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Eplerenone Dosage

Medically reviewed on July 12, 2018.

Applies to the following strengths: 25 mg; 50 mg

Usual Adult Dose for Congestive Heart Failure

Initial dose: 25 mg orally once a day; titrate to the target dose preferably within 4 weeks as tolerated.
Target dose: 50 mg orally once a day

Use: To improve survival of stable patients with symptomatic heart failure with reduced ejection fraction (40% or less) after an acute myocardial infarction.

Usual Adult Dose for Hypertension

Initial dose: 50 mg orally once a day
Maintenance dose: 50 mg orally once or twice a day
Maximum dose: 100 mg/day

Comments:
-Full therapeutic effect is apparent within 4 weeks.
-Patients with inadequate blood pressure response to the initial dose may be increased to 50 mg twice a day.

Renal Dose Adjustments

Heart failure post-myocardial infarction:
-CrCl greater than 30 mL/min: Dose adjustment(s) may be required; however, no specific guidelines have been suggested. Caution recommended.
-CrCl 30 mL/min or less: Contraindicated

Hypertension:
-CrCl 50 mL/min or greater: Dose adjustment(s) may be required; however, no specific guidelines have been suggested. Caution recommended.
-CrCl less than 50 mL/min or serum creatinine greater than 1.8 mg/dL (females) or greater than 2 mg/dL (males): Contraindicated

Liver Dose Adjustments

No adjustment recommended.

Dose Adjustments

HEART FAILURE POST-MYOCARDIAL INFARCTION:
Dose Adjustments Based on Serum Potassium Level:
Less than 5 mEq/L: Increase dosage from 25 mg every other day to 25 mg once a day or from 25 mg once a day to 50 mg once a day
5 to 5.4 mEq/L: No adjustment recommended
5.5 to 5.9 mEq/L: Decrease dosage from 50 mg once a day to 25 mg once a day or from 25 mg once a day to 25 mg every other day or from 25 mg every other day to withhold
6 mEq/L or greater: Withhold; may restart at 25 mg every other day when potassium levels decrease to less than 5.5 mEq/L

Dose Adjustment for Use with Moderate CYP450 3A Inhibitors:
Maximum dose: 25 mg once a day

HYPERTENSION:
Dose Adjustment for Use with Moderate CYP450 3A Inhibitors:
Initial dose: 25 mg once a day
Maximum dose: 25 mg twice a day

Precautions

CONTRAINDICATIONS:
For all patients:
-Serum potassium greater than 5.5 mEq/L at initiation
-CrCl 30 mL/min or less
-Concomitant use with strong CYP450 3A inhibitors (e.g., ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, and nelfinavir)
For the treatment of hypertension:
-Type 2 diabetes with microalbuminuria
-Serum creatinine greater than 1.8 mg/dL in females, greater than 2 mg/dL in males
-CrCl less than 50 mL/min
-Concomitant use of potassium supplements or potassium-sparing diuretics (e.g., amiloride, spironolactone, or triamterene)

This drug is not recommended for use in pediatric patients.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Monitoring:
-Metabolic: Serum potassium (before starting this drug, within the first week of treatment, one month after the start of treatment or dose adjustment, and periodically thereafter); serum potassium and serum creatinine (within 3 to 7 days of starting a moderate CYP450 3A inhibitor, an angiotensin-converting enzyme (ACE) inhibitor, an angiotensin receptor blocker (ARB), or a nonsteroidal anti-inflammatory drug (NSAID).

Patient advice:
-Advise patients not to use potassium-containing supplements or salt substitutes without consulting the prescribing physician.
-Advise patients to contact their healthcare provider if they experience dizziness, diarrhea, vomiting, rapid or irregular heartbeat, lower extremity edema, or difficulty breathing.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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