INSPRA 50MG TABLETS 28`S

Eplerenone is a selective aldosterone receptor antagonist (also called a mineralocorticoid receptor antagonist, MRA). By blocking the aldosterone receptor, it prevents sodium retention and potassium loss in the kidney tubules, reduces blood pressure, and attenuates the harmful effects of aldosterone on the heart and blood vessels (including fibrosis, hypertrophy, and inflammation).

Inspra 50 mg is indicated for:

•       Post-myocardial infarction heart failure — in stable patients with reduced ejection fraction (LVEF ≤ 40%) following acute MI with clinical signs of heart failure, to reduce cardiovascular mortality and morbidity.

•       Chronic systolic heart failure with reduced ejection fraction (HFrEF) — New York Heart Association (NYHA) class II — in addition to standard therapy (ACE inhibitor/ARB, beta-blocker, diuretic) to reduce mortality and hospitalisation.

Start at 25 mg once daily; if tolerated after 4 weeks, increase to 50 mg once daily — the recommended maintenance dose. Take with or without food at the same time each day. Swallow whole with water.

Contraindicated in: hyperkalaemia (K+ > 5.0 mmol/L at baseline); severe renal impairment (eGFR < 30); severe hepatic impairment; concomitant potassium-sparing diuretics or potassium supplements; and concomitant strong CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir, nefazodone, clarithromycin, telithromycin).

•       Strong CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir, clarithromycin): CONTRAINDICATED — dramatically increase eplerenone levels.

•       ACE inhibitors / ARBs: additive hyperkalaemia risk — monitor K+ closely.

•       NSAIDs: reduce diuretic efficacy and may worsen renal function — avoid.

•       Moderate CYP3A4 inhibitors (fluconazole, diltiazem, verapamil, amiodarone): increase eplerenone levels — reduce dose to 25 mg once daily.

Store below 30°C. Original packaging. Keep out of reach of children.

Eplerenone is an evidence-based heart failure medicine shown to reduce deaths and hospitalisations after heart attack and in chronic heart failure. The most important safety measure is regular potassium level monitoring. Do not miss your blood test appointments.

Avoid potassium-rich salt substitutes (which contain potassium chloride), potassium supplements, and any herbal remedies that may affect potassium levels without checking with your doctor.

Eplerenone has significantly less anti-androgenic and progestogenic activity than spironolactone — making it preferable in patients who experience gynaecomastia or sexual dysfunction on spironolactone.

EMPHASIS-HF and EPHESUS trials established mortality benefit. Contraindication with strong CYP3A4 inhibitors is absolute — check the medication list at every dispensing.

The dose adjustment with moderate CYP3A4 inhibitors (max 25 mg/day) is clinically important. Type 2 diabetics with microalbuminuria should not receive eplerenone (increased hyperkalaemia risk).

Can I eat bananas and oranges on this medicine?

Potassium-rich foods (bananas, oranges, tomatoes, potatoes) in moderation are generally fine but avoid very large quantities, especially in the first few weeks when potassium is rising.

Can I use salt substitute?

No — most salt substitutes contain potassium chloride and can raise your potassium to dangerous levels when combined with eplerenone.

I feel dizzy when I stand up — is this normal?

Dizziness on standing (orthostatic hypotension) can occur, especially in the first few weeks. Rise from sitting or lying slowly, and hold onto a stable surface. Tell your doctor if it persists.

What dose am I likely to be on?

Most patients start at 25 mg daily and increase to 50 mg after 4 weeks. The maximum dose is 50 mg once daily.

Can this medicine affect my kidneys?

Eplerenone can cause a modest rise in creatinine, which is usually clinically acceptable. It is contraindicated in severe kidney disease (eGFR < 30). Your kidney function will be monitored regularly.