20 to 50     : Dose as in normal renal function1
10 to 20     : Dose as in normal renal function1
<10           : Dose as in normal renal function1
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Unknown dialysability. Dose as in GFR <10 mL/min
HD                     :10% dialysed.1 Dose as in GFR <10 mL/min
HDF/high flux   :Unknown dialysability. Dose as in GFR <10 mL/min
CAV/VVHD      :Unknown dialysability. Dose as in GFR=10-20 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsACE inhibitors or AT-II antagonists: enhanced hypotensive effect; risk of severe hyperkalaemia
Anti-arrhythmics: concentration increased by amiodarone – reduce eplerenone dose
Antibacterials: concentration increased by clarithromycin and telithromycin – avoid concomitant use; concentration increased by erythromycin – reduce eplerenone dose; concentration reduced by rifampicin – avoid concomitant use; avoid concomitant use with lymecycline; increased risk of hyperkalaemia with trimethoprim
Antidepressants: concentration reduced by St John’s wort – avoid concomitant use; increased risk of postural hypotension with tricyclics; enhanced hypotensive effect with MAOIs
Anti-epileptics: concentration reduced by carbamazepine, phenytoin and phenobarbital – avoid concomitant use
Antifungals: concentration increased by itraconazole and ketoconazole – avoid concomitant use; concentration increased by fluconazole – reduce eplerenone doseAntihypertensives: enhanced hypotensive effect, increased risk of first dose hypotensive effect with post-synaptic alpha-blockers
Antivirals: concentration increased by nelfinavir and ritonavir – avoid concomitant use; concentration increased by saquinavir – reduce eplerenone dose
Ciclosporin: increased risk of hyperkalaemia and nephrotoxicityNSAIDs: increased risk of hyperkalaemia (especially with indometacin); increased risk of nephrotoxicity; antagonism of diuretic effect
Potassium salts: increased risk of hyperkalaemia
Lithium: reduced lithium excretion – avoid concomitant use
Tacrolimus: increased risk of hyperkalaemia and nephrotoxicityCYP3A4 inhibitors: Do not exceed a dose of 25 mg daily for eplerenoneCYP3A4 inducers: reduced eplerenone concentration – avoid concomitant use
ADMINISTRATION
Reconstition
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Route
Oral
Rate of Administration
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Comments
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OTHER INFORMATION
Monitor potassium levels regularly in people with renal impairment