Medication Names

spironolactone (Aldactone®)
eplerenone (Inspra®)

Why these medications are prescribed?

Spironolactone is prescribed in low doses for people with advanced systolic heart failure to improve outcomes and to prevent symptoms from becoming worse. Eplerenone is prescribed for patients who develop left ventricular dysfunction (an ejection fraction of less than or equal to 40%) following a heart attack. When given early after a heart attack, it may prevent heart muscle damage from worsening. Both spironolactone and eplerenone block a certain chemical (aldosterone) in the body that causes salt and fluid build-up and stiffening of the heart muscle.

When to take spironolactone or eplerenone

Follow the label directions on how often to take these medications. The number of doses you take each day, the time allowed between doses, and how long you need to take the medication will depend on your condition. These medications can be taken with or without food.

Special directions for spironolactone or eplerenone

• Weigh yourself at the same time every day (on the same scale) and record your weight. Call your doctor or nurse if you gain 3 pounds in one day or 5 pounds in one week.
• While taking these medications, have your blood potassium level tested regularly, as advised by your doctor or nurse. Lab tests will be performed three days after you start taking the medication, then at one week, every month for three months, and every three months thereafter. The tests are needed because these drugs can increase blood potassium levels.

Before these medications are prescribed, tell your doctor or nurse if you have diabetes, kidney disease, liver disease, gout, a history of kidney stones, menstrual problems, breast enlargement (in men), and/or high potassium (hyperkalemia).

Food and drug interactions

These medications are generally prescribed in combination with other heart failure medications. If you experience an increase in side effects after taking your medications together, contact your doctor or nurse. You may need to change the times you are taking each medication.

Before these medications are prescribed, tell your doctor or nurse if you are taking medications for high blood pressure, cyclosporine, potassium-containing medications, digoxin, lithium, or arthritis medications such as ibuprofen.

Follow your health care provider’s dietary advice, including:

• Following a low-sodium diet
• Limiting potassium supplements or decreasing potassium intake (such as bananas and orange juice)

Do not use salt substitutes, as they contain potassium and these medications can cause the body to retain potassium. Learn how to read food labels so you can identify the potassium content. A dietitian can help you select the appropriate foods.

Side effects and how to manage them

• Extreme tiredness: This side effect may be strongest when you first start taking the medication. It should decrease as your body adjusts to the medication. Contact your doctor or nurse if this symptom persists.
• Increased urination: This is normal and may last for up to 6 hours after a dose.
• Upset stomach: Take the medication with meals or milk to reduce this symptom. Contact your doctor or nurse if this symptom persists or is severe.
• Skin rash or itching: Stop taking the medication and contact your doctor or nurse right away.
• Shortness of breath: Contact your doctor or nurse right away.
• Confusion; irregular heartbeat; nervousness; numbness or tingling in the hands, feet, or lips: Contact your doctor or nurse right away.

Contact your doctor or nurse right away if you have any other symptoms that cause concern.