Mineralocorticoid receptor antagonists for HFrEF
Treatment with a mineralocorticoid receptor antagonist (also known as an aldosterone antagonist) improves survival and reduces hospitalisation in patients with heart failure with reduced ejection fraction (HFrEF). Start a mineralocorticoid receptor antagonist (along with a renin-angiotensin system inhibitor, beta blocker and sodium-glucose co-transporter 2 inhibitor) at diagnosis or within 2 to 4 weeks of diagnosis of HFrEF; see Starting drug therapy for HFrEF.
Start with a low dose of the mineralocorticoid receptor antagonist and consider increasing the dose if signs and symptoms of heart failure persist. Use:
1eplerenone 25 mg orally, daily, increasing to 50 mg daily if required1 eplerenone eplerenone eplerenone
OR
1spironolactone 25 mg orally, daily, increasing to 50 mg daily if required. spironolactone spironolactone spironolactone
The combination of a mineralocorticoid receptor antagonist and a renin-angiotensin system inhibitor can cause life-threatening hyperkalaemia in patients with kidney impairment. Consider starting with a lower dose in patients with kidney impairment. A small rise in serum potassium (within the normal range) can occur when therapy is started or the dose is increased; this may be transient and should not necessarily prompt dose reduction or cessation of the mineralocorticoid receptor antagonist. For more information, see Monitoring drug therapy for HFrEF.