Eplerenone - Heart failure

GENERIC Eplerenone has been considered by the PCN and has been assigned a BLUE traffic light status. Transfer to primary care only after initiation and at least the first month supply from the specialist.

NOTE - the branded product, Inspra, was considered BLACK at the PCN in May 2017.

The Surrey Heart and Stroke Network requested that the PCN reconsider their recommendations made in January 2012 where Eplerenone should be reserved for patients that cannot tolerate/ have a contraindication to spironolactone. The network members noted the license for eplerenone and concurred that it is currently licensed for patients with New York Heart Association (NYHA) Class II chronic heart failure. They concurred that spironolactone should continue to be the first line aldosterone antagonist at all stages of heart failure with eplerenone used in patients who have side effects with spironolactonee.g. gynaecomastia, or perhaps a significant fear of gynaecomastia. This would be on the basis that spironolactone has high quality, randomised controlled trial evidence of effectiveness from the RALES study in heart failure NYHA class III or IV, established data for hyperkalaemia risks, it is likely (but not known) that spironolactone would also be effective at other stages of heart failure as well as NYHA III and IV, and it has a broad licence for congestive cardiac failure which is not restricted to any heart failure class.

Spironolactone should be 1st line with eplerenone reserved for patients with NYHA class II CHF who are intolerant to/ have contraindications to spironolactone. Eplerenone should also only be initiated under the supervision of a cardiologist and as such will be considered amber*. The document will be uploaded again once the amber* document has been through internal governance processes at the actue trusts and contact details have been added.