Which medications in the drug class Aldosterone Antagonists, Selective are used in the treatment of Dilated Cardiomyopathy?

Updated: Mar 02, 2021
  • Author: Vinh Q Nguyen, MD, FACC; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Aldosterone Antagonists, Selective

Spironolactone is complementary to standard therapy in modulating the renin-angiotensin-aldosterone system (RAAS) because aldosterone levels remain elevated despite ACE inhibitor therapy. Spironolactone is currently indicated for treating patients with mild-to-severe heart failure (NYHA class II-IV) in addition to ACE inhibitors, beta-blockers, diuretics, and digoxin.

Aldosterone antagonist therapy should be used with great caution in patients with serum potassium levels greater than 5 mmol/L or those with serum creatinine levels greater than 2.5 mg/dL. Whether mortality is more significantly lowered by reduction and reversal of fibrosis or by maintenance of potassium/magnesium tissue levels is unclear.

Eplerenone (Inspra)

Eplerenone selectively blocks aldosterone at the mineralocorticoid receptors in epithelial (eg, kidney) and nonepithelial (eg, heart, blood vessels, and brain) tissues; thus, it decreases blood pressure and sodium reabsorption. This agent is indicated to improve survival for congestive heart failure or left ventricular dysfunction following acute myocardial infarction (MI). It is a more specific mineralocorticoid antagonist than spironolactone, and thus avoids the gynecomastia, breast pain, and menstrual disturbances common in patients on spironolactone.

Spironolactone (Aldactone)

Spironolactone is indicated for management of edema resulting from excessive aldosterone excretion. It competes with aldosterone for receptor sites in distal renal tubules, increasing water excretion while retaining potassium and hydrogen ions. Therapy may be switched to eplerenone in the presence of gynecomastia.

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