Heart failure:
Note: When initiating therapy, verify the following: serum potassium <5 mEq/L and either serum creatinine ≤2.5 mg/dL in men and ≤2 mg/dL in women or eGFR >30 mL/minute/1.73 m2. Monitor closely and if patient develops hyperkalemia (serum potassium >5.5 mEq/L), reduce the dose, change to every-other-day dosing, or discontinue therapy; assess for other causes of hyperkalemia before permanent discontinuation. If renal function worsens, consider dose reduction or discontinuation (ACC [Maddox 2021]; ACCF/AHA [Yancy 2017]; ACCF/AHA [Yancy 2013]).
Heart failure with preserved ejection fraction (off-label use):
Note: May be considered for use in patients with symptomatic heart failure with preserved ejection fraction (≥45%) who have an elevated serum natriuretic peptide level or have been hospitalized for heart failure in the last 12 months (ACCF/AHA [Yancy 2017]). Some experts recommend initiating therapy only if serum potassium is ≤4.7 mEq/L and eGFR is ≥30 mL/minute/1.73 m2. The same experts recommend dose reduction when serum potassium is >5 mEq/L and discontinuation when serum potassium is >5.5 mEq/L (Borlaug 2020).
Oral: Initial: 25 mg once daily; may double the dose after 4 weeks if serum potassium remains <5 mEq/L and renal function is stable, to a maximum target dose of 50 mg once daily (ACCF/AHA [Yancy 2017]; Borlaug 2020). Some experts recommend up-titrating therapy only if serum potassium is ≤4.5 mEq/L (Borlaug 2020).
Heart failure with reduced ejection fraction (off-label use):
Note: Should be considered for use in patients with symptomatic (New York Heart Association class II to IV) heart failure with reduced ejection fraction (HFrEF) (≤35%) as part of an optimal medical regimen for HFrEF (ACCF/AHA [Yancy 2017]; ACCF/AHA [Yancy 2013]).
Oral: Initial: 25 mg once daily; may double the dose after 4 weeks if serum potassium remains <5 mEq/L and renal function is stable, to a maximum target dose of 50 mg once daily (ACCF/AHA [Yancy 2017]; ACCF/AHA [Yancy 2013]; Zannad 2011).
Post myocardial infarction, complicated by reduced ejection fraction:
Note: Should be considered for use following acute myocardial infarction in patients with left ventricular ejection fraction ≤40% plus symptoms of heart failure or diabetes. Use in addition to other pharmacologic therapies (ACCF/AHA [O’Gara 2013]; ACCF/AHA [Yancy 2013]).
Oral: Initial: 25 mg once daily; may double the dose after 4 weeks if serum potassium remains <5 mEq/L and renal function is stable, up to a maximum target dose of 50 mg once daily (ACCF/AHA [Yancy 2013]).
Hypertension, chronic (alternative agent):
Note: Not recommended for initial management but may be considered as additional therapy for resistant hypertension in patients who do not respond adequately to combination therapy with preferred agents (ACC/AHA [Whelton 2018]; Bazoukis 2018).
Oral: Initial: 50 mg once daily; evaluate response after ~2 to 4 weeks and titrate dose, as needed, to a maximum of 50 mg twice daily. Twice daily dosing is usually required for adequate BP lowering. Patients with severe asymptomatic hypertension and no signs of acute end organ damage should be evaluated for medication titration within 1 week (ACC/AHA [Whelton 2018]; Bazoukis 2018; Mann 2021).
Primary aldosteronism (alternative agent) (off-label use):
Note: Alternative to spironolactone (ES [Funder 2016]).
Oral: Initial: 25 mg twice daily; gradually titrate to the lowest effective dose; usual maximum dose: 300 mg/day. For surgical candidates, the last dose should be administered the day of surgery; discontinue eplerenone on postoperative day one (ES [Funder 2016]; Parthasarathy 2011).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Heart failure:
eGFR ≥50 mL/minute/1.73 m2: No initial dose adjustment necessary.
eGFR 31 to 49 mL/minute/1.73 m2: Initial: 25 mg every other day; may double the dose after 4 weeks if serum potassium remains <5 mEq/L and renal function is stable, up to a maximum target dose of 25 mg once daily (ACCF/AHA [Yancy 2013]).
eGFR ≤30 mL/minute/1.73 m2: Not recommended (ACCF/AHA [Yancy 2013]).
Hemodialysis: Not removed by hemodialysis.
Hypertension, chronic (alternative agent):
CrCl ≥50 mL/minute: There are no dosage adjustments provided in the manufacturer's labeling.
CrCl <50 mL/minute or serum creatinine >2 mg/dL (males) or >1.8 mg/dL (females): Use is contraindicated; risk of hyperkalemia increases with declining renal function.
There are no dosage adjustments provided in the manufacturer's labeling. Systemic exposure is increased in moderate hepatic impairment (Child-Pugh class B).
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, Oral:
Inspra: 25 mg, 50 mg
Generic: 25 mg, 50 mg
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, Oral:
Inspra: 25 mg, 50 mg [contains polysorbate 80]
Generic: 25 mg, 50 mg
Oral: Administer with or without food.
Hypertension, chronic: Management of hypertension. Note: Not recommended for the initial treatment of hypertension (ACC/AHA [Whelton 2018]).
Post myocardial infarction, complicated by heart failure with reduced ejection fraction: To improve survival of stable patients with symptomatic heart failure (left ventricular ejection fraction ≤40%) following acute myocardial infarction.
Heart failure with preserved ejection fraction; Heart failure with reduced ejection fraction; Primary aldosteronism
Beers Criteria: Diuretics (eplerenone) are identified in the Beers Criteria as potentially inappropriate medications to be used with caution in patients 65 years and older due to the potential to cause or exacerbate syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatremia; monitor sodium concentration closely when initiating or adjusting the dose in older adults (Beers Criteria [AGS 2019]).
Inspra may be confused with Spiriva
Eplerenone can cause reversible hyperkalemia; however, if potassium is monitored periodically and with suspected changes in electrolytes (vomiting, diarrhea), the risk does not appear to translate into a higher risk of hospitalization or death (Ref).
Mechanism: Dose-related; related to the pharmacologic action. Competes with aldosterone for binding to the mineralocorticoid receptor, thereby inhibiting the exchange of sodium for potassium in the distal convoluted renal tubule and preventing potassium excretion (Ref).
Onset: Intermediate; usually occurs within 4 weeks of initiation or dose titration (Ref).
Risk factors:
• Doses >100 mg daily (Ref)
• Older patients (≥75 years of age) (Ref)
• Diabetes (Ref)
• Kidney impairment (Ref)
• Excessive potassium intake (eg, potassium supplements, potassium-containing salt substitutes)
• Concomitant use of certain medications (eg, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, sacubitril/valsartan, nonsteroidal anti-inflammatory drugs, moderate CYP3A inhibitors)
• Baseline serum potassium >4.3 mEq/L (Ref)
• Prior use of antiarrhythmic agents (Ref)
• Proteinuria
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Endocrine & metabolic: Hyperkalemia (cardiac failure, post-myocardial infarction: 3%; >5.5 mEq/L: 16%; ≥6 mEq/L: 6%) (table 1)
Drug (Eplerenone) |
Placebo |
Indication |
Number of Patients (Eplerenone) |
Number of Patients (Placebo) |
Comments |
---|---|---|---|---|---|
16% |
11% |
Cardiac failure, post-myocardial infarction |
3251 |
3237 |
>5.5 mEq/L |
6% |
4% |
Cardiac failure, post-myocardial infarction |
3251 |
3237 |
≥6 mEq/L |
3% |
2% |
Cardiac failure, post-myocardial infarction |
3307 |
3301 |
N/A |
1% to 10%: Renal: Increased serum creatinine (cardiac failure, post-myocardial infarction: 2% to 7%)
Frequency not defined:
Cardiovascular: Acute myocardial infarction, angina pectoris
Endocrine & metabolic: Gynecomastia, increased gamma-glutamyl transferase
Genitourinary: Abnormal vaginal hemorrhage
Nervous system: Dizziness, headache
Renal: Renal insufficiency
Postmarketing:
Dermatologic: Skin rash
Hypersensitivity: Angioedema
Serum potassium >5.5 mEq/L at initiation; CrCl ≤30 mL/minute; concomitant use of strong CYP3A4 inhibitors (eg, ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir).
The following additional contraindications apply to patients with hypertension: Type 2 diabetes mellitus (noninsulin dependent, NIDDM) with microalbuminuria; serum creatinine >2.0 mg/dL in males or >1.8 mg/dL in females; CrCl <50 mL/minute; concomitant use with potassium supplements or potassium-sparing diuretics (eg, amiloride, spironolactone, triamterene).
Per the Endocrine Society clinical practice guidelines, use in patients with Addison disease is contraindicated (Endocrine Society [Bornstein 2016])
Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to eplerenone or any component of the formulation; serum potassium >5 mEq/L at initiation; severe hepatic impairment (Child-Pugh class C); clinically significant hyperkalemia; concomitant use with potassium supplements or potassium-sparing diuretics
The following additional contraindications apply to patients with hypertension: Serum creatinine >1.5 mg/dL [132 micromole/L] in males or >1.3 mg/dL [115 micromole/L] in females
Concerns related to adverse effects:
• Hyperkalemia: Hyperkalemia may occur; risk of hyperkalemia is increased with renal impairment, proteinuria, diabetes, and patients taking concomitant angiotensin-converting enzyme (ACE) inhibitors, angiotensin-II receptor blockers (ARBs), nonsteroidal anti-inflammatory drugs (NSAIDs), and/or moderate CYP3A inhibitors. Monitor closely for hyperkalemia; increases in serum potassium were dose related during clinical trials (ACCF/AHA [Yancy 2013]). Dose reduction or interruption of therapy may be necessary with development of hyperkalemia. If concomitant moderate CYP3A4 inhibitor therapy cannot be avoided, reduce dose of eplerenone. Use is contraindicated in patients with potassium >5.5 mEq/L at initiation of therapy.
Disease-related concerns:
• Diabetes: Use with caution in patients with heart failure post-myocardial infarction with diabetes (especially if patient has proteinuria); risk of hyperkalemia is increased.
• Heart failure: When evaluating a heart failure patient for eplerenone treatment, eGFR should be >30 mL/minute/1.73 m2 or creatinine should be ≤2.5 mg/dL (men) or ≤2 mg/dL (women) with no recent worsening and potassium <5 mEq/L with no history of severe hyperkalemia. Serum potassium levels require close monitoring and management if elevated. The American College of Cardiology Foundation/American Heart Association recommends considering discontinuation upon the development of serum potassium >5.5 mEq/L or worsening renal function with careful evaluation of the entire medical regimen. Avoid triple therapy with the combined use of an ACE inhibitor, ARB, and eplerenone. Therapy may need to be modified during an episode of diarrhea or dehydration or when loop diuretic therapy is interrupted (ACCF/AHA [Yancy 2013]).
• Hepatic impairment: Use with caution in patients with moderate to severe hepatic impairment.
• Renal impairment: Risk of hyperkalemia is increased with declining renal function. Use with caution in patients with mild renal impairment; based on indication and degree of impairment use may be contraindicated (refer to contraindications field).
Concurrent drug therapy issues:
• Potassium supplements: Avoid potassium supplements, potassium-containing salt substitutes, a diet rich in potassium, or other drugs that can cause hyperkalemia (eg, other potassium-sparing diuretics, NSAIDs). Concomitant use of potassium supplements or potassium-sparing diuretics is contraindicated in the treatment of hypertension.
Substrate of CYP3A4 (major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider therapy modification
Ammonium Chloride: Potassium-Sparing Diuretics may enhance the adverse/toxic effect of Ammonium Chloride. Specifically the risk of systemic acidosis. Risk C: Monitor therapy
Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Angiotensin II Receptor Blockers: Eplerenone may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy
Angiotensin-Converting Enzyme Inhibitors: Eplerenone may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy
Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy
Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Risk C: Monitor therapy
Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination
Cardiac Glycosides: Potassium-Sparing Diuretics may diminish the therapeutic effect of Cardiac Glycosides. In particular, the inotropic effects of digoxin appear to be diminished. Potassium-Sparing Diuretics may increase the serum concentration of Cardiac Glycosides. This particular effect may be unique to Spironolactone. Risk C: Monitor therapy
Clofazimine: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor therapy
CycloSPORINE (Systemic): Eplerenone may enhance the hyperkalemic effect of CycloSPORINE (Systemic). Risk X: Avoid combination
CYP3A4 Inducers (Strong): May decrease the serum concentration of Eplerenone. Risk C: Monitor therapy
CYP3A4 Inhibitors (Moderate): May increase the serum concentration of Eplerenone. Management: If coadministered with moderate CYP3A4 inhibitors, the max dose of eplerenone is 25 mg daily if used for heart failure; if used for hypertension initiate eplerenone 25 mg daily, titrate to max 25 mg twice daily. Risk D: Consider therapy modification
CYP3A4 Inhibitors (Strong): May increase the serum concentration of Eplerenone. Risk X: Avoid combination
Desmopressin: Hyponatremia-Associated Agents may enhance the hyponatremic effect of Desmopressin. Risk C: Monitor therapy
Dexmethylphenidate: May diminish the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy
Diacerein: May enhance the therapeutic effect of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. Risk C: Monitor therapy
Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Drospirenone-Containing Products: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy
DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy
Erdafitinib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor therapy
Fexinidazole: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination
Finerenone: Potassium-Sparing Diuretics may enhance the hyperkalemic effect of Finerenone. Risk C: Monitor therapy
Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination
Heparin: May enhance the hyperkalemic effect of Eplerenone. Risk C: Monitor therapy
Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Eplerenone. Risk C: Monitor therapy
Herbal Products with Blood Pressure Increasing Effects: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy
Levodopa-Containing Products: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products. Risk C: Monitor therapy
Lithium: Eplerenone may increase the serum concentration of Lithium. Risk C: Monitor therapy
Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nicorandil: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy
Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nitrofurantoin: May enhance the hyperkalemic effect of Eplerenone. Risk C: Monitor therapy
Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy
Nonsteroidal Anti-Inflammatory Agents: May diminish the antihypertensive effect of Eplerenone. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Eplerenone. Risk C: Monitor therapy
Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification
Opioid Agonists: May enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics. Risk C: Monitor therapy
Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy
Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Potassium Salts: Eplerenone may enhance the hyperkalemic effect of Potassium Salts. Management: This combination is contraindicated in patients receiving eplerenone for treatment of hypertension. Potassium supplements may be needed to treat/prevent hypokalemia in selected patients with heart failure receiving eplerenone and high dose loop diuretics. Risk D: Consider therapy modification
Potassium-Sparing Diuretics: Eplerenone may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Management: This combination is contraindicated in patients receiving eplerenone for treatment of hypertension. Potassium supplements may be needed to treat/prevent hypokalemia in selected patients with heart failure receiving eplerenone and high dose loop diuretics. Risk D: Consider therapy modification
Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
QuiNIDine: Potassium-Sparing Diuretics may diminish the therapeutic effect of QuiNIDine. Risk C: Monitor therapy
Sodium Phosphates: Diuretics may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with diuretics, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, hydrate adequately and monitor fluid and renal status. Risk D: Consider therapy modification
Tacrolimus (Systemic): Eplerenone may enhance the hyperkalemic effect of Tacrolimus (Systemic). Risk X: Avoid combination
Tolvaptan: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy
Trimethoprim: May enhance the hyperkalemic effect of Eplerenone. Risk C: Monitor therapy
Grapefruit juice increases eplerenone AUC ~25%. Management: Dosage adjustments of eplerenone may be needed.
Information related to eplerenone use in pregnancy is limited to case reports (Cabassi 2012; Gunganah 2015; Hutter 2006; Morton 2011; Morton 2017).
Chronic maternal hypertension is associated with adverse events in the fetus/infant. The risk of birth defects, low birth weight, premature delivery, stillbirth, and neonatal death may be increased with chronic hypertension in pregnancy. Actual risks may be related to duration and severity of maternal hypertension. The use of mineralocorticoid receptor antagonists for the treatment of hypertension in pregnancy is generally not recommended (ACOG 203 2019).
The treatment of edema associated with chronic heart failure during pregnancy is similar to that of nonpregnant patients. However, the use of mineralocorticoid receptor antagonists is not recommended. Patients diagnosed after delivery can be treated according to heart failure guidelines (ESC [Bauersachs 2016]; ESC [Regitz-Zagrosek 2018]).
Information related to the use of mineralocorticoid receptor antagonists for the treatment of primary hyperaldosteronism in pregnancy is limited. Use of eplerenone may be considered in some cases (Riester 2015).
It is not known if eplerenone is present in breast milk.
Do not use salt substitutes containing potassium.
BP; serum potassium (prior to therapy, within the first week, 1 month after start of treatment or dose adjustment, then periodically as clinically indicated); serum potassium and serum creatinine within 3 to 7 days after initiating concurrent therapy with a moderate CYP3A inhibitor, angiotensin-converting enzyme (ACE) inhibitor, angiotensin-II receptor blocker (ARB), or nonsteroidal anti-inflammatory drug.
Heart failure: Serum potassium and renal function should be checked in 3 days after initiation, at 1 week after initiation, at least monthly for the first 3 months of therapy, and every 3 months thereafter. If adding or increasing the dose of concomitant ACE inhibitors or ARBs, a new cycle of monitoring should be done. If serum potassium increases to >5.5 mEq/L or renal function worsens, hold doses until potassium is <5 mEq/L and consider restarting with a reduced dose after confirming resolution of hyperkalemia/renal insufficiency for at least 72 hours (ACCF/AHA [Yancy 2013]).
Aldosterone, a mineralocorticoid, increases blood pressure primarily by inducing sodium and water retention. Overexpression of aldosterone is thought to contribute to myocardial fibrosis (especially following myocardial infarction) and vascular fibrosis. Mineralocorticoid receptors are located in the kidney, heart, blood vessels, and brain. Eplerenone selectively blocks mineralocorticoid receptors reducing blood pressure in a dose-dependent manner and appears to prevent myocardial and vascular fibrosis.
Distribution: Vd: 42 to 90 L
Protein binding: ~50%; primarily to alpha1-acid glycoproteins
Metabolism: Primarily hepatic via CYP3A4; metabolites inactive
Bioavailability: 69%
Half-life elimination: ~3 to 6 hours
Time to peak, plasma: ~1.5 to 2 hours; may take up to 4 weeks for full antihypertensive effect
Excretion: Urine (~67%); feces (~32%); <5% as unchanged drug in urine and feces
Renal function impairment: AUC and Cmax increased 38% and 24%, respectively, in severe renal impairment and decreased by 26% and 3%, respectively, in hemodialysis.
Hepatic function impairment: Cmax and AUC increased 3.6% and 42%, respectively, in moderate hepatic impairment.
Geriatric: Cmax and AUC increased 22% and 45%, respectively.
Race: Cmax and AUC decreased 19% and 25%, respectively, in black patients.
Tablets (Eplerenone Oral)
25 mg (per each): $4.17 - $4.34
50 mg (per each): $4.17 - $4.34
Tablets (Inspra Oral)
25 mg (per each): $15.05
50 mg (per each): $15.05
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.