Eplerenone is a selective mineralocorticoid receptor antagonist that reduces mortality and hospitalizations in heart failure and post-myocardial infarction with fewer sexual side effects than spironolactone.
Eplerenone is a multifaceted mineralocorticoid receptor antagonist with proven benefits in heart failure, post-myocardial infarction, and resistant hypertension, offering an alternative to spironolactone with fewer androgenic side effects.
Conventionally, rennin-angiotensin-aldosterone system (RAAS) inhibition has focused on angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers and angiotensin receptor-neprilysin inhibitors (ARNI) are the latest addition to this armamentarium. However, mineralocorticoid receptor antagonists (MRAs) also constitute an integral part of this anti-RAAS brigade, which are perceived more often as diuretics and are often under prescribed in heart failure (HF) despite being universally advocated by all major guidelines. Apart from HF, they have also shown promise in the management of hypertension, post-myocardial infarction, and hyperaldosteronism. Eplerenone, Food and Drug Administration (FDA) approved in 2002, is an acceptable alternative to spironolactone due to its sparing androgenic effects. In two big pivotal trials in heart failure (EMPHASIS -HF) and post-myocardial infarction (EPHESUS), the drug has firmly shown a reduction in adverse cardiovascular events. It has an established place in the management of resistant hypertension too. In this article, we will discuss the role of RAAS and its pathophysiology, pitfalls of spironolactone, which led to success of its congener, eplerenone, major studies conducted on eplerenone, current role of eplerenone, and comparison of the two MRAs.
Pradhan et al. (Wed,) conducted a review in Heart failure, post-myocardial infarction, and hypertension. Eplerenone vs. Spironolactone, Placebo, or other active controls was evaluated. Eplerenone is a selective mineralocorticoid receptor antagonist that reduces mortality and hospitalizations in heart failure and post-myocardial infarction with fewer sexual side effects than spironolactone.