b. Eplerenone (Inspra)
Because spironolactone causes gynecomastia and other mild adverse effects, new aldosterone receptor blockers are being sought. A new compound, eplerenone, does not have the same side effects as spironolactone. Eplerenone was developed by replacing the 17 alpha-thiacetyl group of spironolactone with a carbomethoxy group. The drug is devoid of sex hormonal effects of spironolactone because it has a greater selectivity for the mineralo-corticoid receptor than for steroid receptors.
Pitt et al. have shown that 200 mg of eplerenone daily was as effective as enalapril in controlling BP and in obtaining LVH regression. The combination of eplerenone and enalapril was more effective in reducing LV mass and SBP than eplerenone alone.
Dosage. 50–200 mg once daily. Hyperkalemia may occur when used concomitantly with ACE inhibitors, ARBS, or potassium-retaining agents.

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