A comparison of the aldosterone-blocking agents eplerenone and spironolactone

Allan Struthers, Henry Krum, Gordon H. Williams

    Research output: Contribution to journalReview articlepeer-review

    147 Citations (Scopus)

    Abstract

    Improved understand in g of the adverse pharmacological properties of aldosterone has prompted investigation of the clinical benefits of blocking aldosterone at the receptor level. This article reviews the pharmacology, clinical efficacy, and tolerability of the two available blocking agents, spironolactone and eplerenone. A Medline search identified clinical studies assessing spironolactone and eplerenone. Priority was given to large, well-controlled, clinical trials and comparative studies. Pharmacological differences between spironolactone and eplerenone include lower affinity of eplerenone for progesterone, androgen, and glucocorticoid receptors; more consistently demonstrated nongenomic properties for eplerenone; and the presence of long-acting metabolites for spironolactone. Both agents effectively treat hypertension and heart failure but comparisons are complicated by the deficiency of head-to-head trials and differences between patient populations. There are differences in the tolerability profiles; spironolactone is associated with dose-dependent sexual side effects. Both agents produce dose-dependent increases in potassium concentrations, although the effect with spironolactone appears to be greater when both agents are administered at recommended doses. Choice of a specific agent should be based on individual patient issues, such as the nature of heart failure and patient concerns about adverse events.

    Original languageEnglish
    Pages (from-to)153-158
    Number of pages6
    JournalClinical Cardiology
    Volume31
    Issue number4
    DOIs
    Publication statusPublished - Apr 2008

    Keywords

    • eplerenone
    • spironolactone
    • aldosterone blockade
    • hypertension
    • heart failure
    • LEFT-VENTRICULAR DYSFUNCTION
    • SMOOTH-MUSCLE-CELLS
    • HEART-FAILURE
    • ESSENTIAL-HYPERTENSION
    • MYOCARDIAL-INFARCTION
    • EFFICACY
    • BLOCKADE
    • ENALAPRIL

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