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Eplerenone

December 18, 2023

Eplerenone, sold under the brand name Inspra, is an aldosterone antagonist type of potassium-sparing diuretic that is used to treat chronic heart failure and high blood pressure, particularly for patients with resistant hypertension due to elevated aldosterone. It is a steroidal antimineralocorticoid of the spirolactone group and a selective aldosterone receptor antagonist (SARA).[6] Eplerenone is more selective than spironolactone at the mineralocorticoid receptor relative to binding at androgen, progestogen, glucocorticoid, or estrogen receptors.

Eplerenone
Clinical data
Pronunciation/ɛpˈlɛrənoʊn/
Trade namesInspra, Epnone, Dosterep
Other namesSC-66110; CGP-30083; 9-11α-Epoxymexrenone; 9,11α-Epoxy-7α-methoxycarbonyl-3-oxo-17α-pregn-4-ene-21,17-carbolactone
AHFS/Drugs.comMonograph
MedlinePlusa603004
Pregnancy
category
  • AU: B3
Routes of
administration		By mouth (tablets)
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability~70%[2]
Protein binding~50% (33–60%) (primarily to α1-acid glycoprotein)[2][3]
MetabolismLiver (CYP3A4)[2][3]
Metabolites6β-OH-EPL, 6β,21-OH-EPL, 21-OH-EPL, 3α,6β-OH-EPL[2] (All inactive)[2]
Elimination half-life4–6 hours[4]
ExcretionUrine (67%), feces (32%)[5]
Identifiers
  • methyl (4aS,4bR,5aR,6aS,7R,9aS,9bR,10R)-4a,6a-dimethyl-2,5'-dioxo-2,4,4',4a,5',5a,6,6a,8,9,9a,9b,10,11-tetradecahydro-3H,3'H-spiro[cyclopenta[7,8]phenanthro[4b,5-b]oxirene-7,2'-furan]-10-carboxylate
CAS Number
  • 107724-20-9 Y
PubChem CID
  • 5282131
IUPHAR/BPS
  • 2876
DrugBank
  • DB00700 Y
ChemSpider
  • 10203511 Y
UNII
  • 6995V82D0B
KEGG
  • D01115 Y
ChEBI
  • CHEBI:31547 Y
ChEMBL
  • ChEMBL1095097 Y
PDB ligand
  • YNU (PDBe, RCSB PDB)
CompTox Dashboard (EPA)
  • DTXSID2046094
ECHA InfoCard100.106.615
Chemical and physical data
FormulaC24H30O6
Molar mass414.498 g·mol−1
3D model (JSmol)
  • Interactive image
  • COC(=O)[C@@H]4C\C1=C\C(=O)CC[C@]1(C)[C@@]65O[C@@H]6C[C@@]3(C)[C@@H](CC[C@]23CCC(=O)O2)[C@H]45
  • InChI=1S/C24H30O6/c1-21-7-4-14(25)10-13(21)11-15(20(27)28-3)19-16-5-8-23(9-6-18(26)30-23)22(16,2)12-17-24(19,21)29-17/h10,15-17,19H,4-9,11-12H2,1-3H3/t15-,16+,17-,19+,21+,22+,23-,24-/m1/s1 Y
  • Key:JUKPWJGBANNWMW-VWBFHTRKSA-N Y
  (verify)

Medical uses edit

Heart failure edit

Eplerenone reduces risk of death in patients with heart failure,[7] particularly in patients with recent myocardial infarction (heart attack).[8]

Hypertension edit

Eplerenone lowers blood pressure in patients with primary hypertension.[9] Eplerenone also reduces arterial stiffness and vascular endothelial dysfunction.[10]

For persons with resistant hypertension, eplerenone is safe and effective for reducing blood pressure,[11] particularly in persons with resistant hypertension due to hyperaldosteronism.[12][13]

Central serous chorioretinopathy edit

Eplerenone is often prescribed for people with central serous chorioretinopathy (CSC). However, the most recent and largest randomized controlled trial showed that eplerenone has no significant effect on chronic CSC that has been untreated for four months.[14][15]

Adverse effects edit

Common adverse drug reactions (ADRs) associated with the use of eplerenone include: hyperkalaemia, hypotension, dizziness, and reduced renal clearance.[16] Eplerenone may have a lower incidence than spironolactone of sexual side effects such as feminization, gynecomastia, impotence, low sex drive and reduction of size of male genitalia.[17] This is because other antimineralocorticoids have structural elements of the progesterone molecule, causing progestogenic and antiandrogenic outcomes.[4] When considering taking these medicines, it is important to note the variations in their ability to offset the nongenomic effects of aldosterone.[4]

Currently, there is not enough evidence available from the randomized controlled trials on side effects of eplerenone to do a benefit versus risk assessment in people with primary hypertension.[18]

Interactions edit

Eplerenone is primarily metabolized by the cytochrome P450 enzyme CYP3A4. Thus the potential exists for adverse drug interactions with other drugs that induce or inhibit CYP3A4. Specifically, the concomitant use of the CYP3A4 potent inhibitors ketoconazole and itraconazole is contraindicated. Other CYP3A4 inhibitors including erythromycin, saquinavir, and verapamil should be used with caution. Other drugs that increase potassium concentrations may increase the risk of hyperkalemia associated with eplerenone therapy, including salt substitutes,[19] potassium supplements and other potassium-sparing diuretics.

Pharmacology edit

Eplerenone is an antimineralocorticoid, or an antagonist of the mineralocorticoid receptor (MR).[20] Eplerenone is also known chemically as 9,11α-epoxy-7α-methoxycarbonyl-3-oxo-17α-pregn-4-ene-21,17-carbolactone and "was derived from spironolactone by the introduction of a 9α,11α-epoxy bridge and by substitution of the 17α-thoacetyl group of spironolactone with a carbomethoxy group."[21] The drug controls high blood pressure by blocking the binding of aldosterone to the mineralocorticoid receptor (MR) in epithelial tissues, such as the kidney.[4] Blocking the action of aldosterone decreases blood volume and lowers blood pressure.[22] It has 10- to 20-fold lower affinity for the MR relative to spironolactone,[20] and is less potent in vivo as an antimineralocorticoid.[4] However, in contrast to spironolactone, eplerenone has little affinity for the androgen, progesterone, and glucocorticoid receptors.[20][4] It also has more consistently observed non-genomic antimineralocorticoid effects relative to spironolactone (see membrane mineralocorticoid receptor).[4] Eplerenone differs from spironolactone in its extensive metabolism, with a short half-life and inactive metabolites.[4]

Eplerenone seems to be about 50 to 75% as potent as spironolactone as an antimineralocorticoid.[23] Hence, 25 mg/day spironolactone may be equivalent to approximately 50 mg/day eplerenone.[24]

Regulatory and Patent History edit

Eplerenone was patented in 1983 and approved for medical use in the United States in 2002.[25][22] Eplerenone is currently approved for sale in Canada, the US, EU, Netherlands and Japan.[22] Eplerenone costs an estimated $2.93 per day when treating congestive heart failure and $5.86 per day when treating hypertension.[17]

See also edit

References edit

  1. ^ "FDA-sourced list of all drugs with black box warnings (Use Download Full Results and View Query links.)". nctr-crs.fda.gov. FDA. Retrieved 22 Oct 2023.
  2. ^ a b c d e Lemke TL, Williams DA (24 January 2012). Foye's Principles of Medicinal Chemistry. Lippincott Williams & Wilkins. pp. 743–. ISBN 978-1-60913-345-0.
  3. ^ a b Sica DA (January 2005). "Pharmacokinetics and pharmacodynamics of mineralocorticoid blocking agents and their effects on potassium homeostasis". Heart Failure Reviews. 10 (1): 23–9. doi:10.1007/s10741-005-2345-1. PMID 15947888. S2CID 21437788.
  4. ^ a b c d e f g h Struthers A, Krum H, Williams GH (April 2008). "A comparison of the aldosterone-blocking agents eplerenone and spironolactone". Clinical Cardiology. 31 (4): 153–8. doi:10.1002/clc.20324. PMC 6652937. PMID 18404673.
  5. ^ Frishman WH, Cheng-Lai A, Nawarskas J (4 January 2005). Current Cardiovascular Drugs. Springer Science & Business Media. pp. 246–. ISBN 978-1-57340-221-7.
  6. ^ Delyani JA, Rocha R, Cook CS, Tobert DS, Levin S, Roniker B, et al. (2001). "Eplerenone: a selective aldosterone receptor antagonist (SARA)". Cardiovascular Drug Reviews. 19 (3): 185–200. doi:10.1111/j.1527-3466.2001.tb00064.x. PMID 11607037.
  7. ^ Frankenstein L, Seide S, Täger T, Jensen K, Fröhlich H, Clark AL, Seiz M, Katus HA, Nee P, Uhlmann L, Naci H, Atar D (March 2020). "Relative Efficacy of Spironolactone, Eplerenone, and cAnRenone in patients with Chronic Heart failure (RESEARCH): a systematic review and network meta-analysis of randomized controlled trials". Heart Fail Rev. 25 (2): 161–171. doi:10.1007/s10741-019-09832-y. PMID 31364027. S2CID 198999728.
  8. ^ De Luca L (October 2020). "Established and Emerging Pharmacological Therapies for Post-Myocardial Infarction Patients with Heart Failure: a Review of the Evidence". Cardiovasc Drugs Ther. 34 (5): 723–735. doi:10.1007/s10557-020-07027-4. PMID 32564304. S2CID 219936888.
  9. ^ Tam TS, Wu MH, Masson SC, Tsang MP, Stabler SN, Kinkade A, et al. (February 2017). "Eplerenone for hypertension". The Cochrane Database of Systematic Reviews. 2017 (2): CD008996. doi:10.1002/14651858.CD008996.pub2. PMC 6464701. PMID 28245343.
  10. ^ Sakima A, Arima H, Matayoshi T, Ishida A, Ohya Y (March 2021). "Effect of Mineralocorticoid Receptor Blockade on Arterial Stiffness and Endothelial Function: A Meta-Analysis of Randomized Trials". Hypertension. 77 (3): 929–937. doi:10.1161/HYPERTENSIONAHA.120.16397. PMID 33461316.
  11. ^ Dahal K, Kunwar S, Rijal J, Alqatahni F, Panta R, Ishak N, Russell RP (November 2015). "The Effects of Aldosterone Antagonists in Patients With Resistant Hypertension: A Meta-Analysis of Randomized and Nonrandomized Studies". American Journal of Hypertension. 28 (11): 1376–85. doi:10.1093/ajh/hpv031. PMID 25801902.
  12. ^ Morimoto S, Ichihara A (August 2020). "Management of primary aldosteronism and mineralocorticoid receptor-associated hypertension". Hypertens Res. 43 (8): 744–753. doi:10.1038/s41440-020-0468-3. PMID 32424201. S2CID 218670505.
  13. ^ Spence JD (May 2017). "Rational Medical Therapy Is the Key to Effective Cardiovascular Disease Prevention". The Canadian Journal of Cardiology. 33 (5): 626–634. doi:10.1016/j.cjca.2017.01.003. PMID 28449833.
  14. ^ "Eplerenone does not improve vision in people with central serous chorioretinopathy". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. 2020-03-25. doi:10.3310/signal-000893. S2CID 241440498.
  15. ^ Lotery A, Sivaprasad S, O'Connell A, Harris RA, Culliford L, Ellis L, et al. (January 2020). "Eplerenone for chronic central serous chorioretinopathy in patients with active, previously untreated disease for more than 4 months (VICI): a randomised, double-blind, placebo-controlled trial". Lancet. 395 (10220): 294–303. doi:10.1016/S0140-6736(19)32981-2. PMID 31982075.
  16. ^ Rossi S (2006). Australian Medicines Handbook 2006. Australian Medicines Handbook. ISBN 978-0-9757919-2-9.
  17. ^ a b Craft J (April 2004). "Eplerenone (Inspra), a new aldosterone antagonist for the treatment of systemic hypertension and heart failure". Proceedings. 17 (2): 217–20. doi:10.1080/08998280.2004.11927973. PMC 1200656. PMID 16200104.
  18. ^ Tam TS, Wu MH, Masson SC, Tsang MP, Stabler SN, Kinkade A, et al. (February 2017). "Eplerenone for hypertension". The Cochrane Database of Systematic Reviews. 2017 (2): CD008996. doi:10.1002/14651858.CD008996.pub2. PMC 6464701. PMID 28245343.
  19. ^ LoSalt Advisory Statement (PDF)
  20. ^ a b c Delyani JA (April 2000). "Mineralocorticoid receptor antagonists: the evolution of utility and pharmacology". Kidney International. 57 (4): 1408–11. doi:10.1046/j.1523-1755.2000.00983.x. PMID 10760075.
  21. ^ Brown NJ (May 2003). "Eplerenone: cardiovascular protection". Circulation. 107 (19): 2512–8. doi:10.1161/01.CIR.0000071081.35693.9A. PMID 12756192. S2CID 13904574.
  22. ^ a b c "Inspra (Eplerenone)". Drug Development Technology. Retrieved 2016-04-19.
  23. ^ Struthers A, Krum H, Williams GH (April 2008). "A comparison of the aldosterone-blocking agents eplerenone and spironolactone". Clin Cardiol. 31 (4): 153–8. doi:10.1002/clc.20324. PMC 6652937. PMID 18404673.
  24. ^ Peter L. Thompson (28 January 2011). Coronary Care Manual. Elsevier Health Sciences. pp. 254–. ISBN 978-0-7295-7927-8.
  25. ^ Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 459. ISBN 9783527607495.


December 18, 2023
eplerenone, sold, under, brand, name, inspra, aldosterone, antagonist, type, potassium, sparing, diuretic, that, used, treat, chronic, heart, failure, high, blood, pressure, particularly, patients, with, resistant, hypertension, elevated, aldosterone, steroida. Eplerenone sold under the brand name Inspra is an aldosterone antagonist type of potassium sparing diuretic that is used to treat chronic heart failure and high blood pressure particularly for patients with resistant hypertension due to elevated aldosterone It is a steroidal antimineralocorticoid of the spirolactone group and a selective aldosterone receptor antagonist SARA 6 Eplerenone is more selective than spironolactone at the mineralocorticoid receptor relative to binding at androgen progestogen glucocorticoid or estrogen receptors EplerenoneClinical dataPronunciation ɛ p ˈ l ɛr e n oʊ n Trade namesInspra Epnone DosterepOther namesSC 66110 CGP 30083 9 11a Epoxymexrenone 9 11a Epoxy 7a methoxycarbonyl 3 oxo 17a pregn 4 ene 21 17 carbolactoneAHFS Drugs comMonographMedlinePlusa603004PregnancycategoryAU B3Routes ofadministrationBy mouth tablets ATC codeC03DA04 WHO Legal statusLegal statusAU S4 Prescription only US WARNING 1 Rx onlyPharmacokinetic dataBioavailability 70 2 Protein binding 50 33 60 primarily to a1 acid glycoprotein 2 3 MetabolismLiver CYP3A4 2 3 Metabolites6b OH EPL 6b 21 OH EPL 21 OH EPL 3a 6b OH EPL 2 All inactive 2 Elimination half life4 6 hours 4 ExcretionUrine 67 feces 32 5 IdentifiersIUPAC name methyl 4aS 4bR 5aR 6aS 7R 9aS 9bR 10R 4a 6a dimethyl 2 5 dioxo 2 4 4 4a 5 5a 6 6a 8 9 9a 9b 10 11 tetradecahydro 3H 3 H spiro cyclopenta 7 8 phenanthro 4b 5 b oxirene 7 2 furan 10 carboxylateCAS Number107724 20 9 YPubChem CID5282131IUPHAR BPS2876DrugBankDB00700 YChemSpider10203511 YUNII6995V82D0BKEGGD01115 YChEBICHEBI 31547 YChEMBLChEMBL1095097 YPDB ligandYNU PDBe RCSB PDB CompTox Dashboard EPA DTXSID2046094ECHA InfoCard100 106 615Chemical and physical dataFormulaC 24H 30O 6Molar mass414 498 g mol 13D model JSmol Interactive imageSMILES COC O C H 4C C1 C C O CC C 1 C C 65O C H 6C C 3 C C H CC C 23CCC O O2 C H 45InChI InChI 1S C24H30O6 c1 21 7 4 14 25 10 13 21 11 15 20 27 28 3 19 16 5 8 23 9 6 18 26 30 23 22 16 2 12 17 24 19 21 29 17 h10 15 17 19H 4 9 11 12H2 1 3H3 t15 16 17 19 21 22 23 24 m1 s1 YKey JUKPWJGBANNWMW VWBFHTRKSA N Y verify Contents 1 Medical uses 1 1 Heart failure 1 2 Hypertension 1 3 Central serous chorioretinopathy 2 Adverse effects 2 1 Interactions 3 Pharmacology 4 Regulatory and Patent History 5 See also 6 ReferencesMedical uses editHeart failure edit Eplerenone reduces risk of death in patients with heart failure 7 particularly in patients with recent myocardial infarction heart attack 8 Hypertension edit Eplerenone lowers blood pressure in patients with primary hypertension 9 Eplerenone also reduces arterial stiffness and vascular endothelial dysfunction 10 For persons with resistant hypertension eplerenone is safe and effective for reducing blood pressure 11 particularly in persons with resistant hypertension due to hyperaldosteronism 12 13 Central serous chorioretinopathy edit Eplerenone is often prescribed for people with central serous chorioretinopathy CSC However the most recent and largest randomized controlled trial showed that eplerenone has no significant effect on chronic CSC that has been untreated for four months 14 15 Adverse effects editCommon adverse drug reactions ADRs associated with the use of eplerenone include hyperkalaemia hypotension dizziness and reduced renal clearance 16 Eplerenone may have a lower incidence than spironolactone of sexual side effects such as feminization gynecomastia impotence low sex drive and reduction of size of male genitalia 17 This is because other antimineralocorticoids have structural elements of the progesterone molecule causing progestogenic and antiandrogenic outcomes 4 When considering taking these medicines it is important to note the variations in their ability to offset the nongenomic effects of aldosterone 4 Currently there is not enough evidence available from the randomized controlled trials on side effects of eplerenone to do a benefit versus risk assessment in people with primary hypertension 18 Interactions edit Eplerenone is primarily metabolized by the cytochrome P450 enzyme CYP3A4 Thus the potential exists for adverse drug interactions with other drugs that induce or inhibit CYP3A4 Specifically the concomitant use of the CYP3A4 potent inhibitors ketoconazole and itraconazole is contraindicated Other CYP3A4 inhibitors including erythromycin saquinavir and verapamil should be used with caution Other drugs that increase potassium concentrations may increase the risk of hyperkalemia associated with eplerenone therapy including salt substitutes 19 potassium supplements and other potassium sparing diuretics Pharmacology editEplerenone is an antimineralocorticoid or an antagonist of the mineralocorticoid receptor MR 20 Eplerenone is also known chemically as 9 11a epoxy 7a methoxycarbonyl 3 oxo 17a pregn 4 ene 21 17 carbolactone and was derived from spironolactone by the introduction of a 9a 11a epoxy bridge and by substitution of the 17a thoacetyl group of spironolactone with a carbomethoxy group 21 The drug controls high blood pressure by blocking the binding of aldosterone to the mineralocorticoid receptor MR in epithelial tissues such as the kidney 4 Blocking the action of aldosterone decreases blood volume and lowers blood pressure 22 It has 10 to 20 fold lower affinity for the MR relative to spironolactone 20 and is less potent in vivo as an antimineralocorticoid 4 However in contrast to spironolactone eplerenone has little affinity for the androgen progesterone and glucocorticoid receptors 20 4 It also has more consistently observed non genomic antimineralocorticoid effects relative to spironolactone see membrane mineralocorticoid receptor 4 Eplerenone differs from spironolactone in its extensive metabolism with a short half life and inactive metabolites 4 Eplerenone seems to be about 50 to 75 as potent as spironolactone as an antimineralocorticoid 23 Hence 25 mg day spironolactone may be equivalent to approximately 50 mg day eplerenone 24 Regulatory and Patent History editEplerenone was patented in 1983 and approved for medical use in the United States in 2002 25 22 Eplerenone is currently approved for sale in Canada the US EU Netherlands and Japan 22 Eplerenone costs an estimated 2 93 per day when treating congestive heart failure and 5 86 per day when treating hypertension 17 See also editFinerenone MexrenoneReferences edit FDA sourced list of all drugs with black box warnings Use Download Full Results and View Query links nctr crs fda gov FDA Retrieved 22 Oct 2023 a b c d e Lemke TL Williams DA 24 January 2012 Foye s Principles of Medicinal Chemistry Lippincott Williams amp Wilkins pp 743 ISBN 978 1 60913 345 0 a b Sica DA January 2005 Pharmacokinetics and pharmacodynamics of mineralocorticoid blocking agents and their effects on potassium homeostasis Heart Failure Reviews 10 1 23 9 doi 10 1007 s10741 005 2345 1 PMID 15947888 S2CID 21437788 a b c d e f g h Struthers A Krum H Williams GH April 2008 A comparison of the aldosterone blocking agents eplerenone and spironolactone Clinical Cardiology 31 4 153 8 doi 10 1002 clc 20324 PMC 6652937 PMID 18404673 Frishman WH Cheng Lai A Nawarskas J 4 January 2005 Current Cardiovascular Drugs Springer Science amp Business Media pp 246 ISBN 978 1 57340 221 7 Delyani JA Rocha R Cook CS Tobert DS Levin S Roniker B et al 2001 Eplerenone a selective aldosterone receptor antagonist SARA Cardiovascular Drug Reviews 19 3 185 200 doi 10 1111 j 1527 3466 2001 tb00064 x PMID 11607037 Frankenstein L Seide S Tager T Jensen K Frohlich H Clark AL Seiz M Katus HA Nee P Uhlmann L Naci H Atar D March 2020 Relative Efficacy of Spironolactone Eplerenone and cAnRenone in patients with Chronic Heart failure RESEARCH a systematic review and network meta analysis of randomized controlled trials Heart Fail Rev 25 2 161 171 doi 10 1007 s10741 019 09832 y PMID 31364027 S2CID 198999728 De Luca L October 2020 Established and Emerging Pharmacological Therapies for Post Myocardial Infarction Patients with Heart Failure a Review of the Evidence Cardiovasc Drugs Ther 34 5 723 735 doi 10 1007 s10557 020 07027 4 PMID 32564304 S2CID 219936888 Tam TS Wu MH Masson SC Tsang MP Stabler SN Kinkade A et al February 2017 Eplerenone for hypertension The Cochrane Database of Systematic Reviews 2017 2 CD008996 doi 10 1002 14651858 CD008996 pub2 PMC 6464701 PMID 28245343 Sakima A Arima H Matayoshi T Ishida A Ohya Y March 2021 Effect of Mineralocorticoid Receptor Blockade on Arterial Stiffness and Endothelial Function A Meta Analysis of Randomized Trials Hypertension 77 3 929 937 doi 10 1161 HYPERTENSIONAHA 120 16397 PMID 33461316 Dahal K Kunwar S Rijal J Alqatahni F Panta R Ishak N Russell RP November 2015 The Effects of Aldosterone Antagonists in Patients With Resistant Hypertension A Meta Analysis of Randomized and Nonrandomized Studies American Journal of Hypertension 28 11 1376 85 doi 10 1093 ajh hpv031 PMID 25801902 Morimoto S Ichihara A August 2020 Management of primary aldosteronism and mineralocorticoid receptor associated hypertension Hypertens Res 43 8 744 753 doi 10 1038 s41440 020 0468 3 PMID 32424201 S2CID 218670505 Spence JD May 2017 Rational Medical Therapy Is the Key to Effective Cardiovascular Disease Prevention The Canadian Journal of Cardiology 33 5 626 634 doi 10 1016 j cjca 2017 01 003 PMID 28449833 Eplerenone does not improve vision in people with central serous chorioretinopathy NIHR Evidence Plain English summary National Institute for Health and Care Research 2020 03 25 doi 10 3310 signal 000893 S2CID 241440498 Lotery A Sivaprasad S O Connell A Harris RA Culliford L Ellis L et al January 2020 Eplerenone for chronic central serous chorioretinopathy in patients with active previously untreated disease for more than 4 months VICI a randomised double blind placebo controlled trial Lancet 395 10220 294 303 doi 10 1016 S0140 6736 19 32981 2 PMID 31982075 Rossi S 2006 Australian Medicines Handbook 2006 Australian Medicines Handbook ISBN 978 0 9757919 2 9 a b Craft J April 2004 Eplerenone Inspra a new aldosterone antagonist for the treatment of systemic hypertension and heart failure Proceedings 17 2 217 20 doi 10 1080 08998280 2004 11927973 PMC 1200656 PMID 16200104 Tam TS Wu MH Masson SC Tsang MP Stabler SN Kinkade A et al February 2017 Eplerenone for hypertension The Cochrane Database of Systematic Reviews 2017 2 CD008996 doi 10 1002 14651858 CD008996 pub2 PMC 6464701 PMID 28245343 LoSalt Advisory Statement PDF a b c Delyani JA April 2000 Mineralocorticoid receptor antagonists the evolution of utility and pharmacology Kidney International 57 4 1408 11 doi 10 1046 j 1523 1755 2000 00983 x PMID 10760075 Brown NJ May 2003 Eplerenone cardiovascular protection Circulation 107 19 2512 8 doi 10 1161 01 CIR 0000071081 35693 9A PMID 12756192 S2CID 13904574 a b c Inspra Eplerenone Drug Development Technology Retrieved 2016 04 19 Struthers A Krum H Williams GH April 2008 A comparison of the aldosterone blocking agents eplerenone and spironolactone Clin Cardiol 31 4 153 8 doi 10 1002 clc 20324 PMC 6652937 PMID 18404673 Peter L Thompson 28 January 2011 Coronary Care Manual Elsevier Health Sciences pp 254 ISBN 978 0 7295 7927 8 Fischer J Ganellin CR 2006 Analogue based Drug Discovery John Wiley amp Sons p 459 ISBN 9783527607495 Retrieved from https en wikipedia org w index php title Eplerenone amp oldid 1189259736, wikipedia, wiki, book, books, library,

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