Why the study?
Spironolactone and eplerenone have demonstrated clinical utility in chronic heart failure, but differ in receptor selectivity, endocrine side effects, and safety considerations like hyperkalemia and renal impairment.
This review summarizes the pharmacokinetic and pharmacodynamic profiles of spironolactone and eplerenone, emphasizing their mechanisms of action and key safety considerations like hyperkalemia in heart failure management.
May inform MRA selection by endocrine-risk profile; leaves open head-to-head outcome trials in contemporary HF.
Among the established mineralocorticoid receptor antagonists (MRAs), spironolactone and eplerenone have demonstrated significant clinical utility in managing conditions such as chronic heart failure, resistant hypertension, and hyperaldosteronism. Spironolactone, the first steroidal MRA, is known for its broad receptor affinity, contributing to both therapeutic benefits and endocrine-related side effects. Eplerenone, a more selective agent, offers improved tolerability with reduced hormonal adverse effects. This review explores the pharmacokinetic and pharmacodynamic profiles of these agents, highlighting their mechanisms of action, receptor-binding characteristics, and clinical implications. The safety considerations associated with long-term use, particularly hyperkalemia and renal function impairment, are also discussed to provide a comprehensive understanding of their therapeutic roles.
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Solanki et al. (2026) studied this question.
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