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Eplerenone is a medication used in the management and treatment of heart failure with reduced ejection fraction and hypertension. It is in the aldosterone antagonist class of drugs. This activity outlines the indications, action, and contraindications for eplerenone as a valuable agent in managing heart failure and hypertension. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, and monitoring) pertinent for members of the interprofessional team in treating patients with hypertension, heart failure, and related conditions. Objectives: Identify the mechanism of action and administration of eplerenone as regards its use in heart failure and hypertension. Describe the potential adverse effects of eplerenone. Outline appropriate monitoring for patients on therapy with eplerenone. Review interprofessional team strategies for improving care coordination and communication to support optimal medication outcomes for patients prescribed eplerenone. Access free multiple choice questions on this topic.

There are no known overdose reports of eplerenone, but the most likely manifestations of overdose would be hypotension or hyperkalemia.  Researchers have not observed any lethality in overdose studies in mice, rats, or dogs, but dogs demonstrated emesis, salivations, and tremors at a concentration 41 times the human therapeutic concentration of eplerenone. These progressed to sedation and convulsions at higher exposures. Should toxicity occur, eplerenone binds extensively to charcoal but is not removable by hemodialysis. There is no specific antidote to eplerenone; thus, supportive treatment for hypotension or hyperkalemia would be necessary. Eplerenone is not dialyzable.

Over two decades of experience have demonstrated the effect of aldosterone antagonists on survival and hospitalizations in heart failure patients with reduced ejection fraction. Therefore, one of the chief duties of the interprofessional healthcare team is to ensure that such patients receive aldosterone antagonists, including eplerenone, when appropriate, as part of guideline-directed medical therapy. Pharmacists should review the dose, check for drug interactions, and provide patient education. Specialty trained nurses such are cardiology nurses monitor patients, provide education, and report status changes to the team. These examples of interprofessional interaction and collaboration should lead to more effective use of eplerenone. [Level 5] As regards safety, regular lab monitoring is of paramount importance for patients taking eplerenone. Following the release of the RALES trial, hospitalizations and deaths secondary to serious hyperkalemia significantly increased.[14] Researchers postulated this to be due to the increased use of spironolactone without the close lab monitoring utilized during the clinical trial. Since patients with heart failure are often co-managed by primary care clinicians and specialists, it is easy to become siloed and assume the other clinician is monitoring therapy. When used for patients who have experienced gynecomastia on spironolactone, the patient requires monitoring to resolve this adverse effect. Finally, though eplerenone is now generic, it is more expensive than spironolactone.