Inspra Dosage/Direction for Use

The maximum dose regimen is 50 mg daily for heart failure and 100 mg daily for hypertension.
Hypertension: Eplerenone may be used alone or in combination with other antihypertensive agents. The recommended starting dose of eplerenone is 50 mg administered once daily. If blood pressure is not adequately controlled, the dose of eplerenone can be increased to 100 mg daily.
Heart Failure - Post MI: The recommended maintenance dose of eplerenone is 50 mg once daily. Treatment should be initiated at 25 mg once daily and titrated in one step to the target dose of 50 mg once daily preferably within 4 weeks, taking into account the serum potassium level (see Table 1 Dose Adjustment Table in Heart Failure - Post MI). After initiation, the dose should be adjusted based on the serum potassium level as shown in Table 1 Dose Adjustment Table in Heart Failure - Post MI.
NYHA Class II (Chronic) Heart Failure: For chronic heart failure NYHA class II patients, treatment should be initiated at a dose of 25 mg once daily and titrated to the target dose of 50 mg once daily preferably within 4 weeks, taking into account the serum potassium level (see Table 1 Dose Adjustment Table in Heart Failure - Post MI and Precautions).

Click on icon to see table/diagram/image

Following withholding eplerenone due to serum potassium ≥6.0 mmol/L (or ≥6.0 mEq/L), eplerenone can be re-started at a dose of 25 mg every other day when potassium levels have fallen below 5.0 mmol/L (or 5.0 mEq/L).
General Considerations: Potassium: Serum potassium should be measured before initiating eplerenone therapy, within the first week and at one month after the start of treatment or dose adjustment. Serum potassium should be assessed periodically thereafter.
Food: Eplerenone may be administered with or without food.
Concomitant CYP3A4 Medications: Patients receiving mild to moderate CYP3A4 inhibitors, such as erythromycin, saquinavir, verapamil, and fluconazole should receive the dose of 25 mg once daily. (See Interactions.)
Special Populations and Special Considerations for Dosing: Use in Hepatic Impairment: Mild-to-Moderate Hepatic Impairment: No initial dose adjustment is necessary. (See Contraindications and Precautions.)
Use in Renal Impairment: No initial dose adjustment is required in patients with mild renal impairment. The rates of hyperkalemia increase with declining renal function. Periodic monitoring of serum potassium with dose adjustment according to Table 1 Dose Adjustment Table in Heart Failure - Post MI is recommended (see Precautions).
Patients with NYHA Class II (Chronic) Heart Failure and moderate renal impairment (CrCl 30-60 mL/min) should be started at 25 mg every other day, and dose should be adjusted based on the potassium level (see Table 1 Dose Adjustment Table in Heart Failure - Post MI). Periodic monitoring of serum potassium is recommended (see Precautions).
There is no experience in Post MI heart failure patients with CrCl <50 mL/min. The use of eplerenone in these patients should be done cautiously. Doses above 25 mg daily have not been studied in patients with CrCl <50 mL/min.
Use in patients with severe renal impairment (CrCl ˂30 mL/min) is contraindicated (see Contraindications). Eplerenone is not dialyzable.
For hypertensive patients with moderate-to-severe renal impairment or Type 2 diabetes with microalbuminuria, see Contraindications and Precautions.
Use in the Elderly: No initial adjustment of the dose is required in elderly patients (see Precautions).
Use in Children: Eplerenone has not been studied in hypertensive patients less than 4 years old because the study in older pediatric patients did not demonstrate efficacy. Currently available data are described in Pharmacology: Pharmacodynamics and Pharmacokinetics under Actions.
Safety and efficacy of eplerenone have not been studied in pediatric patients with heart failure.