Using this page · Individualise medicines monitoring

This medicines monitoring page has been written using publications and expert opinion. It is designed to save clinician time, but not replace professional responsibility. When using this page you should: ensure an individualised monitoring plan is developed in partnership with the patient and take account of any locally agreed advice and guidance.

Before starting

Required

  • Baseline
    • Estimated glomerular filtration ratecontraindicated if eGFR less than 30mL/min/1.73m2; reduce starting dose to 25 mg on alternate days if eGFR 30–60 mL/minute/1.73 m2
    • Serum potassiumcontraindicated if over 5.0 mmol/L
    • Electrolytes

After started or dose changed

Required

  • After 1 week, then monthly for the first 3 months
    • Estimated glomerular filtration rate
    • Serum potassiumadjust dose to level
  • Before and after each dose change
    • Blood pressure

Post myocardial infarction with heart failure

  • After 48 hours
    • Estimated glomerular filtration rate
    • Serum potassium
    • Electrolytes

Ongoing once stable

Required

  • Periodically
    • Estimated glomerular filtration rate
    • Serum potassiumadjust dose to level

Abnormal results

Renal function

  • Stop if eGFR less than 30mL/min/1.73m2
  • Reduce dose and monitor serum potassium if eGFR under 60mL/min/1.73m2

Adjusting doses to serum potassium

After initiation, adjust dose to potassium level.

Level lower than 5.0 mmol/L

  • If dose normally 25mg every other day, increase to 25mg daily
  • If dose normally 25mg daily, increase to 50mg daily

Level between 5.0 mmol/L and 5.4 mmol/L

  • No dose adjustment required

Level between 5.5 mmol/L and 5.9 mmol/L

  • If dose normally 25mg every other day, then withhold
  • If dose normally 25mg daily, reduce to 25mg every other day
  • If dose normally 50mg daily, reduce to 25mg daily

Notes

Advice to patients

Advise patients to:

  • Avoid concomitant NSAIDs that have not been prescribed (e.g. those bought over the counter)
  • Avoid salt substitutes containing potassium
  • Be aware of diarrhoea, vomiting, or infections with fever and sweating; stop eplerenone if this occurs and contact specialist

Bibliography

Enquiries about this page

Contact us if you have any enquiries about the drug monitoring information on this page.