Eplerenone interactions
Full monograph for EplerenoneCheck it against another medicine
Medicines
355 documented
| Medicine | Severity | Mechanism | Effect | Sources |
|---|---|---|---|---|
| Amiodarone Hydrochloride | Major | Metabolism | Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme. | 1 sources — open the full entry |
| Aprepitant | Major | Metabolism | Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme. | 1 sources — open the full entry |
| Beclomethasone Dipropionate + Chloramphenicol + Clotrimazole + Lidocaine | Major | Metabolism | Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme. | 1 sources — open the full entry |
| Betamethasone + Clotrimazole | Major | Antagonism · Metabolism | Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme.2 documented mechanisms | 3 sources — open the full entry |
| Betamethasone + Clotrimazole + Gentamicin | Major | Antagonism · Metabolism | Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme.2 documented mechanisms | 3 sources — open the full entry |
| Ceritinib | Major | Metabolism | Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and risk of adverse reactions of eplerenone, which… | 3 sources — open the full entry |
| Clarithromycin | Major | Metabolism | Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and risk of adverse reactions of eplerenone, which… | 3 sources — open the full entry |
| ClotrimazoleEar dropEye ointmentTopicalVaginal tablet | Major | Metabolism | Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme. | 1 sources — open the full entry |
| Clotrimazole + Hydrocortisone | Major | Antagonism · Metabolism | Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme.2 documented mechanisms | 3 sources — open the full entry |
| Crizotinib | Major | Metabolism | Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme. | 1 sources — open the full entry |
| Diltiazem Hydrochloride | Major | Metabolism | Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme. | 1 sources — open the full entry |
| ErythromycinLotionOral | Major | Metabolism | Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme. | 1 sources — open the full entry |
| Esomeprazole + Amoxicillin + Clarithromycin | Major | Metabolism | Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and risk of adverse reactions of eplerenone, which… | 3 sources — open the full entry |
| Finerenone | Major | Synergy | The principal risk of eplerenone is hyperkalemia. Coadministration with potassium salts or potassium-sparing diuretics may increase this risk due to additive… | 2 sources — open the full entry |
| FluconazolebaseOphthalmic | Major | Metabolism | Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme. | 1 sources — open the full entry |
| Furosemide + Spironolactone | Major | Synergy · Unknown | The principal risk of eplerenone is hyperkalemia. Coadministration with potassium salts or potassium-sparing diuretics may increase this risk due to additive…2 documented mechanisms | 2 sources — open the full entry |
| Imatinib Mesylate | Major | Metabolism | Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme. | 1 sources — open the full entry |
| Itraconazole | Major | Metabolism | Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and risk of adverse reactions of eplerenone, which… | 3 sources — open the full entry |
| Ketoconazole | Major | Metabolism | Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and risk of adverse reactions of eplerenone, which… | 3 sources — open the full entry |
| Ketoconazole + Zinc Pyrithione + Aleovera | Major | Metabolism | Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and risk of adverse reactions of eplerenone, which… | 3 sources — open the full entry |
| Lansoprazole + Amoxicillin + Clarithromycin | Major | Metabolism · Unknown | Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and risk of adverse reactions of eplerenone, which…2 documented mechanisms | 3 sources — open the full entry |
| Lopinavir + Ritonavir | Major | Metabolism | Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and risk of adverse reactions of eplerenone, which… | 3 sources — open the full entry |
| Mifepristone | Major | Metabolism | Coadministration with mifepristone may significantly increase the plasma concentrations of drugs that are primarily metabolized by the CYP450 3A4 isoenzyme… | 12 sources — open the full entry |
| Mifepristone + Misoprostol | Major | Metabolism | Coadministration with mifepristone may significantly increase the plasma concentrations of drugs that are primarily metabolized by the CYP450 3A4 isoenzyme… | 12 sources — open the full entry |
| Nelfinavir | Major | Metabolism | Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and risk of adverse reactions of eplerenone, which… | 3 sources — open the full entry |
| Nirmatrelvir + Ritonavir | Major | Metabolism | Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and risk of adverse reactions of eplerenone, which… | 3 sources — open the full entry |
| Ofloxacin + Clotrimazole + Beclomethasone + Lidocaine | Major | Metabolism · Unknown | Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme.2 documented mechanisms | 1 sources — open the full entry |
| Posaconazole | Major | Metabolism | Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and risk of adverse reactions of eplerenone, which… | 3 sources — open the full entry |
| Potassium Chloride | Major | Synergy | The principal risk of eplerenone is hyperkalemia. Coadministration with potassium salts or potassium-sparing diuretics may increase this risk due to additive… | 2 sources — open the full entry |
| Potassium Citrate | Major | Synergy | The principal risk of eplerenone is hyperkalemia. Coadministration with potassium salts or potassium-sparing diuretics may increase this risk due to additive… | 2 sources — open the full entry |
| Potassium Citrate + Citric Acid | Major | Synergy | The principal risk of eplerenone is hyperkalemia. Coadministration with potassium salts or potassium-sparing diuretics may increase this risk due to additive… | 2 sources — open the full entry |
| Rabeprazole + Amoxicillin + Clarithromycin | Major | Metabolism · Unknown | Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and risk of adverse reactions of eplerenone, which…2 documented mechanisms | 3 sources — open the full entry |
| Ribociclib | Major | Metabolism | Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme. | 1 sources — open the full entry |
| Sodium Alginate + Potassium Bicarbonate | Major | Synergy | The principal risk of eplerenone is hyperkalemia. Coadministration with potassium salts or potassium-sparing diuretics may increase this risk due to additive… | 2 sources — open the full entry |
| Sodium Chloride + Potassium Chloride + Sodium Acetate | Major | Synergy | The principal risk of eplerenone is hyperkalemia. Coadministration with potassium salts or potassium-sparing diuretics may increase this risk due to additive… | 2 sources — open the full entry |
| Spironolactone | Major | Synergy | The principal risk of eplerenone is hyperkalemia. Coadministration with potassium salts or potassium-sparing diuretics may increase this risk due to additive… | 2 sources — open the full entry |
| Sulphamethoxazole + Trimethoprim | Major | Excretion | The use of trimethoprim in combination with other potassium-sparing drugs or potassium salts may increase the risk of hyperkalemia. Trimethoprim inhibits… | 35 sources — open the full entry |
| Tizanidine Hydrochloride | Major | Synergy | Tizanidine may potentiate the hypotensive effect of some medications secondary to its alpha-2 adrenergic activity. Pharmacologic studies have found tizanidine… | 1 sources — open the full entry |
| Triamterene + Hydrochlorothiazide | Major | Synergy · Unknown | The principal risk of eplerenone is hyperkalemia. Coadministration with potassium salts or potassium-sparing diuretics may increase this risk due to additive…2 documented mechanisms | 2 sources — open the full entry |
| Tucatinib | Major | Metabolism | Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and risk of adverse reactions of eplerenone, which… | 3 sources — open the full entry |
| Verapamil Hydrochloride | Major | Metabolism | Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme. | 1 sources — open the full entry |
| Vonoprazan + Amoxicillin + Clarithromycin | Major | Metabolism | Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and risk of adverse reactions of eplerenone, which… | 3 sources — open the full entry |
| Voriconazole | Major | Metabolism | Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations and risk of adverse reactions of eplerenone, which… | 3 sources — open the full entry |
| Abametapir | Moderate | Metabolism | Based on in vitro inhibition data, a single topical application of abametapir lotion may increase plasma concentrations of drugs that are substrates of CYP450… | 1 sources — open the full entry |
| Acyclovir + Hydrocortisone | Moderate | Antagonism · Metabolism · Unknown | Corticosteroids may antagonize the effects of antihypertensive medications by inducing sodium and fluid retention. These effects may be more common with the…2 documented mechanisms | 2 sources — open the full entry |
| Allium cepa + Heparin + Allantoin | Moderate | Synergy | Heparin and low molecular weight heparins (LMWHs) may cause hyperkalemia. Concomitant use with potassium-sparing diuretics or aldosterone receptor antagonists… | 3 sources — open the full entry |
| Alprazolam | Moderate | Synergy | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)… | 11 sources — open the full entry |
| Amisulpride | Moderate | Synergy | Phenothiazines and neuroleptic agents may potentiate the hypotensive effect of some medications secondary to their peripheral alpha-1 adrenergic blocking… | 11 sources — open the full entry |
| Amitriptyline Hydrochloride | Moderate | Synergy | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)… | 11 sources — open the full entry |
| Amitriptyline Hydrochloride + Chlordiazepoxide | Moderate | Synergy | Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants)…2 documented mechanisms | 11 sources — open the full entry |
Food & lifestyle
alcohol
ModerateSynergy
Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.
What to do: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.
8 sources
- Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
- Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
- Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
- Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
- Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
- Cerner Multum, Inc. "Australian Product Information." O 0
- Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
- Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
Conditions
Conditions in which Eplerenone needs care, as documented in this source.
Diabetes Mellitus, Type 2
MajorThe use of eplerenone is contraindicated in patients with type II diabetes mellitus and microalbuminuria. These patients are at increased risk of developing persistent hyperkalemia, which is the principal adverse effect of eplerenone and can lead to potentially life-threatening cardiac arrhythmias. In a study of such patients treated with a 200 mg/day dose, the frequency of maximum serum potassium levels exceeding 5.5 mEq/L was 33% with eplerenone alone and 38% in combination with enalapril. In other patient populations, the frequency has been reported at 1% for the 200 mg/day dose and 8.7% for the 400 mg/day dose. Careful monitoring of serum potassium levels is necessary in patients treated with eplerenone who are at risk for the development of hyperkalemia, especially during initiation of therapy, after dosage adjustment, and during illness that could alter renal function. In clinical trials, monitoring occurred every 2 weeks for the first 1 to 2 months, then monthly thereafter. Eplerenone should be withdrawn immediately if hyperkalemia develops, and measures should be initiated to lower serum potassium if it exceeds 6.5 mEq/L.
1 source
- "Product Information. Inspra (eplerenone)." Searle (2002):
Hyperkalemia
MajorThe use of eplerenone is contraindicated in the presence of elevated serum potassium concentrations (> 5.5 mEq/L). Eplerenone is a blocker of aldosterone binding at the mineralocorticoid receptor and can cause hyperkalemia, which may result in life-threatening cardiac arrhythmias. Careful monitoring of serum potassium levels is necessary in patients who are at risk for the development of hyperkalemia (including those receiving concomitant ACE inhibitors or angiotensin II receptor antagonists), especially during initiation of therapy, after dosage adjustment, and during illness that could alter renal function. In clinical trials, monitoring occurred every 2 weeks for the first 1 to 2 months, then monthly thereafter. Eplerenone should be withdrawn immediately if hyperkalemia develops, and measures should be initiated to lower serum potassium if it exceeds 6.5 mEq/L.
1 source
- "Product Information. Inspra (eplerenone)." Searle (2002):
Kidney Diseases
MajorThe use of eplerenone is contraindicated in patients with renal impairment as defined by serum creatinine above 2.0 mg/dL for males or 1.8 mg/dL for females, or a creatinine clearance (CrCl) below 50 mL/min. These patients are at increased risk of developing persistent hyperkalemia, which is the principal adverse effect of eplerenone and can lead to potentially life-threatening cardiac arrhythmias. The incidence of hyperkalemia increases with decreasing renal function. In clinical studies of eplerenone, serum potassium levels exceeding 5.5 mEq/L were observed in 10.4% of treated patients with baseline calculated CrCl less than 70 mL/min, 5.6% of patients with baseline CrCl 70 to 100 mL/min, and 2.6% of patients with baseline CrCl greater than 100 mL/min. Careful monitoring of serum potassium levels is necessary in patients treated with eplerenone who are at risk for the development of hyperkalemia, especially during initiation of therapy, after dosage adjustment, and during illness that could alter renal function. In clinical trials, monitoring occurred every 2 weeks for the first 1 to 2 months, then monthly thereafter. Eplerenone should be withdrawn immediately if hyperkalemia develops, and measures should be initiated to lower serum potassium if it exceeds 6.5 mEq/L.
1 source
- "Product Information. Inspra (eplerenone)." Searle (2002):
Liver Diseases
ModerateEplerenone is primarily metabolized by the liver. In patients with moderate (Child-Pugh Class B) hepatic impairment given eplerenone 400 mg, the steady-state peak plasma concentration (Cmax) and systemic exposure (AUC) of eplerenone were increased by 3.6% and 42%, respectively, compared to those in normal subjects. In 16 patients with mild to moderate hepatic impairment who received 400 mg of eplerenone, no elevations in serum potassium above 5.5 mmol/L were observed. Their mean increase in serum potassium was 0.12 mEq/L compared to 0.13 mEq/L in normal controls. No adjustment of the starting dosage is recommended for patients with mild to moderate hepatic impairment. The use of eplerenone in patients with severe hepatic impairment has not been evaluated, thus caution is advised.
1 source
- "Product Information. Inspra (eplerenone)." Searle (2002):
Therapeutic duplication
Drug classes that overlap with Eplerenone, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.
potassium sparing diuretics
The recommended maximum number of medicines in the 'potassium sparing diuretics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'potassium sparing diuretics' category.
Example product in the source data (US market): Rajani
potassium sparing diuretics
The recommended maximum number of medicines in the 'potassium sparing diuretics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'potassium sparing diuretics' category.
Example product in the source data (US market): Hydrochlorothiazide/triamterene
potassium sparing diuretics
The recommended maximum number of medicines in the 'potassium sparing diuretics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'potassium sparing diuretics' category.
Example product in the source data (US market): Moduretic 5-50
potassium sparing diuretics
The recommended maximum number of medicines in the 'potassium sparing diuretics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'potassium sparing diuretics' category.
Example product in the source data (US market): Drospirenone/estradiol
potassium sparing diuretics
The recommended maximum number of medicines in the 'potassium sparing diuretics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'potassium sparing diuretics' category.
Example product in the source data (US market): Hydrochlorothiazide/spironolactone
potassium sparing diuretics
The recommended maximum number of medicines in the 'potassium sparing diuretics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'potassium sparing diuretics' category.
Example product in the source data (US market): Nextstellis
potassium sparing diuretics
The recommended maximum number of medicines in the 'potassium sparing diuretics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'potassium sparing diuretics' category.
Example product in the source data (US market): Ocella