Эплеренон

Сильные ингибиторы изофермента CYP3A4: при применении эплеренона со средствами, ингибирующими изофермент CYP3A4, возможно значимое фармакокинетическое взаимодействие. Сильный ингибитор изофермента CYP3A4 (кетоконазол 200 мг 2 раза в сутки) вызывал увеличение AUC эплеренона на 441%. Одновременное применение эплеренона с сильными ингибиторами изофермента CYP3A4, такими как кетоконазол, итраконазол, ритонавир, нелфинавир, кларитромицин, телитромицин и нефазодон, противопоказано (см. раздел «Противопоказания»).

Эплеренон (Eplerenone)

Одна таблетка, покрытая пленочной оболочкой, содержит:

Действующее вещество: эплеренон — 25 мг, 50 мг.

Вспомогательные вещества: лактозы моногидрат, целлюлоза микрокристаллическая (тип 102), кроскармеллоза натрия, гипромеллоза, натрия лаурилсульфат, тальк, магния стеарат.

Пленочная оболочка: Опадрай желтый (YS‑1‑12524‑А) [гипромеллоза, титана диоксид, макрогол 400, полисорбат 80, краситель железа оксид желтый, краситель железа оксид красный].

Эплеренон

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Эплеренон при высоком артериальном давлении

Цель этого обзора заключалась в определении эффективности эплеренона для снижения артериального давления, профиля его побочных эффектов и влияния на такие клинически значимые исходы, как смертность и заболеваемость.

Актуальность

С 2002 года клиницисты используют эплеренон для лечения высокого артериального давления. Важно определить клиническое воздействие всех антигипертензивных средств, назначаемых пациентам для продолжительного применения при эссенциальной гипертензии. Мы провели поиск в различных базах данных и обнаружили пять подходящих исследований с участием 1437 человек, которые при распределении в группы в случайном порядке получали либо эплеренон, либо не получали никаких лекарств.

Характеристика исследований

Дозы эплеренона, применяемые в этих исследованиях, были в диапазоне от 25 мг до 400 мг в день. В этих исследованиях пациенты наблюдались от 8 до 16 недель во время получения терапии. Ни в одном из исследований не сообщали о таких клинически значимых исходах, связанных с приемом эплеренона, как снижение риска сердечного приступа, инсульта или смерти, по сравнению с плацебо. Только в трех из пяти исследований сообщали о побочных эффектах.

Основные результаты

В настоящее время нет доказательств, что эплеренон оказывает положительное влияние на ожидаемую продолжительность жизни или осложнения, связанные с гипертензией (например, инфаркт, инсульт). Доказательства риска развития побочных эффектов, связанных с приемом эплеренона, ограничены и низкого качества; сложно определить степень возможного вреда при приеме эплеренона в сравнении с плацебо. Этот мета-анализ показывает, что эплеренон в дозе от 50 до 200 мг в день снижает систолическое артериальное давление примерно на 9 мм рт. ст. и диастолическое артериальное давление на 4 мм рт. ст. в сравнении с отсутствием приема лекарств.

Качество доказательств

Мы оценили качество пяти включенных испытаний как среднее, так как авторы не достаточно подробно описали методологию проведения испытаний.

Если вы нашли эти доказательства полезными, рассмотрите возможность пожертвования в Кокрейн. Мы — благотворительная организация, которая предоставляет доступные доказательства , чтобы помочь людям принимать решения о здоровье и помощи.

Заметки по переводу:

Перевод: Нефедова Дарья Дмитриевна. Редактирование: Гиниятуллина Лейля Камиловна, Юдина Екатерина Викторовна. Координация проекта по переводу на русский язык: Cochrane Russia — Кокрейн Россия (филиал Северного Кокрейновского Центра на базе Казанского федерального университета). По вопросам, связанным с этим переводом, пожалуйста, обращайтесь к нам по адресу: [email protected]; [email protected]

Побочные действия вещества Эплеренон

Ниже перечислены нежелательные явления, которые могли быть связаны с лечением, а также серьезные нежелательные явления, частота которых сопоставима с частотой нежелательных и серьезных нежелательных явлений в группе плацебо. Нежелательные явления распределены по системам организма и частоте: часто (≥1/100, < 1/10); нечасто (≥1/1000, < 1/100); частота неизвестна (не может быть подсчитана по имеющимся данным).

Со стороны системы кроветворения и лимфатической системы: нечасто — эозинофилия.

Со стороны обмена веществ и нарушение питания: часто — гиперкалиемия, дегидратация, гиперхолестеринемия, гипертриглицеридемия; нечасто — гипонатриемия, гипотиреоз.

Нарушения психики: нечасто — бессонница.

Неврологические нарушения: часто — головокружение, обморок; нечасто — головная боль, гипестезия.

Со стороны сердца: часто — инфаркт миокарда; нечасто — фибрилляция предсердий, левожелудочковая недостаточность, тахикардия.

Со стороны сосудов: часто — выраженное снижение АД; нечасто — ортостатическая гипотензия, тромбоз артерий нижних конечностей.

Со стороны органов дыхания, грудной клетки и средостения: часто — кашель; нечасто — фарингит.

Со стороны ЖКТ: часто — диарея, тошнота, запор; нечасто — метеоризм, рвота.

Со стороны печени и желчевыводящих путей: нечасто — холецистит.

Со стороны кожи и подкожно-жировой клетчатки: часто — кожный зуд; нечасто —- повышенное потоотделение, сыпь; частота неизвестна — ангионевротический отек.

Со стороны опорно-двигательного аппарата и соединительной ткани: часто — судороги икроножных мышц, мышечно-скелетные боли; нечасто — боль в спине.

Со стороны почек и мочевыводящих путей: часто — нарушение функции почек.

Общие и местные реакции: нечасто — астения, недомогание.

Лабораторные показатели: нечасто — повышение концентрации остаточного азота мочевины, креатинина, снижение экспрессии рецептора эпидермального фактора роста, повышение концентрации глюкозы в сыворотке крови.

Инфекции: нечасто — пиелонефрит, гинекомастия.

Эплеренон

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Interactions

Interaction Checker

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Contraindicated (8)

chloramphenicol chloramphenicol will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
cobicistat cobicistat will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
itraconazole itraconazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. May increase the risk of hyperkalemia and hypotension
lopinavir lopinavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
mifepristone mifepristone will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
nefazodone nefazodone will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
nirmatrelvir/ritonavir nirmatrelvir/ritonavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Nirmatrelvir/ritonavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions. May increase risk of hyperkalemia associated with eplerenone.
tipranavir tipranavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

Serious (20)

amiloride amiloride, eplerenone. Mechanism: pharmacodynamic synergism. Contraindicated. Hyperkalemia.
apalutamide apalutamide will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.
ceritinib ceritinib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
danazol danazol will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
diltiazem diltiazem will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of eplerenone and mdoerate CYP3A4 inhibitor is not recommended. If combination is unavoidable, eplerenone dose should not exceed 25 mg/day for patients with congestive heart failure following MI.
drospirenone drospirenone, eplerenone. Mechanism: pharmacodynamic synergism. Contraindicated. Hyperkalemia.
enzalutamide enzalutamide will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
fexinidazole fexinidazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.
idelalisib idelalisib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates
isoniazid isoniazid will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
ketoconazole ketoconazole increases levels of eplerenone by decreasing metabolism. Contraindicated.
levoketoconazole levoketoconazole increases levels of eplerenone by decreasing metabolism. Contraindicated.
lofexidine lofexidine, eplerenone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.
potassium acid phosphate potassium acid phosphate, eplerenone. Mechanism: pharmacodynamic synergism. Contraindicated. Hyperkalemia.
potassium chloride potassium chloride, eplerenone. Mechanism: pharmacodynamic synergism. Contraindicated. Hyperkalemia.
potassium phosphates, IV eplerenone and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
spironolactone spironolactone, eplerenone. Mechanism: pharmacodynamic synergism. Contraindicated. Hyperkalemia.
tovorafenib tovorafenib will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of tovorafenib (a weak CYP3A4 inducer) with CYP3A substrates where minimal concentration changes may lead to serious therapeutic failures. If unavoidable, monitor patients for loss of efficacy unless otherwise recommended in the CYP3A4 substrate prescribing information.
triamterene triamterene, eplerenone. Mechanism: pharmacodynamic synergism. Contraindicated. Hyperkalemia.
tucatinib tucatinib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

Monitor Closely (72)

aldesleukin aldesleukin increases effects of eplerenone by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
amifostine amifostine, eplerenone. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.
avanafil avanafil increases effects of eplerenone by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
belzutifan belzutifan will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.
benazepril benazepril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
canagliflozin eplerenone and canagliflozin both increase serum potassium. Use Caution/Monitor.
candesartan candesartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
captopril captopril, eplerenone. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia. Monitor potassium.
carbamazepine carbamazepine will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
carbidopa carbidopa increases effects of eplerenone by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.
cenobamate cenobamate will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
cimetidine cimetidine will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
clarithromycin clarithromycin will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
crofelemer crofelemer increases levels of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.
dabrafenib dabrafenib will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
deferasirox deferasirox will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
dronedarone dronedarone will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decrease eplerenone dose to 25mg/day when administered with moderate inhibitors of 3A4, monitor potassium.
duvelisib duvelisib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.
elagolix elagolix will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.
elvitegravir/cobicistat/emtricitabine/tenofovir DF elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
enalapril enalapril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
encorafenib encorafenib, eplerenone. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
eprosartan eprosartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
erythromycin base erythromycin base will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
erythromycin ethylsuccinate erythromycin ethylsuccinate will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
erythromycin lactobionate erythromycin lactobionate will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
erythromycin stearate erythromycin stearate will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
fedratinib fedratinib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
finerenone eplerenone and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.
fosinopril fosinopril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
grapefruit grapefruit will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for hyperkalemia
iloperidone iloperidone increases levels of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.
imidapril imidapril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
irbesartan irbesartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
istradefylline istradefylline will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
ketoconazole ketoconazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
lenacapavir lenacapavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir (a moderate CYP3A4 inhibitor) may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.
letermovir letermovir increases levels of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
levodopa levodopa increases effects of eplerenone by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.
levoketoconazole levoketoconazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
lisinopril lisinopril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
lorlatinib lorlatinib will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
losartan losartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
lurasidone lurasidone increases effects of eplerenone by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.
mavorixafor mavorixafor will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for adverse effects of sensitive CYP3A4 substrates if coadministered with mavorixafor (a weak CYP3A4 inhibitor).
mitotane mitotane decreases levels of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.
moexipril moexipril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
nitroglycerin rectal nitroglycerin rectal, eplerenone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .
olanzapine/samidorphan olanzapine/samidorphan increases effects of eplerenone by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Monitor blood pressure and reduce antihypertensive drug dosage in accordance with its product labeling.
olmesartan olmesartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
perindopril perindopril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
potassium citrate potassium citrate and eplerenone both increase serum potassium. Modify Therapy/Monitor Closely.
potassium citrate/citric acid eplerenone and potassium citrate/citric acid both increase serum potassium. Modify Therapy/Monitor Closely.
quinapril quinapril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
ramipril ramipril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
ribociclib ribociclib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
rifabutin rifabutin will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
rifampin rifampin will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
rucaparib rucaparib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.
sacubitril/valsartan sacubitril/valsartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
St John’s Wort St John’s Wort will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
stiripentol stiripentol, eplerenone. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
tadalafil tadalafil increases effects of eplerenone by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
tazemetostat tazemetostat will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
tecovirimat tecovirimat will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.
telmisartan telmisartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
trandolapril trandolapril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
trimethoprim trimethoprim and eplerenone both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
valsartan valsartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
verapamil verapamil will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Plasma concentrations and pharmacologic or toxic effects of eplerenone may be increased by verapamil.
voclosporin voclosporin and eplerenone both increase serum potassium. Use Caution/Monitor.
xipamide xipamide increases effects of eplerenone by pharmacodynamic synergism. Use Caution/Monitor.

Minor (102)

aceclofenac aceclofenac decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
acemetacin acemetacin decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
acetazolamide acetazolamide will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
agrimony agrimony increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
amobarbital amobarbital will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
anastrozole anastrozole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
aprepitant aprepitant will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
armodafinil armodafinil will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
artemether/lumefantrine artemether/lumefantrine will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
aspirin aspirin decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
aspirin rectal aspirin rectal decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
aspirin/citric acid/sodium bicarbonate aspirin/citric acid/sodium bicarbonate decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
atazanavir atazanavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
bosentan bosentan will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
brimonidine brimonidine increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
budesonide budesonide will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
butabarbital butabarbital will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
butalbital butalbital will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
celecoxib celecoxib decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
choline magnesium trisalicylate choline magnesium trisalicylate decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
conivaptan conivaptan will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
cornsilk cornsilk increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
cortisone cortisone will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
cyclophosphamide cyclophosphamide will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
cyclosporine cyclosporine will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
darifenacin darifenacin will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
darunavir darunavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
dasatinib dasatinib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
dexamethasone dexamethasone will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
DHEA, herbal DHEA, herbal will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
diclofenac diclofenac decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
diflunisal diflunisal decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
drospirenone drospirenone will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
efavirenz efavirenz will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
eslicarbazepine acetate eslicarbazepine acetate will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
ethinylestradiol ethinylestradiol will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
etodolac etodolac decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
etravirine etravirine will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
fenoprofen fenoprofen decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
fluconazole fluconazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
fludrocortisone fludrocortisone will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
flurbiprofen flurbiprofen decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
forskolin forskolin increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
fosamprenavir fosamprenavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
fosaprepitant fosaprepitant will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
fosphenytoin fosphenytoin will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
griseofulvin griseofulvin will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
hydrocortisone hydrocortisone will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
ibuprofen ibuprofen decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
ibuprofen IV ibuprofen IV decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
indinavir indinavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
indomethacin indomethacin decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
ketoprofen ketoprofen decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
ketorolac ketorolac decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
ketorolac intranasal ketorolac intranasal decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
lapatinib lapatinib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
larotrectinib larotrectinib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
lornoxicam lornoxicam decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
lumefantrine lumefantrine will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
maitake maitake increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
marijuana marijuana will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
meclofenamate meclofenamate decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
mefenamic acid mefenamic acid decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
meloxicam meloxicam decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
methylprednisolone methylprednisolone will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
metronidazole metronidazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
miconazole vaginal miconazole vaginal will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
nabumetone nabumetone decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
naproxen naproxen decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
nelfinavir nelfinavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
nevirapine nevirapine will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
nifedipine nifedipine will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
nilotinib nilotinib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
octacosanol octacosanol increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
oxaprozin oxaprozin decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
oxcarbazepine oxcarbazepine will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
parecoxib parecoxib decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
patiromer patiromer, eplerenone. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
pentobarbital pentobarbital will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
phenobarbital phenobarbital will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
phenytoin phenytoin will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
piroxicam piroxicam decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
posaconazole posaconazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
prednisone prednisone will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
primidone primidone will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
quinupristin/dalfopristin quinupristin/dalfopristin will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
reishi reishi increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
rifapentine rifapentine will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
ritonavir ritonavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
rufinamide rufinamide will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
salicylates (non-asa) salicylates (non-asa) decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
salsalate salsalate decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
shepherd’s purse shepherd’s purse, eplerenone. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd’s purse may interfere with BP control.
sulfasalazine sulfasalazine decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
sulindac sulindac decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
tizanidine tizanidine increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.
tolfenamic acid tolfenamic acid decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
tolmetin tolmetin decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
topiramate topiramate will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
treprostinil treprostinil increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
voriconazole voriconazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
zafirlukast zafirlukast will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

aceclofenac Minor (1) aceclofenac decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
acemetacin Minor (1) acemetacin decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
acetazolamide Minor (1) acetazolamide will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
agrimony Minor (1) agrimony increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
aldesleukin Monitor Closely (1) aldesleukin increases effects of eplerenone by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
amifostine Monitor Closely (1) amifostine, eplerenone. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.
amiloride Serious — Use Alternative (1) amiloride, eplerenone. Mechanism: pharmacodynamic synergism. Contraindicated. Hyperkalemia.
amobarbital Minor (1) amobarbital will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
anastrozole Minor (1) anastrozole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
apalutamide Serious — Use Alternative (1) apalutamide will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.
aprepitant Minor (1) aprepitant will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
armodafinil Minor (1) armodafinil will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
artemether/lumefantrine Minor (1) artemether/lumefantrine will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
aspirin Minor (1) aspirin decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
aspirin rectal Minor (1) aspirin rectal decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
aspirin/citric acid/sodium bicarbonate Minor (1) aspirin/citric acid/sodium bicarbonate decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
atazanavir Minor (1) atazanavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
avanafil Monitor Closely (1) avanafil increases effects of eplerenone by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
belzutifan Monitor Closely (1) belzutifan will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.
benazepril Monitor Closely (1) benazepril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
bosentan Minor (1) bosentan will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
brimonidine Minor (1) brimonidine increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
budesonide Minor (1) budesonide will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
butabarbital Minor (1) butabarbital will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
butalbital Minor (1) butalbital will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
canagliflozin Monitor Closely (1) eplerenone and canagliflozin both increase serum potassium. Use Caution/Monitor.
candesartan Monitor Closely (1) candesartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
captopril Monitor Closely (1) captopril, eplerenone. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia. Monitor potassium.
carbamazepine Monitor Closely (1) carbamazepine will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
carbidopa Monitor Closely (1) carbidopa increases effects of eplerenone by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.
celecoxib Minor (1) celecoxib decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
cenobamate Monitor Closely (1) cenobamate will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
ceritinib Serious — Use Alternative (1) ceritinib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
chloramphenicol Contraindicated (1) chloramphenicol will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
choline magnesium trisalicylate Minor (1) choline magnesium trisalicylate decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
cimetidine Monitor Closely (1) cimetidine will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
clarithromycin Monitor Closely (1) clarithromycin will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
cobicistat Contraindicated (1) cobicistat will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
conivaptan Minor (1) conivaptan will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
cornsilk Minor (1) cornsilk increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
cortisone Minor (1) cortisone will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
crofelemer Monitor Closely (1) crofelemer increases levels of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.
cyclophosphamide Minor (1) cyclophosphamide will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
cyclosporine Minor (1) cyclosporine will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
dabrafenib Monitor Closely (1) dabrafenib will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
danazol Serious — Use Alternative (1) danazol will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
darifenacin Minor (1) darifenacin will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
darunavir Minor (1) darunavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
dasatinib Minor (1) dasatinib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
deferasirox Monitor Closely (1) deferasirox will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
dexamethasone Minor (1) dexamethasone will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
DHEA, herbal Minor (1) DHEA, herbal will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
diclofenac Minor (1) diclofenac decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
diflunisal Minor (1) diflunisal decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
diltiazem Serious — Use Alternative (1) diltiazem will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of eplerenone and mdoerate CYP3A4 inhibitor is not recommended. If combination is unavoidable, eplerenone dose should not exceed 25 mg/day for patients with congestive heart failure following MI.
dronedarone Monitor Closely (1) dronedarone will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Decrease eplerenone dose to 25mg/day when administered with moderate inhibitors of 3A4, monitor potassium.
drospirenone Serious — Use Alternative (1) drospirenone, eplerenone. Mechanism: pharmacodynamic synergism. Contraindicated. Hyperkalemia. Minor (1) drospirenone will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
duvelisib Monitor Closely (1) duvelisib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.
efavirenz Minor (1) efavirenz will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
elagolix Monitor Closely (1) elagolix will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.
elvitegravir/cobicistat/emtricitabine/tenofovir DF Monitor Closely (1) elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
enalapril Monitor Closely (1) enalapril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
encorafenib Monitor Closely (1) encorafenib, eplerenone. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
enzalutamide Serious — Use Alternative (1) enzalutamide will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
eprosartan Monitor Closely (1) eprosartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
erythromycin base Monitor Closely (1) erythromycin base will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
erythromycin ethylsuccinate Monitor Closely (1) erythromycin ethylsuccinate will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
erythromycin lactobionate Monitor Closely (1) erythromycin lactobionate will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
erythromycin stearate Monitor Closely (1) erythromycin stearate will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
eslicarbazepine acetate Minor (1) eslicarbazepine acetate will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
ethinylestradiol Minor (1) ethinylestradiol will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
etodolac Minor (1) etodolac decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
etravirine Minor (1) etravirine will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
fedratinib Monitor Closely (1) fedratinib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
fenoprofen Minor (1) fenoprofen decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
fexinidazole Serious — Use Alternative (1) fexinidazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.
finerenone Monitor Closely (1) eplerenone and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.
fluconazole Minor (1) fluconazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
fludrocortisone Minor (1) fludrocortisone will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
flurbiprofen Minor (1) flurbiprofen decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
forskolin Minor (1) forskolin increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
fosamprenavir Minor (1) fosamprenavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
fosaprepitant Minor (1) fosaprepitant will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
fosinopril Monitor Closely (1) fosinopril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
fosphenytoin Minor (1) fosphenytoin will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
grapefruit Monitor Closely (1) grapefruit will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for hyperkalemia
griseofulvin Minor (1) griseofulvin will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
hydrocortisone Minor (1) hydrocortisone will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
ibuprofen Minor (1) ibuprofen decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
ibuprofen IV Minor (1) ibuprofen IV decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
idelalisib Serious — Use Alternative (1) idelalisib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates
iloperidone Monitor Closely (1) iloperidone increases levels of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.
imidapril Monitor Closely (1) imidapril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
indinavir Minor (1) indinavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
indomethacin Minor (1) indomethacin decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
irbesartan Monitor Closely (1) irbesartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
isoniazid Serious — Use Alternative (1) isoniazid will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
istradefylline Monitor Closely (1) istradefylline will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
itraconazole Contraindicated (1) itraconazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. May increase the risk of hyperkalemia and hypotension
ketoconazole Monitor Closely (1) ketoconazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Serious — Use Alternative (1) ketoconazole increases levels of eplerenone by decreasing metabolism. Contraindicated.
ketoprofen Minor (1) ketoprofen decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
ketorolac Minor (1) ketorolac decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
ketorolac intranasal Minor (1) ketorolac intranasal decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
lapatinib Minor (1) lapatinib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
larotrectinib Minor (1) larotrectinib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
lenacapavir Monitor Closely (1) lenacapavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir (a moderate CYP3A4 inhibitor) may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.
letermovir Monitor Closely (1) letermovir increases levels of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
levodopa Monitor Closely (1) levodopa increases effects of eplerenone by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.
levoketoconazole Monitor Closely (1) levoketoconazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Serious — Use Alternative (1) levoketoconazole increases levels of eplerenone by decreasing metabolism. Contraindicated.
lisinopril Monitor Closely (1) lisinopril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
lofexidine Serious — Use Alternative (1) lofexidine, eplerenone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.
lopinavir Contraindicated (1) lopinavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
lorlatinib Monitor Closely (1) lorlatinib will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
lornoxicam Minor (1) lornoxicam decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
losartan Monitor Closely (1) losartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
lumefantrine Minor (1) lumefantrine will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
lurasidone Monitor Closely (1) lurasidone increases effects of eplerenone by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.
maitake Minor (1) maitake increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
marijuana Minor (1) marijuana will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
mavorixafor Monitor Closely (1) mavorixafor will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for adverse effects of sensitive CYP3A4 substrates if coadministered with mavorixafor (a weak CYP3A4 inhibitor).
meclofenamate Minor (1) meclofenamate decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
mefenamic acid Minor (1) mefenamic acid decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
meloxicam Minor (1) meloxicam decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
methylprednisolone Minor (1) methylprednisolone will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
metronidazole Minor (1) metronidazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
miconazole vaginal Minor (1) miconazole vaginal will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
mifepristone Contraindicated (1) mifepristone will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
mitotane Monitor Closely (1) mitotane decreases levels of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.
moexipril Monitor Closely (1) moexipril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
nabumetone Minor (1) nabumetone decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
naproxen Minor (1) naproxen decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
nefazodone Contraindicated (1) nefazodone will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
nelfinavir Minor (1) nelfinavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
nevirapine Minor (1) nevirapine will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
nifedipine Minor (1) nifedipine will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
nilotinib Minor (1) nilotinib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
nirmatrelvir/ritonavir Contraindicated (1) nirmatrelvir/ritonavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Nirmatrelvir/ritonavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions. May increase risk of hyperkalemia associated with eplerenone.
nitroglycerin rectal Monitor Closely (1) nitroglycerin rectal, eplerenone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .
octacosanol Minor (1) octacosanol increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
olanzapine/samidorphan Monitor Closely (1) olanzapine/samidorphan increases effects of eplerenone by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Monitor blood pressure and reduce antihypertensive drug dosage in accordance with its product labeling.
olmesartan Monitor Closely (1) olmesartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
oxaprozin Minor (1) oxaprozin decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
oxcarbazepine Minor (1) oxcarbazepine will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
parecoxib Minor (1) parecoxib decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
patiromer Minor (1) patiromer, eplerenone. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
pentobarbital Minor (1) pentobarbital will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
perindopril Monitor Closely (1) perindopril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
phenobarbital Minor (1) phenobarbital will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
phenytoin Minor (1) phenytoin will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
piroxicam Minor (1) piroxicam decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
posaconazole Minor (1) posaconazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
potassium acid phosphate Serious — Use Alternative (1) potassium acid phosphate, eplerenone. Mechanism: pharmacodynamic synergism. Contraindicated. Hyperkalemia.
potassium chloride Serious — Use Alternative (1) potassium chloride, eplerenone. Mechanism: pharmacodynamic synergism. Contraindicated. Hyperkalemia.
potassium citrate Monitor Closely (1) potassium citrate and eplerenone both increase serum potassium. Modify Therapy/Monitor Closely.
potassium citrate/citric acid Monitor Closely (1) eplerenone and potassium citrate/citric acid both increase serum potassium. Modify Therapy/Monitor Closely.
potassium phosphates, IV Serious — Use Alternative (1) eplerenone and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
prednisone Minor (1) prednisone will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
primidone Minor (1) primidone will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
quinapril Monitor Closely (1) quinapril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
quinupristin/dalfopristin Minor (1) quinupristin/dalfopristin will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
ramipril Monitor Closely (1) ramipril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
reishi Minor (1) reishi increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
ribociclib Monitor Closely (1) ribociclib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
rifabutin Monitor Closely (1) rifabutin will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
rifampin Monitor Closely (1) rifampin will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
rifapentine Minor (1) rifapentine will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
ritonavir Minor (1) ritonavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
rucaparib Monitor Closely (1) rucaparib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.
rufinamide Minor (1) rufinamide will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
sacubitril/valsartan Monitor Closely (1) sacubitril/valsartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
salicylates (non-asa) Minor (1) salicylates (non-asa) decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
salsalate Minor (1) salsalate decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
shepherd’s purse Minor (1) shepherd’s purse, eplerenone. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd’s purse may interfere with BP control.
spironolactone Serious — Use Alternative (1) spironolactone, eplerenone. Mechanism: pharmacodynamic synergism. Contraindicated. Hyperkalemia.
St John’s Wort Monitor Closely (1) St John’s Wort will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
stiripentol Monitor Closely (1) stiripentol, eplerenone. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
sulfasalazine Minor (1) sulfasalazine decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
sulindac Minor (1) sulindac decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
tadalafil Monitor Closely (1) tadalafil increases effects of eplerenone by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
tazemetostat Monitor Closely (1) tazemetostat will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
tecovirimat Monitor Closely (1) tecovirimat will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.
telmisartan Monitor Closely (1) telmisartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
tipranavir Contraindicated (1) tipranavir will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
tizanidine Minor (1) tizanidine increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.
tolfenamic acid Minor (1) tolfenamic acid decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
tolmetin Minor (1) tolmetin decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
topiramate Minor (1) topiramate will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
tovorafenib Serious — Use Alternative (1) tovorafenib will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of tovorafenib (a weak CYP3A4 inducer) with CYP3A substrates where minimal concentration changes may lead to serious therapeutic failures. If unavoidable, monitor patients for loss of efficacy unless otherwise recommended in the CYP3A4 substrate prescribing information.
trandolapril Monitor Closely (1) trandolapril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
treprostinil Minor (1) treprostinil increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.
triamterene Serious — Use Alternative (1) triamterene, eplerenone. Mechanism: pharmacodynamic synergism. Contraindicated. Hyperkalemia.
trimethoprim Monitor Closely (1) trimethoprim and eplerenone both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
tucatinib Serious — Use Alternative (1) tucatinib will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.
valsartan Monitor Closely (1) valsartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
verapamil Monitor Closely (1) verapamil will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Plasma concentrations and pharmacologic or toxic effects of eplerenone may be increased by verapamil.
voclosporin Monitor Closely (1) voclosporin and eplerenone both increase serum potassium. Use Caution/Monitor.
voriconazole Minor (1) voriconazole will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
xipamide Monitor Closely (1) xipamide increases effects of eplerenone by pharmacodynamic synergism. Use Caution/Monitor.
zafirlukast Minor (1) zafirlukast will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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Эплеренон

Эплеренон : как принимать препарат

Препарат существует в дозах 25мг и 50мг. Максимальная суточная доза препарата составляет 50мг.

Эплеренон можно принимать как с пищей, так и независимо от приема пищи (см. раздел «фармакокинетика»).

Пациенты с сердечной недостаточностью после перенесенного инфаркта миокарда.Рекомендуемая поддерживающая доза эплеренона составляет 50мг 1раз в сутки. Лечение следует начинать с дозы 25мг 1раз в сутки и постепенно повышать до целевой дозы 50мг 1раз в сутки. Желательно достичь этого уровня дозы за 4 недели, учитывая уровень калия в сыворотке крови (смотри таблицу ниже). Лечение эплереноном обычно необходимо начинать через 3-14 суток после острого инфаркта миокарда.

Пациенты с сердечной недостаточностью II класса (хронической) по классификации NYHA.

Лечение пациентов с хронической сердечной недостаточностью II класса по классификации NYHA следует начинать с дозы 25 мг 1 раз в сутки и постепенно повышать до целевой дозы 50мг 1раз в сутки. Желательно достичь этого уровня дозы за 4 недели, учитывая уровень калия в сыворотке крови (смотри таблицу ниже и раздел «Особенности применения»).

Пациентам, у которых уровень калия в сыворотке крови превышает 5 ммоль/л, не следует начинать лечение эплереноном (см. раздел «противопоказания»).

Уровень калия в сыворотке следует определять до начала лечения эплереноном, во время первой недели лечения и через месяц после начала лечения или коррекции дозы. При необходимости следует периодически определять уровень калия в сыворотке крови позже в течение лечения.

После начала лечения дозу препарата следует корректировать с учетом концентрации калия в сыворотке крови, как указано в таблице ниже.

Коррекция дозы после начала лечения.

Концентрация калия в сыворотке крови (ммоль / л)

Источники:

https://www.rlsnet.ru/drugs/eplerenon-69006&rut=ee3b831fa63185d4052fcd11f0800b6236540d06195a7e69ddebb69e72d1cc54
https://www.vidal.ru/drugs/eplerenon&rut=9af334299e778b03e2ec5344a8aa456568d6be5b16abba2269ed61d0471d7547
https://www.cochrane.org/ru/CD008996/HTN_eplerenon-pri-vysokom-arterialnom-davlenii&rut=666d19443c6afbadcd98272b3854ae4fbbd34689e83e671ec9c2dbbccbca41ea
https://www.rlsnet.ru/active-substance/eplerenon-3012&rut=e742997ff26f6fe27c0a46c84f5a613cc37c671cdf653b2c2bea1807ef0a2f0c
https://www.vidal.ru/drugs/molecule/2226&rut=c5356b27824d957b92da1d93f1eb2ee3edeae60905914b7d4deead7993c59de1
https://allmed.pro/drugs/eplerenon&rut=41134077e27086dc0bee38c487105c51be290fdb08726326249bd7d50520ab48
https://reference.medscape.com/drug/inspra-eplerenone-342397&rut=41b1530ff16a92d1ab500ebdacc68acf8eb0510bfa2e0adcac0f4e6f986def1b
https://www.vidal.ru/drugs/eplerenon-teva&rut=b3ed5f1176e7c00f83c85e90a83df47f0661a56e6fc0a317b61dc6233253f637
https://medicines.unian.net/pharm/e/17429-eplerenon-instrukciya-primenenie-analogi-preparata&rut=ae6c10830151f482a250e108af2cc7197cb5bdd66348c7bcfa5e166ef066d8b9

Новости

Эплеренон при высоком артериальном давлении | Cochrane

Эплеренон

Эплеренон (Eplerenone)

Эплеренон

Эплеренон при высоком артериальном давлении

Побочные действия вещества Эплеренон

Эплеренон

Контактная информация

Interactions

Interaction Checker

Contraindicated

Serious

Significant — Monitor Closely

Minor

Contraindicated (8)

Serious (20)

Monitor Closely (72)

Minor (102)

Эплеренон

Эплеренон : как принимать препарат

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Эплеренон при высоком артериальном давлении | Cochrane

Эплеренон

Эплеренон (Eplerenone)

Эплеренон

Эплеренон при высоком артериальном давлении

Побочные действия вещества Эплеренон

Эплеренон

Контактная информация

Interactions

Interaction Checker

Contraindicated

Serious

Significant — Monitor Closely

Minor

Contraindicated (8)

Serious (20)

Monitor Closely (72)

Minor (102)

Эплеренон

Эплеренон : как принимать препарат

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