Aldosterone Antagonist

3 Drugs classified under this drug class

Aldosterone Antagonist. Spironolactone 25 mg.
TABS: 20 x 25 mg. 50-100 mg dly.
Congest. card. fail. with oedema
For manag. of edema an init. dly. dose
of 100 mg of spironolactone admin. in
either single or divided doses is
recom., but may range from 25 mg-
200 mg dly. Mainten. dose should be
individ. determin.
Pts. who tolerate 25 mg once dly. may
have their dose incr. to 50 mg×1/d. as
clinic. indic. Pts. who do not tolerate
25mg ×1/d may have their dose
reduced to 25 mg every other d.
Admin. with food.
Congest. heart fail; Cirrhot. ascites.
C/I: Acute renal insuffic. , signific. renal
compromise, anuria; Addison’s dis.;
Hyperkalaem.; Hypersens. to spironolactone.; Concom. use of
eplerenone or other K+ spar. diuret.;
Ped. pts. with moder.- sev. renal impair.;
Concom. use with other K+conserve.
diuret., K+supplem. should not be given
routin. with Aldactone as hyperkalaem.
may be induced.

Aldosterone Antagonist. Eplerenone 25 mg, 50 mg.
F.C. TABS.:28. For the individ. adjust. of dose, of 25 mg, 50 mg are available. The max. dose 50 mg dly.
For post-MI heart fail. pts.: The recomm. maint. dose of eplerenone is 50 mg×1/d. Tmt. should be initiated at 25 mg×1/d and titrat. to the target dose of 50 mg×1/d preferably within 4 wks., taking into account the serum K⁺ level. Eplerenone ther. should usually be start. within 3-14 d after an acute MI. See lit.
For pts. with NYHA class II (chron.) heart fail.: For chron. heart fail. NYHA class II pts., tmt. should be init. at a dose of 25 mg×1/d and titrat. to the target dose of 50 mg×1/d preferably within 4 wks.; taking into account the serum K⁺ level. See lit.
Eplerenone is indicated: In addit. to standard ther. include. β-block., to reduce the risk of CV mortal. & morbid. in stable pts. with left LVEF ≤ 40 % and clin. evidence of heart fail. after recent MI.
In addit. to standard optimal ther., to reduce the risk of CV mortal. and morbid. in adult pts. with NYHA class II (chron.) heart fail. and left ventric. syst. dysfunct. (LVEF ≤30%).
C/I: Hypersens. Pts. with serum K⁺ level > 5.0 mmol/L at init. Pts. with sev. renal insuffic. (eGFR <30 mL per min. per 1.73 m²). Pts. with sev. hep. insuffic. (Child-Pugh Class C). Pts. receiv. K⁺-spar. diuretics, strong inhib. of CYP 3A4 (e.g., itraconazole, ketoconazole, ritonavir, nelfinavir, clarithromycin, telithromycin, nefazodone). The comb. of an ACE's inhib. and an ARB's inhib with eplerenone.

Aldosterone Antagonist. Spironolactone 25 mg, 100 mg.
TABS: 20 x 25 mg, 20 x 100 mg.
Admin.  once dly. with a meal is recomm.
Adult.: CHF with oedema: For manag. of oedema an init. dly. dose of 100 mg admin. in either single or divid. doses is recomm., but may range from 25 mg -200 mg dly. Mainten. dose should be individ. determin.
Severe heart fail.(NYHA Class III-IV): Based on the Randomized Aldactone Evaluat. Study, tmt. in conjunct. with standard therapy should be init. at a dose
of spironolactone 25 mg ×1/d if serum K⁺ is ≤5.0 mEq/L and serum Cr is ≤2.5 mg/dL. Pts. who tolerate 25 mg×1/d may have their dose incr. to 50 mg ×1/d as clinic. indic.. Pts. who do not tolerate 25 mg×1/d may have their dose reduced to 25 mg every other day. See lit.
Hepatic cirrhosis with ascites and oedema: If urinary Na+/K+ ratio is greater than 1.0, 100 mg/day. If the ratio is less than 1.0, 200 mg/day to 400 mg/d. Mainten. dosage should be individ. determ.
Elder.: It is recomm. that tmt. is started with the lowest dose and titrated upwards as requir. to achieve max. benefit. Care should be taken with severe hep. and renal impair. which may alter drug metabolism and excretion.
Ped. population: Init. dly. dosage should provide 3 mg/kg bdy. wt. given in divided doses. Dosage should be adjust. on the basis of response and tolerance.
Child. should only be treated under guidance of a paediatric specialist. There is limited ped. data available.
Ed. conds. in pts. with congest. heart fail., hepatic cirrhosis with ed.,
essential hypertens., hypokalem, diagn. of prim. hyperaldosteronism.
C/I: Hypersens.
Adult. and ped. pts.  patients with acute renal insuffic., signific. renal compromise, anuria, addison’s dis., hyperkalaem.
Concom. use of eplerenone or other K⁺ spar. diuret.
Spironolactone should not be admin.concurr. with other K+  conserve. diuret. and K+  supplem. should not be given routinely with Spironolactone as hyperkalaem. may be induced.
Ped. pts. with moder.- sev. ren. impair.