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Drug Interactions between eplerenone and Teveten

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

eprosartan eplerenone

Applies to: Teveten (eprosartan) and eplerenone

MONITOR: Coadministration of eplerenone with ACE inhibitors or angiotensin II receptor antagonists may increase the risk of hyperkalemia due to additive pharmacodynamic effects. In clinical studies of patients with hypertension, the addition of eplerenone 50 to 100 mg to ACE inhibitors and angiotensin II receptor antagonists increased mean serum potassium slightly, by about 0.09 to 0.13 mEq/L. However, the concomitant use of another mineralocorticoid receptor blocker with these agents has led to clinically relevant hyperkalemia. In a study of diabetics with microalbuminuria, the combination of eplerenone 200 mg and enalapril 10 mg resulted in increased frequency of hyperkalemia (i.e., serum potassium greater than 5.5 mEq/L) compared to enalapril alone (38% vs. 17%). In a study of eplerenone 25 to 50 mg for the treatment of congestive heart failure postmyocardial infarction, maximum potassium levels exceeding 5.5 mEq/L were observed at a similar rate in the 90% of patients who also received ACE inhibitors or angiotensin II receptor antagonists compared to the patients who didn't.

MANAGEMENT: Given the potential for serious, sometimes fatal cardiac arrhythmias associated with hyperkalemia, caution is advised if eplerenone is administered with ACE inhibitors or angiotensin II receptor antagonists. Periodic monitoring of serum potassium levels is recommended until the effect of eplerenone is established. In clinical trials, monitoring occurred every 2 weeks for the first 1 to 2 months, then monthly thereafter. Particular caution is warranted in patients with renal impairment, diabetes, old age, or dehydration. Patients should be advised to seek medical attention if they experience signs and symptoms of hyperkalemia such as nausea, vomiting, weakness, listlessness, tingling of the extremities, paralysis, confusion, weak pulse, and a slow or irregular heartbeat.

References

  1. "Product Information. Inspra (eplerenone)." Searle (2002):
  2. Marcy TR, Ripley TL "Aldosterone antagonists in the treatment of heart failure." Am J Health Syst Pharm 63 (2006): 49-58

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Drug and food interactions

Major

eplerenone food

Applies to: eplerenone

GENERALLY AVOID: Coadministration with grapefruit juice may increase the plasma concentrations of eplerenone. The primary mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. Inhibition of hepatic CYP450 3A4 may also contribute. In drug interaction studies, administration of a single 100 mg dose of eplerenone in combination with grapefruit juice resulted in a 25% increase in eplerenone systemic exposure (AUC). High blood levels of eplerenone can increase the risk of side effects including hyperkalemia. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition.

MANAGEMENT: It may be advisable for patients to avoid the consumption of grapefruit, grapefruit juice, or supplements that contain grapefruit during treatment with eplerenone.

References

  1. "Product Information. Inspra (eplerenone)." Searle (2002):
  2. "Product Information. Eplerenone (eplerenone)." MSN Laboratories Europe Ltd (2021):
  3. "Product Information. Eplerenone (Apotex) (eplerenone)." Apotex Pty Ltd (2023):

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Moderate

eprosartan food

Applies to: Teveten (eprosartan)

GENERALLY AVOID: Moderate-to-high dietary intake of potassium, especially salt substitutes, may increase the risk of hyperkalemia in some patients who are using angiotensin II receptor blockers (ARBs). ARBs can promote hyperkalemia through inhibition of angiotensin II-induced aldosterone secretion. Patients with diabetes, heart failure, dehydration, or renal insufficiency have a greater risk of developing hyperkalemia.

MANAGEMENT: Patients should receive dietary counseling and be advised to not use potassium-containing salt substitutes or over-the-counter potassium supplements without consulting their physician. If salt substitutes are used concurrently, regular monitoring of serum potassium levels is recommended. Patients should also be advised to seek medical attention if they experience symptoms of hyperkalemia such as weakness, irregular heartbeat, confusion, tingling of the extremities, or feelings of heaviness in the legs.

References

  1. "Product Information. Cozaar (losartan)." Merck & Co., Inc PROD (2001):
  2. "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals PROD (2001):

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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