Eplerenone

Eplerenone

(a selective aldosterone blocker, more specific for the
aldosterone receptor with a lower affinity for progesterone and androgen
receptors than spironolactone) has been studied in patients with heart failure,
hypertension, and renal disease.⁵⁹^,⁶⁰ The
usual dose for eplerenone is 25 to 50 mg/day.⁶¹
No dosage adjustment is needed with mild to moderate liver disease, but severe
liver disease has
not been studied.⁶² Approximately 10% of
patients treated with spironolactone develop gynecomastia or breast pain, with
2% requiring drug discontinuation.⁶³ In
contrast, gynecomastia occurs at a similar rate with eplerenone as with placebo
(0.5%).⁶⁴^,⁶⁵ Eplerenone is also much more expensive than
spironolactone.⁶⁵ The lower risk of
gynecomastia with eplerenone may make it a useful alternative to spironolactone.
However, given its higher cost and the lack of data in the treatment of ascites
and patients with severe liver disease, its eventual role in ascites treatment
remains unclear.