Eplerenone vs spironolactone

buy now

Looking for the best medication for heart failure or high blood pressure? Eplerenone and spironolactone are both potassium-sparing diuretics, but they have some key differences.

Eplerenone is a newer drug with fewer side effects compared to spironolactone. While both medications are effective in treating conditions like heart failure and hypertension, eplerenone may be a better choice for individuals who are concerned about side effects such as breast tenderness or gynecomastia.

If you’re considering these medications, speak with your healthcare provider to determine which option is best for you.

Overview of Eplerenone

Eplerenone is a medication used to treat high blood pressure and heart failure. It belongs to a class of drugs known as mineralocorticoid receptor antagonists. Eplerenone works by blocking the action of aldosterone, a hormone that can cause high blood pressure and fluid retention in the body.

Eplerenone is often prescribed to patients who cannot tolerate spironolactone or have certain conditions that make spironolactone unsuitable. It is effective in reducing blood pressure and improving heart function in patients with heart failure.

How Eplerenone Works

  • Eplerenone blocks the effects of aldosterone
  • Reduces sodium and water retention
  • Lowers blood pressure

Eplerenone is usually taken orally in the form of a tablet. It is important to follow your healthcare provider’s instructions and dosage recommendations when taking this medication. Common side effects of eplerenone include dizziness, headache, and elevated potassium levels.

See also  Spironolactone et lasilix

Key Differences

Spironolactone and Eplerenone are both potassium-sparing diuretics commonly used to treat heart failure and high blood pressure. The key differences between the two medications lie in their chemical structure and selectivity for mineralocorticoid receptors.

Chemical Structure: Spironolactone is a steroidal compound that acts as a competitive antagonist of mineralocorticoid receptors, while Eplerenone is a non-steroidal compound that exhibits more selective mineralocorticoid receptor binding.

Mineralocorticoid Receptor Selectivity: Eplerenone has greater selectivity for mineralocorticoid receptors compared to Spironolactone, which can lead to a lower risk of certain side effects such as gynecomastia and menstrual irregularities.

Metabolism: Spironolactone is metabolized to active metabolites in the body, while Eplerenone undergoes minimal metabolism, leading to a shorter half-life and potentially faster onset of action.

Clinical Use: Due to its more selective mineralocorticoid receptor binding and reduced risk of some adverse effects, Eplerenone may be preferred in patients where these considerations are important, while Spironolactone remains a valuable option for individuals who tolerate it well and require its broader spectrum of effects.

Key Differences

When comparing Eplerenone and Spironolactone, one of the key differences lies in their selectivity for the mineralocorticoid receptor. Eplerenone is a more selective mineralocorticoid receptor antagonist compared to Spironolactone, which also has antiandrogenic properties due to its interaction with other steroid receptors.

Another important difference is the metabolism of these two drugs. Eplerenone is primarily metabolized by the liver through CYP3A4, whereas Spironolactone undergoes extensive hepatic metabolism to active metabolites such as canrenone.

Table: Mechanism of Action

Property Eplerenone Spironolactone
Mineralocorticoid receptor selectivity More selective Less selective
Metabolism Primarily through CYP3A4 Extensive hepatic metabolism
See also  Long term spironolactone use for acne

Mechanism of Action

Eplerenone and spironolactone are both aldosterone antagonists that work by blocking aldosterone receptors in the distal tubules of the kidney. This inhibition leads to decreased sodium reabsorption and increased potassium retention, resulting in diuresis and natriuresis.


Eplerenone is a selective aldosterone receptor antagonist that primarily targets the mineralocorticoid receptor, which is responsible for regulating sodium and water balance in the body. By blocking this receptor, eplerenone helps reduce the harmful effects of aldosterone, such as fluid retention and electrolyte imbalance.


Spironolactone, on the other hand, is a non-selective aldosterone antagonist that also has anti-androgenic effects. It competes with aldosterone for binding to the mineralocorticoid receptor, leading to similar effects on sodium and water balance. Additionally, spironolactone can block androgen receptors, making it useful in conditions like hirsutism and acne.

Overall, both eplerenone and spironolactone are effective in treating conditions related to aldosterone excess, such as hypertension, heart failure, and edema, by modulating the body’s water and electrolyte balance through their aldosterone-blocking mechanisms.

Side Effects


Common side effects of eplerenone may include dizziness, headache, diarrhea, and stomach pain. In some cases, it may also cause hyperkalemia (high potassium levels in the blood), which can lead to serious complications.

If you experience any of these side effects or other symptoms while taking eplerenone, it is important to consult your healthcare provider immediately.


Spironolactone may cause side effects such as dizziness, nausea, vomiting, and diarrhea. It may also lead to hyperkalemia, especially in patients with kidney problems or when taken with other medications that increase potassium levels.

See also  Does spironolactone cause indigestion

It is crucial to report any adverse effects or unusual symptoms to your doctor or pharmacist when using spironolactone.

Comparison in Clinical Practice

When it comes to choosing between Eplerenone and Spironolactone in clinical practice, several factors need to be considered. Eplerenone is often preferred for its higher selectivity towards the mineralocorticoid receptor, resulting in a lower risk of side effects such as gynecomastia and menstrual irregularities compared to Spironolactone. Additionally, Eplerenone has a shorter half-life and does not require metabolic activation, making it a more straightforward choice for patients with hepatic impairment.

On the other hand, Spironolactone has been extensively studied and proven effective in various cardiovascular conditions, including heart failure. It also has a lower cost, which may be a critical factor for some patients.


  • In conclusion, the choice between Eplerenone and Spironolactone should be individualized based on the patient’s specific needs, comorbidities, and tolerance to potential side effects.