6. Conclusion. These findings indicate that the metabolic effects of eplerenone are different from those of
spironolactone and that a selective mineralocorticoid receptor blocker eplerenone is superior to spironolactone in
metabolic effects in patients with CHF.
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Pagourelias Efstathios D; Anagnostis Panagiotis; Athyros Vasilios G; Mikhailidis Dimitri P
Aldosterone Antagonists Spironolactone versus eplerenone for the treatment of idiopathic hyperaldosteronism.
Antihypertensive Agents Expert opinion on pharmacotherapy 2008;9(4):509-15. Visualized networks:
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Drug Dose-Response Relationship
The aim of this prospective, randomised, open-label, blinded-end point study was to compare
Gynecomastia
the efficacy and safety of eplerenone versus spironolactone in patients with bilateral idiopathic
Hyperaldosteronism
hyperaldosteronism (IHA). After a 2-week washout period, 34 patients with IHA were assigned
Hyperkalemia to receive either spironolactone 25 mg b.i.d. (n = 17) or eplerenone 25 mg b.i.d. (n = 17) for
Hypertension 24 weeks. If the patients' blood pressure (BP) was not < 140/90 mmHg, the doses were
Hypokalemia gradually increased up to 400 mg for spironolactone and 200 mg for eplerenone. If the patients'
Potassium BP remained uncontrolled, a daily dose of hydrochlorothiazide 12.5 mg was added at week 16.
Prospective Studies The primary outcome was the percentage of patients with BP < 140/90 mmHg at 16 weeks
Spironolactone (i.e., with aldosterone antagonist monotherapy). The patients' BP was normalised in 13 out of
Time Factors 17 (76.5%) and 14 out of 17 (82.4%) patients in the spironolactone and eplerenone groups,
Treatment Outcome respectively (p = 1.00). Systolic BP decreased more rapidly with eplerenone. Serum potassium GeoTargeted Searches:
levels were normalised (> 3.5 mmol/l) in all patients at 4 weeks. Mild hyperkalaemia was Locate experts around the world
observed in two patients receiving 400 mg of spironolactone and in three patients receiving 150 and connect with global collaborators
Sign-in to see more mg of eplerenone. Two patients presented with bilateral painful gynaecomastia at the end of
week 16 while receiving 400 mg of spironolactone. Switching spironolactone to 150 mg of
eplerenone daily resulted in resolution of gynaecomastia and also maintained BP control. At the
end of the study, 19 patients were on eplerenone and 15 were on spironolactone. However, this
did not affect the primary end point, because the switch from spironolactone to eplerenone (in
two patients) occurred at the end of week 16. It was concluded that eplerenone was as
effective as spironolactone in reducing BP in patients with IHA. The risk of mild hyperkalaemia
was similar with both drugs.
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