Aldosterone receptor antagonists: Diuretics for heart failure

Examples

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Brand Name	Chemical Name
Inspra [approved by FDA for high blood pressure]	eplerenone

Brand Name	Chemical Name
Aldactone	spironolactone

How It Works

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Aldosterone receptor antagonists are medicines that help the body get rid of extra salt and water (diuretics). They also have other properties that can prevent heart failure from becoming worse, along with improving symptoms of heart failure.¹

These medicines cause the kidneys to get rid of extra salt and fluid, and they help hold on to (retain) potassium by inhibiting the action of the hormone aldosterone. Because of this, they are called potassium-sparing diuretics.

Why It Is Used

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Aldosterone receptor antagonist medicines may be a good option for people with severe heart failure who are already taking other medicines (such as angiotensin-converting enzyme [ACE] inhibitors, other diuretics, digoxin, and beta-blockers).² These medicines have not been well-studied for use in people who have only mild to moderate heart failure. Aldosterone receptor antagonists belong to the class of medicines called potassium-sparing diuretics. This means that they are not associated with a loss of potassium like other diuretics.

How Well It Works

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Aldosterone receptor antagonists are the only diuretics that improve survival for people with heart failure. They lower the risk of death and hospitalization and improve symptoms of heart failure.^{1, 3}

In one study, people with severe heart failure who also took spironolactone had a 30% lower risk of death from the disease than those who were treated with standard therapy alone.¹

More research is needed to confirm the usefulness of this medicine in treating less severe forms of heart failure.

When spironolactone is combined with an ACE inhibitor, the combination may improve heart failure symptoms and decrease mortality.

Side Effects

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Side effects of aldosterone receptor antagonists include:

• Thirst.
• Skin rash.
• Menstrual abnormalities.
• Deepening of the voice.
• Breast enlargement in men.
• Abdominal cramping and tenderness, bloating, nausea, vomiting, or diarrhea.
• Erection problems.
• High potassium levels.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Because aldosterone receptor antagonists can increase potassium in the bloodstream, they are usually started at a very low dose and then gradually increased over time. Potassium levels need to be carefully monitored if you are taking them.

Avoid eating large amounts of potassium-rich foods.

If you have low blood pressure, you may feel tired for several weeks while your body adjusts to a decrease in blood pressure.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Pitt B, et al. (1999). The effect of spironolactone on morbidity and mortality in patients with severe heart failure. New England Journal of Medicine, 341(10): 709–717.

2. Heart Failure Society of America (2006). HFSA 2006 comprehensive heart failure practice guidelines: Executive summary. Journal of Cardiac Failure, 12(1): 10–38. Also available online: http://www.abouthf.org/guidelines.htm.

3. Pitt B, et al. (2003). Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. New England Journal of Medicine, 348(14): 1309–1321.

Credits

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Author	Robin Parks, MS
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Associate Editor	Terrina Vail
Primary Medical Reviewer	Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer	Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Last Updated	September 1, 2006