Before starting
Required
- Baseline
- Estimated glomerular filtration rate contraindicated if eGFR less than 30mL/min/1.73m2; reduce starting dose to 25 mg on alternate days if eGFR 30–60 mL/minute/1.73 m2
- Serum potassium contraindicated if over 5.0 mmol/L
- Electrolytes
After started or dose changed
Required
- After 1 week, then monthly for the first 3 months
- Estimated glomerular filtration rate
- Serum potassium adjust dose to level
- Before and after each dose change
- Blood pressure
Post myocardial infarction with heart failure
- After 48 hours
- Estimated glomerular filtration rate
- Serum potassium
- Electrolytes
Ongoing once stable
Required
- Periodically
- Estimated glomerular filtration rate
- Serum potassium adjust dose to level
Abnormal results
Renal function
- Stop if eGFR less than 30mL/min/1.73m2
- Reduce dose and monitor serum potassium if eGFR under 60mL/min/1.73m2
Adjusting doses to serum potassium
After initiation, adjust dose to potassium level.
Level lower than 5.0 mmol/L
- If dose normally 25mg every other day, increase to 25mg daily
- If dose normally 25mg daily, increase to 50mg daily
Level between 5.0 mmol/L and 5.4 mmol/L
- No dose adjustment required
Level between 5.5 mmol/L and 5.9 mmol/L
- If dose normally 25mg every other day, then withhold
- If dose normally 25mg daily, reduce to 25mg every other day
- If dose normally 50mg daily, reduce to 25mg daily
Notes
Advice to patients
Advise patients to:
- Avoid concomitant NSAIDs that have not been prescribed (e.g. those bought over the counter)
- Avoid salt substitutes containing potassium
- Be aware of diarrhoea, vomiting, or infections with fever and sweating; stop eplerenone if this occurs and contact specialist
Bibliography
- Upjohn UK Limited. Summary of Product Characteristics – Inspra 25mg film-coated tablets. Last updated 05/2017 [cited 07/01/2020]
- National Institute for Health and Care Excellence (NICE). Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease [CG172]. Nov 2019 [cited 08/01/2020]
- National Institute for Health and Care Excellence (NICE). Chronic heart failure in adults: diagnosis and management [CG172]. Sep 2018 [cited 08/01/2020]
- Scottish Intercollegiate Guidelines Network (SIGN). Management of chronic heart failure (Guideline 147). March 2016. [cited 08/01/2020]
- Ponikowski P, Voors A A, Anker S D, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal, Volume 37, Issue 27, 14 July 2016, Pages 2129–2200 [cited 08/01/2020]
- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press [cited 30/12/2020]