依普利酮的注意事项

It was developed by Pfizer of the United States and first launched in the United States in 2002. It is mainly used clinically to treat hypertension. In 2003, it was approved by the FDA for the treatment of heart failure after acute myocardial infarction. Eplerenone is a new type of selective aldosterone receptor antagonist.

In patients with low-renin hypertension, the antihypertensive effect of eplerenone is better than that of losartan. For patients with hypertension who are poorly controlled by ARB alone, adding eplerenone (50~100 mg·d) for 8 weeks can further enhance the effect of reducing systolic blood pressure (SBP) and diastolic blood pressure (DBP). For elderly patients with hypertension who are poorly controlled by ACEI or ARB, the addition of low-dose (25-50 mg/d, average 37.5 mg) eplerenone can effectively reduce the average 24-hour systolic blood pressure (SBP) and diastolic blood pressure (DBP).

Please pay attention to the following points when taking eplerenone:

1. Use with caution in patients with diabetes and heart failure after myocardial infarction (especially those with proteinuria); the risk of hyperkalemia is increased.

2. When evaluating patients with heart failure to receive eplerenone treatment, the eGFR (epidermal growth factor receptor) should be greater than 30ml/min/1.73m2 or the creatinine should be less than or equal to 2.5mg/dL (men) or less than or equal to 2mg/dL (women) with no recent deterioration, potassium less than 5meq/L and no history of severe hyperkalemia. If blood potassium levels are elevated, close monitoring and management are required. The manufacturer recommends that treatment should be discontinued if serum potassium is >6 meq/L. ACCF/AHA (American College of Cardiology Foundation) recommends that when serum potassium concentration is >5.5 meq/L or renal function worsens, discontinuation of the drug should be considered and the entire medical regimen should be carefully evaluated. Avoid conventional triple therapy and use a combination of ACE (angiotensin-converting enzyme) inhibitors, ARB (one of the first-line treatments for hypertension) and eplerenone. Instruct patients with heart failure to discontinue use during episodes of diarrhea or dehydration or when circulating diuretic therapy is interrupted.

3. Liver damage: Use with caution in patients with moderate to severe liver damage. Kidney Impairment: As kidney function decreases, the risk of hyperkalemia increases. Use with caution in patients with mild renal impairment; it may be disabled depending on the indications and degree of damage.

4. There may be significant interactions with some drugs, requiring dose or frequency adjustment, additional monitoring, and/or the selection of alternative therapies.