Espiro
Espiro Uses, Dosage, Side Effects, Food Interaction and all others data.
Espiro selectively binds to the mineralocorticoid receptor and blocks the binding of aldosterone, a key component in the renin-angiotensin-aldosterone-system, which is involved in the regulation of BP and pathophysiology of CV disease. Aldosterone binds to mineralocorticoid receptors in both epithelial (e.g. kidney, GI tract) and nonepithelial (e.g. heart, blood vessels, brain) tissues; causing increases in BP by inducing Na reabsorption, vascular remodelling, water retention, endothelial dysfunction and possibly other mechanisms.
Espiro, an aldosterone receptor antagonist similar to spironolactone, has been shown to produce sustained increases in plasma renin and serum aldosterone, consistent with inhibition of the negative regulatory feedback of aldosterone on renin secretion. The resulting increased plasma renin activity and aldosterone circulating levels do not overcome the effects of eplerenone. Espiro selectively binds to recombinant human mineralocorticoid receptors relative to its binding to recombinant human glucocorticoid, progesterone and androgen receptors.
Trade Name | Espiro |
Availability | Prescription only |
Generic | Eplerenone |
Eplerenone Other Names | Eplerenona, Eplerenone, Epoxymexrenone |
Related Drugs | amlodipine, lisinopril, metoprolol, losartan, furosemide, carvedilol, hydrochlorothiazide, spironolactone |
Type | |
Formula | C24H30O6 |
Weight | Average: 414.4914 Monoisotopic: 414.204238692 |
Protein binding | 50% |
Groups | Approved |
Therapeutic Class | Potassium-sparing diuretics, Potassium-sparing diuretics & Aldosterone antagonists |
Manufacturer | |
Available Country | Poland, Russia |
Last Updated: | September 19, 2023 at 7:00 am |
Uses
Congestive heart failure after an acute myocardial infarction, Hypertension.
Espiro is also used to associated treatment for these conditions: High Blood Pressure (Hypertension), LVEF <40% Congestive heart failure, Chronic heart failure with reduced ejection fraction (NYHA Class II)
How Espiro works
Espiro binds to the mineralocorticoid receptor and thereby blocks the binding of aldosterone (component of the renin-angiotensin-aldosterone-system, or RAAS). Aldosterone synthesis, which occurs primarily in the adrenal gland, is modulated by multiple factors, including angiotensin II and non-RAAS mediators such as adrenocorticotropic hormone (ACTH) and potassium. Aldosterone binds to mineralocorticoid receptors in both epithelial (e.g., kidney) and nonepithelial (e.g., heart, blood vessels, and brain) tissues and increases blood pressure through induction of sodium reabsorption and possibly other mechanisms.
Dosage
Espiro dosage
Congestive Heart Failure after an acute Myocardial Infarction:The recommended dose of Espiro is 50 mg once daily. Treatment should be initiated at 25 mg once daily and titrated to the target dose of 50 mg once daily preferably within 4 weeks as tolerated by the patient. Espiro may be administered with or without food.
Hypertension: Espiro may be used alone or in combination with other antihypertensive agents. The recommended starting dose of Espiro is 50 mg administered once daily. For patients with an inadequate blood pressure response to 50 mg once daily the dosage of Espiro should be increased to 50 mg twice daily. Higher dosages of Espiro are not recommended either because they have no greater effect on blood pressure than 100 mg or because they are associated with an increased risk of hyperkalemia.
Side Effects
Headache, dizziness, diarrhea, stomach pain, nausea, cough or flu-like symptoms may occur. Symptoms of a serious allergic reaction like: rash, itching, swelling, severe dizziness, trouble breathing can occur.
Toxicity
The most likely symptoms of human overdosage would be anticipated to be hypotension or hyperkalemia. However, no cases of human overdosage with eplerenone have been reported.
Precaution
Espiro should be used with caution in hyperkalemia, severe kidney disease, diabetic patients with congestive heart failure after an acute myocardial infarction including those with proteinuria.
Interaction
May increase risk of hyperkalaemia with ACE inhibitors and/or angiotension receptor blocker, ciclosporin, tacrolimus, trimethoprim. May reduce antihypertensive effect with NSAIDs, glucocorticoids, tetracosactide. May enhance hypotensive effect of α1-blockers (e.g. alfuzosin, prazosin), TCAs, amifostine, baclofen, neuroleptics. May increase plasma level with mild to moderate CYP3A4 inhibitors (e.g. fluconazole, erythromycin, saquinavir, amiodarone, diltiazem, verapamil).
Food Interaction
- Avoid grapefruit products. Grapefruit juice may increase the serum levels of eplerenone by 25% by inhibiting CYP3A4.
- Take with or without food.
Espiro Alcohol interaction
[Moderate]
Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation.
Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.
Caution and close monitoring for development of hypotension is advised during coadministration of these agents.
Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs.
Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.
Espiro Drug Interaction
Moderate: aspirin, aspirin, sacubitril / valsartan, sacubitril / valsartanUnknown: apixaban, apixaban, omega-3 polyunsaturated fatty acids, omega-3 polyunsaturated fatty acids, furosemide, furosemide, metoprolol, metoprolol, clopidogrel, clopidogrel, cyanocobalamin, cyanocobalamin, ascorbic acid, ascorbic acid, cholecalciferol, cholecalciferol
Espiro Disease Interaction
Major: diabetes type II and microalbuminuria, hyperkalemia, renal dysfunctionModerate: liver disease
Volume of Distribution
- 43 to 90 L
Elimination Route
The absolute bioavailability of eplerenone is unknown.
Half Life
4-6 hours
Clearance
- Apparent plasma cl=10 L/hr
Pregnancy & Breastfeeding use
Pregnancy: There are no adequate and well-controlled studies in pregnant women. Espiro should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Lactation: The concentration of Espiro in human breast milk after oral administration is unknown. Because many drugs are excreted in human milk and because of the unknown potential for adverse effects on the nursing infant, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.
Contraindication
Espiro is contraindicated in-
- Hyperkalaemia
- Severe renal impairment (creatinine clearance less than 30 ml/min)
- Severe hepatic impairment
- Concomitant use with potent CYP3A4 inhibitors like Ketoconazole, Itraconazole, Nefazodone, Troleandomycin, Clarithromycin, Ritonavir, and Nelfinavir or other
- Potassium-sparing diuretics are also contraindicated
Special Warning
Pediatric use: The safety and effectiveness of Espiro has not been established in pediatric patients.
Geriatric use: No differences in overall incidence of effectivity or safety was observed in elderly patients.
Acute Overdose
Symptoms: Hyperkalaemia, hypotension.
Management: Symptomatic and supportive treatment. Admin activated charcoal. Initiate standard therapy for hyperkalaemia.
Storage Condition
Store below 30°C in a cool and dry place, protected from light and moisture. Keep out of children’s reach.
Innovators Monograph
You find simplified version here Espiro
Espiro contains Eplerenone see full prescribing information from innovator Espiro Monograph, Espiro MSDS, Espiro FDA label