Introduction
Aldonist is a medicine known as a diuretic (water pill). It is mainly used in the treatment of heart failure and high blood pressure. It is also used to reduce swelling (oedema) caused by some other conditions.
Aldonist can be taken with or without food, but you should take it in the same way each time to get the most benefit. Taking it with food can reduce some side effects and taking it early in the day can prevent you from having to get up at night to go to the toilet. You should keep using this medicine as it has been prescribed, even if you feel well. If you stop taking it, your condition may get worse. Follow your doctor's advice about the type and amount of liquids you should drink. If you are being treated for high blood pressure, lifestyle changes such as taking regular exercise and changes to your diet may increase the effectiveness of this medicine.
The common side effects include nausea, dizziness, diarrhea, headache and cough. If these bother you, or appear serious, let your doctor know. There may be ways of reducing or preventing them. Drinking alcohol can increase certain side effects.
You should be careful about using Aldonist if you have kidney problems or are unable to urinate. Before taking it, tell your doctor if you have ever had kidney, liver or heart disease or you are pregnant. Also let your healthcare team know about all other medications you are using as they may affect, or be affected by this medicine. This medicine should only be used if it is clearly needed during pregnancy and while breastfeeding. While using this medicine, you may be advised to limit your intake of salt or salt substitutes, and you should have your blood pressure checked frequently. Some other tests will be done to monitor your progress.
Uses of Aldonist
- Hypertension (high blood pressure)
- Edema
Side effects of Aldonist
Common
- Dizziness
- Diarrhea
- Nausea
- Cough
- Flu-like symptoms
- Fatigue
- Increased potassium level in blood
- Increased creatinine level in blood
How to use Aldonist
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Aldonist may be taken with or without food, but it is better to take it at a fixed time.
How Aldonist works
Aldonist is a potassium-sparing diuretic. It lowers blood pressure and swelling by removing the extra water and electrolytes from the body without loss of potassium.
What if you forget to take Aldonist?
If you miss a dose of Aldonist, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.
Indication
Hypertension, Heart failure, Congestive heart failure, Left ventricular dysfunction, Acute myocardial infarction
Administration
May be taken with or without food.
Adult Dose
Hypertension (HTN)
Initial 50 mg PO qDay; may increase to 50 mg PO q12hr; may take up to four weeks for full therapeutic response; hyperkelemia may occur with doses >100 mg/day
Heart Failure Post MI
Initial 25 mg PO qDay; may titrate to maximum of 50 mg once daily within 4 weeks as tolerated
Dose adjustments may be required based on potassium levels
Hepatic Impairment
Dose adjustment not necessary
Renal Dose
Renal Impairment
Contraindicated if CrCl <50 mL/min or serum creatinine >2 mg/dL in males or >1.8 mg/dL in females
Contraindication
For all patients: Serum potassium >5.5 mEq/L at initiation; CrCl ?30 mL/min; concomitant use of strong CYP3A4 inhibitors (e.g. ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir). For patients treated for hypertension: Patients with type 2 DM with microalbuminuria; serum creatinine >2 mg/dL (male), or >1.8 mg/dL (female); CrCl <50 mL/min; concomitant use of potassium supplements or potassium-sparing diuretics (e.g. amiloride, spironolactone, or triamterene).
Mode of Action
Aldosterone binds to mineralocorticoid receptors in both epithelial (e.g. kidney, GI tract) and nonepithelial (e.g. heart, blood vessels, brain) tissues; causing increases in blood pressure by inducing sodium reabsorption, vascular remodeling, water retention and possibly other mechanisms. Eplerenone is a relatively selective mineralocorticoid receptor antagonist, blocking binding of aldosterone and reducing blood pressure. Eplerenone also appears to have cardioprotective effect in patients with congestive heart failure (CHF) after myocardial infarction (MI).
Precaution
Measure serum potassium levels before starting therapy, within the first wk, and periodically thereafter. Increased risk of hyperkalaemia in patients with impaired renal functions; diabetic patients with CHF post-MI (especially those with proteinuria); or concurrent use of agents affecting the rennin-angiotensin-aldosterone system. Safety and efficacy not established in patients with severe hepatic impairment; or paediatric patients <18 yr. Elderly. Pregnancy and lactation.
Lactation: unknown if excreted into breast milk, discontinue drug or nursing
Side Effect
1-10%
Hyperkalemia (2-10%),Increased risk of hyperkalemia with presence of renal dysfunction
1-3%
Dizziness,Fatigue/malaise,Abdominal pain,Diarrhea,Albuminuria,Hypercholesterolemia,Hypertriglyceridemia,Cough
<1%
Abnormal vaginal bleeding,Gynecomastia,Mastodynia
Pregnancy Category Note
Pregnancy
Available data from published case reports on eplerenone use during pregnancy are insufficient to establish a drug-associated risk of major birth defects, miscarriage, adverse maternal or fetal outcomes; in animal studies, no adverse developmental effects were observed when eplerenone was administered to pregnant rats and rabbits during organogenesis at exposures 32 and 31 times, respectively the human exposure at the 100 mg/day therapeutic dose
Hypertension in pregnancy increases maternal risk for pre-eclampsia, gestational diabetes, premature delivery, and delivery complications (e.g., need for cesarean section, and post-partum hemorrhage); hypertension increases fetal risk for intrauterine growth restriction and intrauterine death; pregnant women with hypertension should be carefully monitored and managed accordingly
Infertility
Based on animal data, therapy may compromise male fertility; in mature rates, male fertility was decreased with eplerenone exposure at 17 times the 100 mg/day human therapeutic dose; reversibility of effect, not evaluated
Lactation
There are no human data available on whether eplerenone is present in human milk, or has effects on breastfed infants or on milk production; eplerenone was present in milk of lactating rats; when a drug is present in animal milk, it is likely that the drug will be present in human milk
Interaction
Concomitant use with CYP3A4 Inhibitors (e.g. ketoconazole, voriconazole, itraconazole, fluconazole, clarithromycin, diltiazem saquinavir, verpamil, ritonavir) may increase serum concentrations of Eplerenone. CYP3A4 inducers (e.g. rifampicin, carbamazepine, phenytoin, phenobarbital) may decrease Eplerenone efficacy. Eplerenone may enhance hyperkalaemic effect of ACE inhibitors, angiotensin II receptor blockers, potassium-sparing diuretics or potassium salts.
Concomitant use with diazoxide, MAOIs, pentoxifylline, prostacyclin analogues may enhance hypotensive effect of antihypertensives.
NSAIDs may possibly reduce the antihypertensive and/or diuretic effects of potassium-sparing diuretics and may increase risk of hyperkalaemia. Lithium toxicity has been reported when used with ACE inhibitors or diuretics; monitor lithium levels when used with Eplerenone.