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Aldactone vs Eplerenone
Introduction
For patients dealing with high blood pressure or heart failure, certain drugs that alter the balance of fluids and electrolytes in the body can help manage symptoms. Aldactone and Eplerenone are two such drugs often prescribed for these conditions. They each impact different aspects of the renin-angiotensin-aldosterone system (RAAS), but both have beneficial effects in patients with heart problems or hypertension. Aldactone is a non-selective mineralocorticoid receptor antagonist, affecting levels of aldosterone, while it also binds to other steroid hormone receptors which may lead to unwanted side effects such as breast tenderness or menstrual irregularities. On the other hand, Eplerenone is more selective than Aldactone and primarily affects just aldosterone levels without binding significantly to other hormone receptors, thereby limiting some side effects seen with Aldactone.
Aldactone vs Eplerenone Side By Side
| Attribute | Aldactone | Inspra |
|---|---|---|
| Brand Name | Aldactone | Inspra |
| Contraindications | Should not be taken with potassium supplements or other potassium-sparing diuretics. Not recommended for patients with kidney disease or severe liver disease without consulting a healthcare provider. | Should not be taken with potassium supplements or other potassium-sparing diuretics. Not recommended for patients with kidney disease or severe liver disease without consulting a healthcare provider. |
| Cost | For the brand name, around $105 for 30 tablets of 25 mg. Generic versions cost about $0.20 - $0.80/day. | For the brand name, about $485 for 30 tablets of 25 mg. Generic versions cost around $4 - $5 per day for typical dosages. |
| Generic Name | Spironolactone | Eplerenone |
| Most Serious Side Effect | Allergic reactions like skin rash, itching or hives, swelling of the hands, feet, face, lips, throat or tongue, changes in vision, confusion, dizziness, light-headedness, fainting spells, decreased sexual ability, nausea, and vomiting. | Signs of an allergic reaction such as hives, difficulty breathing or swallowing, swelling in your face or throat, high potassium levels - weakness, slow heart rate. |
| Severe Drug Interactions | Can cause a dangerous increase of potassium in your blood when taken with potassium supplements or other potassium-sparing diuretics. | Can cause a dangerous increase of potassium in your blood when taken with potassium supplements or other potassium-sparing diuretics. |
| Typical Dose | Oral dosages range from 25-400 mg/day, depending on the condition. For heart failure, commonly 25 mg once daily or every other day. | Treatment typically begins at a dosage of 25 mg/day, may be increased to 50 mg/day, with a maximum daily dosage generally capped at 100 mg. |
What is Aldactone?
Spironolactone (the generic name for Aldactone) was the first drug of the class of potassium-sparing diuretics and anti-androgen, which marked a significant development upon other classes of diuretic drugs. Spironolactone was first approved by the FDA in 1985. It works by blocking aldosterone activity, effectively reducing fluid buildup in your body while retaining potassium levels. It is prescribed for conditions including heart failure, ascites due to liver disease, kidney disease, high blood pressure and conditions of excessive aldosterone production.
Eplerenone (branded as Inspra), on the other hand, is more selective than spironolactone—it blocks only aldosterone receptors and not those for other hormones such as progesterones or glucocorticoids. This results in it having fewer side effects related to hormonal imbalances like breast tenderness or menstrual irregularities that are often seen with spironolactone use. However, Eplerenone may be less potent than Spironolactone at equal doses because it's more targeted.
What conditions is Aldactone approved to treat?
Aldactone is approved for the treatment of several conditions, including:
- Primary hyperaldosteronism, a condition characterized by overproduction of aldosterone hormone
- Edematous conditions in patients with congestive heart failure
- Nephrotic syndrome, a kidney disorder causing your body to excrete too much protein in your urine
- Essential hypertension, high blood pressure with no identifiable cause
- Hypokalemia or low potassium levels in the blood (in combination with other drugs)
How does Aldactone help with these illnesses?
Aldactone, also known as spironolactone, helps to manage conditions like high blood pressure and heart failure by blocking the action of a hormone in the body called aldosterone. Aldosterone is involved in regulating salt and water balance in our bodies which can affect blood volume and pressure. By inhibiting aldosterone's effect, Aldactone causes the kidneys to excrete more sodium into urine while conserving potassium, reducing fluid build-up and lowering blood pressure.
Eplerenone functions similarly; it too is an aldosterone antagonist that promotes diuresis (urination) thereby decreasing blood volume and consequently lowering elevated blood pressure levels. However, Eplerenone selectively blocks only mineralocorticoid receptors (where aldosterone has its effects), unlike Aldactone which also has some degree of effect on other hormonal receptors such as those for progesterones or androgens. Therefore, though both help manage conditions related to high blood pressure or heart ailments via similar mechanisms, Eplerenone may be chosen if specific selectivity is required by the patient due to side-effect profiles.
What is Eplerenone?
Eplerenone, marketed under the brand name Inspra, is a potassium-sparing diuretic that blocks aldosterone receptors. Aldosterone is a hormone which promotes sodium retention and potassium excretion in the kidneys, leading to increased water retention and blood volume. By blocking this action, eplerenone helps lower high blood pressure and reduce fluid build-up - beneficial for conditions such as heart failure or liver disease. Eplerenone was approved by FDA in 2002.
Unlike spironolactone (Aldactone), another aldosterone antagonist, eplerenone has reduced affinity for other steroid receptors including progesterone and estrogen receptors. This means it tends to cause fewer hormonal side effects like gynecomastia (breast enlargement) or menstrual irregularities - common complaints with Aldactone use.
Its selective nature makes eplerenone an attractive option especially for patients who experience these type of side effects with nonselective antagonists like spironolactone. However, regular monitoring of serum potassium levels are necessary while on any form of aldosterone antagonist therapy due to risk of hyperkalemia.
What conditions is Eplerenone approved to treat?
Eplerenone is approved for the following medical conditions:
- Post-myocardial infarction (also known as a heart attack)
- Heart failure to improve survival in patients with reduced ejection fraction and clinical signs of congestion after an acute myocardial infarction.
It's also used to manage high blood pressure, providing an alternative treatment for those who may not respond well to other medications.
How does Eplerenone help with these illnesses?
Eplerenone, similar to Aldactone (or Spironolactone), acts by blocking the action of aldosterone, a hormone which plays an essential role in the regulation of blood pressure and electrolyte balance. Eplerenone is classified as a selective aldosterone receptor antagonist (SARA) and primarily used for the treatment of conditions such as hypertension and heart failure. It works by binding selectively to aldosterone receptors in your kidneys, helping to maintain a healthy balance of water and salt. This helps lower blood pressure, reduces swelling caused by fluid retention, and alleviates some symptoms associated with heart failure. Its selective action means it has fewer side effects than non-selective alternatives like Aldactone because it does not significantly affect other hormones in your body. This makes Eplerenone especially beneficial when patients do not respond well or experience undesirable side effects with traditional medications like Aldactone.
How effective are both Aldactone and Eplerenone?
Both spironolactone (Aldactone) and eplerenone are potassium-sparing diuretics primarily used to treat heart failure, hypertension and conditions involving excessive aldosterone. Despite being structurally related, they act in different ways due to their selectivity for the mineralocorticoid receptor.
Spironolactone was first approved by the FDA in 1958 while eplerenone came into use much later, receiving approval only in 2002. A direct comparison of these two drugs was conducted through a double-blind clinical trial named EPHESUS study, where patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure were treated with either drug. The results showed that both medications effectively reduced death from cardiovascular causes or hospitalization for heart failure but there were fewer side effects such as gynecomastia or breast pain reported with eplerenone.
In terms of safety profiles, a meta-analysis report on spironolactone shows it is generally well-tolerated although some patients may develop hyperkalemia especially when combined with other medicines like ACE inhibitors or ARBs. It has been widely prescribed worldwide thanks to its proven efficacy over many decades of usage.
Meanwhile, Eplerenon's unique pharmacology makes it particularly suitable for those who need an effective aldosterone antagonist without unwanted estrogenic side effects more commonly associated with Spironolactone. However, it's worth noting that data confirming its long-term standalone effectiveness compared to Spironolactones' historical track record is still ongoing.
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At what dose is Aldactone typically prescribed?
Oral dosages of Aldactone usually range from 25-400 mg/day, depending on the condition being treated. For heart failure, a common dosage is 25 mg once daily or every other day. Dosage can be adjusted based on the response and tolerance of the patient over time. On the other hand, Eplerenone typically starts at an oral dosage of 25 mg per day for heart failure patients and may be increased to a maximum of 50 mg per day after four weeks if there is no adequate response or hyperkalemia occurs. As with any medication, it's important that these guidelines are considered in conjunction with your personal medical history under guidance by a healthcare professional.
At what dose is Eplerenone typically prescribed?
Eplerenone treatment typically begins at a dosage of 25 mg/day. Depending on the patient's response and tolerance, this dose may be increased to 50 mg/day, administered as a single daily dose or split into two doses taken 12 hours apart. Maximum daily dosage is generally capped at 100 mg divided into two doses of 50 mg each, spaced evenly throughout the day. If there is no noticeable improvement in symptoms or condition after several weeks on a regimen of 50 mg/day, your healthcare provider might consider increasing the dose to this higher level.
What are the most common side effects for Aldactone?
Common side effects of Eplerenone may include:
- Headache
- Dizziness, lightheadedness due to low blood pressure
- Fatigue (general weakness and tiredness)
- Diarrhea or constipation
- Stomach pain (burning, discomfort)
- Cough
- Rash or itching skin
- Increased potassium levels in the body which can cause irregular heartbeat.
On the other hand, Aldactone has similar potential side effects as well as some additional ones. These might include:
- Nausea and vomiting
- Changes in menstrual periods
- Breast enlargement in men
- Decreased libido (sex drive)
- Impotence or difficulty having an erection.
It's important to remember individual experiences with these medications will vary, so it is always best to consult a healthcare professional for advice tailored specifically for you.
Are there any potential serious side effects for Aldactone?
In rare cases, Eplerenone can cause potentially serious side effects that include:
- Signs of allergic reaction such as hives; difficulty breathing; swelling in your face, lips, tongue, or throat
- High potassium levels - nausea, slow or unusual heart rate, weakness
- Low sodium levels - headache confusion slurred speech severe weakness vomiting loss of coordination feeling unsteady
- Unusually weak or tired feelings
- Blood in urine
On the other hand Aldactone has similar potential side effects including:
- Allergic reactions like skin rash itching or hives swelling of the hands feet face lips throat or tongue
- Changes in vision
- Confusion dizziness light headedness fainting spells decreased sexual ability -Nausea and vomiting
If you experience any of these symptoms while on either medication it is important to seek medical attention promptly.
What are the most common side effects for Eplerenone?
While taking Eplerenone, you might experience the following side effects:
- Headache or dizziness
- Stomach upset or diarrhea
- Coughing or cold-like symptoms
- Tiredness, weakness
- Increased potassium levels which could lead to serious heart problems (arrhythmias) It's also worth noting that while less common than with Aldactone, some patients on Eplerenone may still experience an increased urge to urinate. In rare cases, there can be abnormal liver function tests and allergic reactions that may include rashes. It is crucial to monitor your health closely and report any significant changes to your doctor immediately.
Are there any potential serious side effects for Eplerenone?
Eplerenone, while effective, can present some potentially serious side effects. If you observe any of the following symptoms after starting this medication, it's important to seek immediate medical attention:
- Signs of an allergic reaction such as hives, difficulty breathing or swallowing, swelling in your face or throat
- Potassium levels that are higher than normal: This could be indicated by weakness, slow heart rate
- Severe skin reactions like a red rash with blistering and peeling
- Symptoms suggestive of high potassium levels like muscle weakness or a heart rate that is slower than usual
- Difficulty thinking clearly or changes in mental state.
Please note that these adverse events are not commonly seen but require immediate medical evaluation if they occur.
Contraindications for Aldactone and Eplerenone?
Both Aldactone and Eplerenone, like most other medications used for heart failure or hypertension, may worsen symptoms in some people. If you notice your condition worsening, such as experiencing an increase in fluid retention, irregular heartbeat, or unusual fatigue or weakness, please seek immediate medical attention.
Neither Aldactone nor Eplerenone should be taken if you are taking potassium supplements or other potassium-sparing diuretics. Always inform your physician about all the medications you are currently on; these drugs can cause a dangerous increase of potassium in your blood which could lead to serious heart problems. Similarly, avoiding foods high in potassium is necessary while on treatment with either of these medicines.
If you have kidney disease or severe liver disease it's crucial that you don't take Aldactone/Eplerenone without consulting with your healthcare provider first. Both medicines may further decrease renal function and exacerbate existing liver conditions.
How much do Aldactone and Eplerenone cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Aldactone (25 mg) averages around $105, which works out to approximately $3.50/day.
- The price for 30 tablets of Inspra (Eplerenone, 25 mg) is significantly higher at about $485, working out to a hefty daily cost of roughly $16.
So if you're taking an equivalent dosage range for both medications, Eplerenone is considerably more expensive than Aldactone on a per-day treatment basis.
However, it's crucial not to let cost be your primary consideration when deciding between these two medications. Always consult with your healthcare provider first.
For the generic versions of Spironolactone (Aldactone) and Eplerenone:
-
Generic spironolactone comes in packs ranging from 15 up to hundreds of capsules (25mg), costing about $0.20 - $0.80/day depending on where and how many you purchase at once.
-
On the other hand, eplerenone costs are still high even in its generic form: around $4 - $5 per day for typical dosages or as low as just under ~$2/day if buying larger quantities upfront.
As always though remember that while generics typically offer significant savings over brand-name alternatives they are identical in terms of efficacy and safety profiles so don't hesitate to choose them based solely on their lower price tag!
Popularity of Aldactone and Eplerenone
Spironolactone, available under the brand name Aldactone among others, was estimated to have been prescribed to about 3.5 million people in the US in 2020. It accounted for approximately 15% of prescriptions within its class of potassium-sparing diuretics and is used primarily to treat fluid build-up due to heart failure, liver scarring, or kidney disease. Additionally, it helps with high blood pressure and certain hormonal conditions. The prevalence of spironolactone has seen a gradual increase over the last decade.
Eplerenone (brand name Inspra), on the other hand, while also being part of the same drug class as spironolactone was not as widely prescribed and only reached around 1 million people in the USA during 2020. Eplerenone accounts for just under 5% of potassium-sparing diuretic prescriptions but serves similar purposes including treating high blood pressure and heart failure after a heart attack. The prescription rate for eplerenone has remained relatively steady over recent years.
Conclusion
Both Aldactone (spironolactone) and Eplerenone are used in the management of heart failure, hypertension, and conditions with excessive aldosterone levels. Their efficacy is backed by clinical studies indicating their significant role over placebo treatments. Both drugs act as aldosterone antagonists, but they function differently due to their selectivity towards the mineralocorticoid receptor. Aldactone has less selectivity compared to eplerenone, meaning it also affects other hormone receptors which can lead to side effects like gynecomastia (breast enlargement in men) and menstrual irregularities.
Aldactone is often considered a first-line treatment option for patients with ascites due to liver disease or those with resistant forms of hypertension. On the other hand, eplerenone would usually be suggested for patients who cannot tolerate the side-effects related to spironolactones' lack of receptor specificity or need an add-on therapy for managing heart failure post-myocardial infarction.
Both drugs are available in generic form which represents significant cost savings especially for patients who must pay out of pocket. However, both may require some time before their full effects become noticeable.
The side effect profile is similar between these two medications; however, due its greater selectivity towards mineralocorticoid receptors only, eplerenone tends to have fewer hormonal-related side effects than Aldactone does such as breast tenderness/enlargement in males or menstrual abnormalities in females. For both drugs though, close monitoring of renal function tests and potassium levels should be done periodically while on therapy.
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Refrences
- Weinberger, M.H. (2004). Eplerenone: A new selective aldosterone receptor antagonist. Drugs of Today. Portico.http://doi.org/10.1358/dot.2004.40.6.850481
- Stier, C. T., Jr. (2003, September). Eplerenone: A Selective Aldosterone Blocker. Cardiovascular Drug Reviews. Wiley.http://doi.org/10.1111/j.1527-3466.2003.tb00114.x
- Parthasarathy, H. K., Ménard, J., White, W. B., Young, W. F., Williams, G. H., Williams, B., … MacDonald, T. M. (2011, May). A double-blind, randomized study comparing the antihypertensive effect of eplerenone and spironolactone in patients with hypertension and evidence of primary aldosteronism. Journal of Hypertension. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/hjh.0b013e3283455ca5
- Lainscak, M., Pelliccia, F., Rosano, G., Vitale, C., Schiariti, M., Greco, C., … Gaudio, C. (2015, December). Safety profile of mineralocorticoid receptor antagonists: Spironolactone and eplerenone. International Journal of Cardiology. Elsevier BV.http://doi.org/10.1016/j.ijcard.2015.05.127
- Stier, C. T., Jr, Koenig, S., Lee, D. Y., Chawla, M., & Frishman, W. H. (2003, March). Aldosterone and Aldosterone Antagonism in Cardiovascular Disease. Heart Disease. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/01.hdx.0000061698.20666.aa
- Chen, J., Jiang, B., Lou, H., Xu, Y., Shao, R., & Ruan, Z. (2015, August 11). Dose Proportionality and Pharmacokinetics of Eplerenone in Healthy Chinese Subjects. Drug Research. Georg Thieme Verlag KG.http://doi.org/10.1055/s-0035-1559623