1. About eplerenone
Eplerenone is a blood pressure medicine
It’s used to treat heart failure and reduce the risk of you having other heart problems or a stroke. It also helps to stop heart failure getting worse.
It can sometimes be used to treat a condition called hyperaldosteronism. This is when your body makes too much aldosterone, a hormone that controls your blood pressure.
Eplerenone comes as tablets and is only available on prescription.
You will normally take it with other blood pressure medicines.
2. Key facts
- Eplerenone works by lowering your blood pressure. This makes it easier for your heart to pump blood around your body.
- You’ll usually take eplerenone once a day. If you’re bothered by side effects your doctor may tell you to take it every other day.
- Taking eplerenone can raise the levels of potassium in your blood. You will have regular blood tests to check your potassium.
- Having too much potassium can give you muscle cramps and diarrhoea. Do not take extra potassium without talking to your doctor.
- It’s important to keep taking eplerenone even if you feel well. You’ll still be getting the benefits of the medicine.
3. Who can and cannot take eplerenone
Eplerenone can be taken by most adults aged 18 years and over.
Eplerenone is not suitable for some people. To make sure it’s safe for you, tell your doctor before starting eplerenone if you have:
- ever had an allergic reaction to eplerenone or other medicine
- liver or kidney disease
- type 2 diabetes
- been told you have high levels of potassium in your blood (you will also have a blood test before starting eplerenone to check for this)
4. How and when to take eplerenone
It is important to take eplerenone exactly as your doctor has told you.
You’ll usually take eplerenone once a day. You can choose a time that suits you, but try to take it at the same time every day. This will make it easier to remember to take your medicine.
Swallow the tablets whole with water. You can take eplerenone with or without food.
Eplerenone comes as 25mg and 50mg tablets.
The usual starting dose is 25mg once a day and your doctor may increase it to 50mg once a day.
Your dose may change depending on the level of potassium in your blood. If your blood test shows you have too much potassium in your blood your doctor may reduce the dose. Or they may ask you to stop taking eplerenone for a short time.
What if I forget to take it?
If you forget to take a dose of eplerenone, take it as soon as you remember on that day and then carry on as normal the next day.
If you forget to take the dose for the whole day, skip the missed dose and carry on as normal the next day. Do not take a double dose to make up for a forgotten one.
If you forget doses often, it may help to set an alarm to remind you, or you could ask your pharmacist for advice on other ways to help you remember to take your medicine.
What if I take too much?
Urgent advice: Contact 111 for advice now if:
- you take too much eplerenone
Call 111 or go to 111.nhs.uk
If you take too much eplerenone, you may feel sleepy, weak or lightheaded or have blurry eyesight. It could also raise the potassium levels in your blood and this can give you muscle cramps and diarrhoea.
5. Side effects
Like all medicines eplerenone can cause side effects, although not everyone gets them.
Side effects often improve as your body gets used to the medicine.
Common side effects
These common side effects happen in more than 1 in 100 people. They’re usually mild and do not last long.
Urgent advice: Contact your doctor if:
- you have muscle cramps, diarrhoea, feel sick or weak and your symptoms last for more than 1 day
This could be due to an increase of potassium in your blood and you may need a blood test.
Talk to your doctor or pharmacist if these side effects bother you:
- feeling dizzy especially when you stand up
- difficulty sleeping
Serious side effects
Serious side effects after taking eplerenone are less common and happen in less than 1 in 100 people.
Immediate action required: Call 999 or go to A&E if:
- you have an irregular or fast heartbeat (your heart feels like it’s pounding or is beating a lot faster than normal) – this is called tachycardia (SVT)
- you have chest pain that is new or worse – this needs to be checked out as chest pain is a possible sign of a heart attack
Serious allergic reaction
In rare cases, eplerenone can cause a serious allergic reaction (anaphylaxis).
Immediate action required: Call 999 or go to A&E now if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of eplerenone. For a full list, see the leaflet inside your medicine packet.
You can report any suspected side effect using the Yellow Card safety scheme.
6. How to cope with side effects of eplerenone
What to do about:
- feeling dizzy – if eplerenone makes you feel dizzy, stop what you’re doing and sit or lie down until you feel better. Do not drive, ride a bike or operate machinery. If the dizziness continues for more than a few days, speak to your doctor as you may need your potassium levels checked.
- headaches – make sure you rest and drink plenty of water or squash. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if the headaches last longer than a week or are severe.
- difficulty sleeping – avoid caffeine (tea, coffee, cola and chocolate) in the afternoon and evening. Keep your bedroom dark and quiet, and try going to bed at the same time each day. Stop watching TV and using electronic devices like mobiles or tablets at least 1 hour before bedtime.
- cough – sometimes the cough will get better on its own. Talk to your doctor if it carries on, bothers you, or stops you sleeping.
7. Pregnancy and breastfeeding
Eplerenone and pregnancy
Eplerenone is not usually recommended in pregnancy.
If you’re trying to get pregnant or you’re already pregnant, talk to your doctor about the benefits and possible risks of taking eplerenone. There may be other medicines that are safer for you.
Eplerenone and breastfeeding
Eplerenone is not usually recommended while you’re breastfeeding. Small amounts of eplerenone may get into breast milk, but there isn’t enough research to know whether it is harmful for babies.
Your doctor may still recommend eplerenone, as it is important to treat your high blood pressure to keep you well. Breastfeeding will also benefit both you and your baby. Your baby may need extra monitoring while you take eplerenone.
Talk to your doctor or health visitor if your baby’s not feeding as well as usual or seems unusually sleepy, or if you have any other concerns.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
8. Cautions with other medicines
There are some medicines that may affect the way eplerenone works. They could also make you more likely to have side effects.
Tell your doctor if you are taking any of these medicines before starting eplerenone:
- high blood pressure medicines like ramipril, enalapril, losartan or candesartan
- tacrolimus or ciclosporin, used to treat skin conditions such as psoriasis or eczema
- trimethoprim, an antibiotic for UTIs and other infections
- digoxin – used for heart conditions
- lithium – used to treat bipolar disorder
- non-steroidal anti-inflammatory drugs (NSAIDs) including ibuprofen
- medicines to treat fungal infections like itraconazole
- spironolactone or amiloride – medicines that affect your potassium levels
- warfarin – a blood thinning medicine
Mixing eplerenone with herbal remedies or supplements
St Johns wort, a herbal medicine taken for depression, can affect how eplerenone works. Talk to your doctor if you are using this or thinking about using it.
Do not take any potassium supplements including salt substitute tablets. Some multivitamin and mineral supplements may contain potassium. Always check the label.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about eplerenone
How does eplerenone work?
Eplerenone is a medicine known as an aldosterone-blocking agent.
Aldosterone is a hormone that controls your blood pressure. It does this by changing the amount of water and salt kept in your body. Too much aldosterone can cause changes in your body that lead to heart failure.
Eplerenone works by stopping aldosterone from increasing your blood pressure. It also reduces the fluid around your heart. This helps improve your heart function after a heart attack and can help prevent heart attacks, strokes or heart failure getting worse.
How long does it take to work?
Once you start taking eplerenone it will take up to 4 weeks to reach the full effect on your blood pressure.
Carry on taking your eplerenone even if you do not feel any different. The medicine will still be working.
How long will I take it for?
Usually treatment with eplerenone is long term, even for the rest of your life.
Is it safe to take long term?
Eplerenone is generally safe to take for a long time but you will have regular blood tests to make sure your potassium levels are not affected.
What will happen if I stop taking it?
Talk to your doctor if you want to stop taking eplerenone.
Stopping eplerenone may cause your blood pressure to rise, and this may increase your risk of a heart attack, stroke or heart failure getting worse.
If you are bothered by side effects, your doctor may be able to prescribe you a different medicine.
Can I come off eplerenone now my blood pressure is lower?
Once eplerenone has brought your blood pressure down, it is still best to carry on taking it. It lowers your risk of having a heart attack, stroke or getting heart failure.
If you stop taking eplerenone, your blood pressure could go back up again.
If you need blood pressure-lowering medicines, you’ll probably have to take them for the rest of your life.
Remember, by keeping your blood pressure low, you’re protecting yourself from having a heart attack or stroke or your heart failure getting worse.
Are there other medicines similar to eplerenone?
There is only 1 other medicine that works in the same way as eplerenone and it is called spironolactone.
Spironolactone stops aldosterone working in the same way as eplerenone, but it can also block some other hormones from working. This means that you can may be more likely to get side effects with spironolactone.
Can I drink alcohol with it?
It’s a good idea not to drink alcohol when you first start taking eplerenone or after an increase in your dose, until you see how the medicine affects you.
Drinking alcohol can increase the blood pressure-lowering effect of eplerenone, which can make you feel dizzy or lightheaded.
If you find eplerenone makes you feel dizzy, it’s best to stop drinking alcohol while you’re taking it.
Is there food and drink I need to avoid?
Apart from avoiding alcohol when you first start taking eplerenone, you can eat and drink normally.
Eating a healthy, balanced diet can help if you have high blood pressure or another heart condition.
Eating too much salt is the biggest cause of high blood pressure. The more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.
However, talk to your doctor or pharmacist before starting a low-salt diet as some salt substitutes may increase your potassium levels.
Will it affect my contraception?
Eplerenone will not stop your contraception working.But some types of hormonal methods of contraception, like the combined pill and contraceptive patch, are not usually recommended for women with high blood pressure.
Talk to your doctor if you're taking a hormonal contraceptive.
If you have severe diarrhoea or eplerenone makes you sick (vomit) your contraceptive pills may not protect you from pregnancy.
If this happens, follow the instructions in the leaflet that comes with your contraceptive pills.
Find out what to do if you're on the pill and you're sick or have diarrhoea.
Will it affect my fertility?
It's unlikely that eplerenone affects fertility in men or women. But there’s not enough evidence to say for certain.
Talk to your doctor if you’re trying for a baby or having problems getting pregnant while on eplerenone.
Can I drive or ride a bike?
During the first few days of taking eplerenone, or after a dose increase, avoid driving, riding a bike or operating machinery until you know how the medicine affects you.
Do not drive, ride a bike or operate machinery if you are feeling dizzy.
Can lifestyle changes help with high blood pressure?
You can help the health of your heart by making some key lifestyle changes.
These will also help if you have high-blood pressure or heart failure.
- Quit smoking – smoking increases your heart rate and blood pressure. Quitting smoking brings down your blood pressure and relieves heart failure symptoms. Try to avoid second-hand smoke too.
- Cut down on alcohol – drinking too much alcohol raises blood pressure over time. It makes heart failure worse too. Try to keep to the recommended guidelines of no more than 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
- Exercise – regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It does not need to be too energetic. Walking every day can help.
- Eat well – aim to eat a diet that includes plenty of fruit and veg, wholegrains, fat-free or low-fat dairy products and lean proteins. It’s a good idea to cut down on salt.
- Eating too much salt is the biggest cause of high blood pressure. The more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day. However, it's important not to go on a low-salt diet while taking this medicine.
- Manage stress – when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Do things you enjoy with friends and family to be social and to help avoid stress.
- Vaccinations – if you have heart failure, it's recommended that you have the flu vaccine every year and the pneumococcal vaccine as recommended by your GP. Ask your doctor about these vaccinations. You can have them free on the NHS if you have heart failure.