Eplerenone - Heart failure

Surrey & Sussex APC: An application to change the formulary status of eplerenone, for its licensed indication, from BLUE to GREEN was approved for Surrey, aligning it with the Sussex existing position.

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.