is 15.6%.

(2) The incidence of serum potassium ≥ 6.0 mEq/L is 5.5%.

(3) Risk factors include renal insufficiency, diabetes mellitus, proteinuria, and concurrent use of ACE inhibitors, ARBs, NSAIDs, or moderate CYP3A inhibitors.

Other Severe Adverse Reactions

(1) Renal impairment: The incidence of serum creatinine elevation > 0.5 mg/dL is 6.5%.

(2) Skin reactions: Angioedema, rash.

Precautions for Eplerenone (Inspra)

Contraindication Screening

(1) Initial serum potassium > 5.5 mEq/L.

(2) Creatinine clearance ≤ 30 mL/min.

(3) Concomitant use with strong CYP3A inhibitors.

Additional Contraindications for Hypertensive Patients

(1) Type 2 diabetes mellitus with microalbuminuria.

(2) Serum creatinine > 2.0 mg/dL in males and > 1.8 mg/dL in females.

(3) Creatinine clearance < 50 mL/min.(4) Concurrent use of potassium supplements or potassium-sparing diuretics.

Monitoring Requirements

(1) Serum potassium monitoring: Must be measured before treatment, within the first week of treatment, and one month after dose adjustment.

(2) Renal function monitoring: Re-examination is required 3–7 days after the initiation of treatment and concomitant medication use.

Medication Use in Special Populations

(1) Elderly patients: Dose adjustment should be made cautiously due to age-related decline in renal function.

(2) Patients with renal insufficiency: Dose adjustment is required based on creatinine clearance.

Risk Control Measures

(1) Patient education: Advise patients to avoid potassium-containing salt substitutes and promptly report symptoms such as dizziness, diarrhea, vomiting, and dyspnea.

(2) Regular assessment: Adhere to regular monitoring until treatment discontinuation.