依普利酮治疗心力衰竭的使用指南

Introduction: Eplerenone, as a selective aldosterone receptor antagonist (MRA), plays an important role in the treatment of heart failure. Eplerenone is indicated for the treatment of heart failure, especially in patients who have not responded well to other treatments. It can bind to aldosterone receptors and block heart disease and vascular damage caused by excessive activation of MR.

INDICATIONS

Classified as an aldosterone antagonist, eplerenone's primary advantage over similar drugs, spironolactone, is its greater selectivity for mineralocorticoid receptors (over glucocorticoids, progesterone, and androgens) and its ability to improve survival in patients with stable left ventricular (LV) systolic dysfunction (LV ejection fraction less than or equal to 40%) and congestive heart failure (CHF) after acute myocardial infarction (MI).

Guidelines for use

The starting dose of eplerenone for the treatment of heart failure is 25 mg once daily, and the target dose is 50 mg once daily. The dosage should be adjusted according to the patient's specific condition. Serum potassium concentrations and renal function need to be monitored regularly while taking eplerenone, as eplerenone may cause hyperkalemia. Additionally, blood pressure and heart rhythm should be monitored as eplerenone may affect these parameters.

Efficacy of eplerenone in the treatment of heart failure

Eplerenone is the second oral aldosterone antagonist in the United States for the treatment of essential hypertension and heart failure. In patients with stable heart failure after myocardial infarction, treatment lowered blood pressure and improved survival, with a 15% reduction in overall mortality.

To evaluate the efficacy of eplerenone in reducing morbidity and mortality in patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure in a 16-month international, multicenter, randomized, double-blind, placebo-controlled study. Patients received eplerenone 25 mg daily or placebo for 4 weeks. The study showed that the 1-year mortality rates in the eplerenone group and the placebo group were 11.8% and 13.6%, respectively. Death from cardiovascular causes or hospitalization for a cardiovascular event occurred in 27% of patients who received eplerenone, compared with 30% of patients who received placebo.