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aldosterone receptor antagonist (aldosterone antagonist)

Indications: 1) heart failure, myocardial infarction - mortality benefit after STEMI with or without heart failure [4] - LVEF < 40% after NSTEMI 2) renal disease a) chronic renal disease due to diabetic nephropathy b) nephrotic syndrome 3) hyperaldosteronism [2] 4) hypertension 5) edema, including peripheral edema, ascites, pulmonary edema 6) cirrhosis 7) polycystic ovary syndrome 8) hypokalemia [2] Adverse effects: - hyperkalemia - little effect on blood pressure [6] Drug interactions: - coadministration of ACE inhibitor or ARB with aldosterone antagonist associated with risk of hyperkalemia - risk for severe hyperkalemia is lower with coadministration of sacubitril/valsartan than with enalapril [3]

Interactions

drug interactions drug adverse effects (more general classes)

Related

K+ sparing diuretic mineralocorticoid receptor; MR; nuclear receptor subfamily 3 group C member 2 (NR3C2, MCR, MLR)

Specific

baxdrostat epleronone (Inspra) lorundrostat spironolactone (Aldactone)

General

hormone antagonist renin-angiotensin-aldosterone system inhibitor (RAAS inhibitor)

References

  1. Rossing K et al. Beneficial effects of adding spironolactone to recommended antihypertensive treatment in diabetic nephropathy. A randomized, double-masked, cross-over study. Diabetes Care 2005 Sep; 28:2106-12. PMID: 16123474
  2. Deprecated Reference
  3. Desai AS, Vardeny O, Claggett B et al Reduced Risk of Hyperkalemia During Treatment of Heart Failure With Mineralocorticoid Receptor Antagonists by Use of Sacubitril/ Valsartan Compared With Enalapril. A Secondary Analysis of the PARADIGM-HF Trial. JAMA Cardiol. Published online November 14, 2016 PMID: 27842179 http://jamanetwork.com/journals/jamacardiology/article-abstract/2583456 - Ezekowitz JA Hyperkalemia, Sacubitril/Valsartan, and Mineralocorticoid Antagonists in Patients With Heart Failure. JAMA Cardiol. Published online November 14, 2016 PMID: 27842180 http://jamanetwork.com/journals/jamacardiology/article-abstract/2583455
  4. Dahal K, Hendrani A, Sharma SP et al Aldosterone Antagonist Therapy and Mortality in Patients With ST-Segment Elevation Myocardial Infarction Without Heart Failure. A Systematic Review and Meta-analysis. JAMA Intern Med. Published online May 21, 2018 PMID: 29799995 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2681656 - Pitt B, Zannad F. Mineralocorticoid Receptor Antagonists in ST-Segment Elevation Myocardial Infarction JAMA Intern Med. Published online May 21, 2018 PMID: 29799990 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2681651
  5. NEJM Knowledge+
  6. Writing Committee; Hollenberg SM, Stevenson LW, Ahmad T et al 2024 ACC Expert Consensus Decision Pathway on Clinical Assessment, Management, and Trajectory of Patients Hospitalized With Heart Failure Focused Update: A Report of the American College of Cardiology Solution Set Oversight Committee J Am Coll Cardiol. 2024 Aug 2:S0735-1097(24)07449-7. PMID: 39127954 https://www.jacc.org/doi/10.1016/j.jacc.2024.06.002