What is a Patient Information Leaflet and why is it useful?

The Patient Information Leaflet (PIL) is the leaflet included in the pack with a medicine. It is written for patients and gives information about taking or using a medicine. It is possible that the leaflet in your medicine pack may differ from this version because it may have been updated since your medicine was packaged.

Below is a text only representation of the Patient Information Leaflet. The original can be viewed in PDF format using the link above.

The text only version may be available from RNIB in large print, Braille or audio CD. For further information call RNIB Medicine Leaflet Line on 0800 198 5000. The product code(s) for this leaflet is: PL 35533/0050 .

Eplerenone 25mg and 50mg film-coated tablets

Package leaflet: Information for the user

Eplerenone 25mg film-coated tablets

Eplerenone 50mg film-coated tablets

eplerenone

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

  • Keep this leaflet. You may need to read it again.
  • If you have any further questions, ask your doctor or pharmacist.
  • This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
  • If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet

1. What Eplerenone is and what it is used for
2. What you need to know before you take Eplerenone
3. How to take Eplerenone
4. Possible side effects
5. How to store Eplerenone
6. Contents of the pack and other information

1. What Eplerenone is and what it is used for

Eplerenone belongs to a group of medicines known as selective aldosterone blocking agents. These blocking agents inhibit the action of aldosterone, a substance produced within the body, which controls your blood pressure and heart function. High levels of aldosterone can cause changes in your body that lead to heart failure.

Eplerenone is used to treat your heart failure; to prevent it worsening and reduce hospitalisation if you:

1. have had a recent heart attack, and in combination with other medicines that are used to treat your heart failure, or
2. have persistent, mild symptoms despite the treatment you have been receiving so far.

2. What you need to know before you take Eplerenone

Do not take Eplerenone

  • if you are allergic to eplerenone or any of the other ingredients of this medicine (listed in section 6).
  • if you have high levels of potassium in your blood (hyperkalemia).
  • if you are taking groups of medicines which help you to excrete excessive body fluid (potassium sparing diuretics).
  • if you have severe kidney disease.
  • if you have severe liver disease.
  • if you are taking medicines that are used to treat fungal infection (ketoconazole or itraconazole).
  • if you are taking antiviral medication for treating HIV (nelfinavir or ritonavir).
  • if you are taking antibiotics used to treat bacterial infections (clarithromycin or telithromycin).
  • if you are taking nefazodone used to treat depression.
  • if you are taking medicines used to treat certain heart conditions or hypertension (called angiotensin converting enzyme [ACE] inhibitors and angiotensin receptor blockers [ARB]) together.

Warnings and precautions

Talk to your doctor or pharmacist before taking Eplerenone:

  • if you have kidney or liver disease (see also ‘Do not take Eplerenone’)
  • if you are taking lithium (usually given for manic depressive disorder, also called bipolar disorder)
  • if you are taking tacrolimus or cyclosporin (used to treat skin conditions such as psoriasis or eczema, and to prevent rejection after organ transplantation)

Children and adolescents

The safety and efficacy of eplerenone in children and adolescents have not been established.

Other medicines and Eplerenone

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

You must not take Eplerenone with the following medications (see section ‘Do not take Eplerenone’):

  • Itraconazole or ketoconazole (used to treat fungal infections), ritonavir, nelfinavir (antiviral medication for treating HIV), clarithromycin, telithromycin (used to treat bacterial infections) or nefazodone (used to treat depression) as these medicines reduce the break-down of Eplerenone, thereby prolonging its effect on the body.
  • Potassium sparing diuretics (medicines which help you to excrete excess body fluid) and potassium supplements (salt tablets) as these medicines increase the risk of high potassium levels in your blood.
  • Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) together (which are used to treat high blood pressure, heart disease or particular kidney conditions) as these medicines may increase the risk of high potassium levels in your blood.

Please inform your doctor if you are taking any of the following medicines:

  • Lithium (usually given for manic depressive disorder, also called bipolar disorder).
    Use of lithium together with diuretics and ACE inhibitors (used to treat high blood pressure and heart disease) has been shown to cause levels of lithium in the blood to become too high, which may cause side effects of: loss of appetite; visual impairment; tiredness; muscle weakness; muscle twitches.
  • Cyclosporin or tacrolimus (used to treat skin conditions such as psoriasis or eczema, and to prevent rejection after organ transplantation). These medicines can cause kidney problems and therefore increase the risk of high potassium levels in your blood.
  • Non-steroidal anti-inflammatory drugs (NSAIDs- certain pain killers such as ibuprofen, used to relieve pain, stiffness and inflammation). These medicines may lead to kidney problems and therefore, increase the risk of high potassium levels in your blood.
  • Trimethoprim (used to treat bacterial infections) may increase the risk of high potassium levels in your blood.
  • Alpha I blockers, such as prazosin or alfuzosin (used to treat high blood pressure and particular prostate conditions) may lead to a fall in blood pressure and dizziness upon standing.
  • Tricyclic antidepressants such as amitryptyline or amoxapine (for treatment of depression), antipsychotics (also known as neuroleptics) such as chlorpromazine or haloperidol (for the treatment of psychiatric disorders), amifostine (used during cancer chemotherapy) and baclofen (used to treat muscle spasm). These medicines may lead to a fall in blood pressure and dizziness upon standing.
  • Glucocorticoids, such as hydrocortisone or prednisone (used to treat inflammation and certain skin conditions) and tetracosactide (mainly used for diagnosing and treating disorders of the adrenal cortex) may reduce the blood-pressure lowering effect of Eplerenone.
  • Digoxin (used in the treatment of heart conditions). Digoxin blood levels may be increased when taken together with Eplerenone.
  • Warfarin (an anti-clotting medicine): Caution is warranted when taking warfarin because high levels of warfarin in the blood may cause changes in the effect of Eplerenone on the body.
  • Erythromycin (used to treat bacterial infections), saquinavir (antiviral medication for treating HIV), fluconazole (used to treat fungal infections), amiodarone, diltiazem and verapamil (for the treatment of heart problems and high blood pressure) reduce the break-down of Eplerenone thereby prolonging the effect of Eplerenone on the body.
  • St John’s Wort (herbal medicinal product), rifampicin (used to treat bacterial infections), carbamazepine, phenytoin, and phenobarbital (used, among others, to treat epilepsy) may increase the break-down of Eplerenone and thus decrease its effect.

Eplerenone with food and drink

Eplerenone may be taken with or without food.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

The effect of Eplerenone has not been evaluated during pregnancy in humans.

It is not known if eplerenone is excreted in human breast milk. A decision should be made with your doctor, whether to discontinue breast-feeding or to discontinue the medicine.

Driving and using machines

You may feel dizzy after taking Eplerenone. If this should happen, do not drive or operate machinery.

Eplerenone contains lactose monohydrate

Eplerenone contains lactose monohydrate (a type of sugar). If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

Eplerenone contains sodium

This medicine contains less than 1 mmol sodium (23mg) per tablet, that is to say essentially ‘sodium-free’.

3. How to take Eplerenone

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

Eplerenone tablets may be taken together with food or on an empty stomach. Swallow the tablets whole with plenty of water.

Eplerenone is usually administered together with other medication for heart failure e.g. beta blockers. The usual starting dose is one 25mg tablet once daily, increasing after about 4 weeks to 50mg once daily (either as one 50mg tablet or two 25mg tablets). The maximum dose regimen is 50mg daily.

Blood potassium levels should be measured before starting Eplerenone therapy, within the first week and at one month after the start of treatment or after a change in dose. The dose may be adjusted by your doctor, depending on the potassium levels in your blood.

Patients with kidney or liver problems

If you have mild kidney disease, you should start on one 25mg tablet every day. If you have moderate kidney disease, you should start on one 25mg tablet every other day. These doses may be adjusted if your doctor recommends and according to your blood potassium levels.

In patients with severe kidney disease, Eplerenone is not recommended.

In patients with mild-to-moderate liver disease no adjustment of the starting dose is required. If you have liver or kidney problems, you may need more frequent testing of your blood potassium levels (see also ‘Do not take Eplerenone’).

Elderly patients

No adjustment of the starting dose is required.

Use in children and adolescents

Eplerenone is not recommended.

If you take more Eplerenone than you should

If you take more Eplerenone than you should, tell your doctor or pharmacist immediately. If you have taken too much of your medicine, the most likely symptoms will be low blood pressure (expressed as a light feeling in your head, dizziness, blurred vision, weakness, acute loss of consciousness) or hyperkalemia, high levels of potassium in the blood (expressed by muscle cramps, diarrhoea, nausea, dizziness or headache).

If you forget to take Eplerenone

If it is almost time for your next tablet, skip the tablet you missed and take your next tablet when it is due. Otherwise take the tablet as soon as you remember, providing there is more than 12 hours to when you are due to take your next tablet. Then go back to taking your medicine as you would normally.

Do not take a double dose to make up for the forgotten tablet.

If you stop taking Eplerenone

It is important to keep taking Eplerenone as prescribed unless your doctor tells you to stop your treatment.

If you have any further questions on the use of this medicine ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

If you experience any of the following, you should seek immediate medical attention

  • swollen face, tongue or throat
  • difficulty swallowing
  • hives and difficulty breathing

These are the symptoms of angioneurotic oedema, an uncommon (affecting up to 1 in 100 people) side effect.

Other reported side effects include:

Common side effects (may affect up to 1 in 10 people):

  • elevated potassium level in your blood (symptoms include muscle cramps, diarrhoea, nausea, dizziness or headache)
  • fainting
  • dizziness
  • elevated quantity of cholesterol in your blood
  • insomnia (difficulty sleeping)
  • headache
  • heart complaints e.g. irregular heartbeat and heart failure
  • cough
  • constipation
  • low blood pressure
  • diarrhoea
  • nausea
  • vomiting
  • abnormal functioning of your kidney
  • rash
  • itching
  • back pain
  • feeling weak
  • muscle spasm
  • increased urea levels in the blood
  • increased creatinine blood levels which may indicate kidney problems

Uncommon side effects (may affect up to 1 in 100 people):

  • infection
  • eosinophilia (increase in certain white blood cells)
  • low levels of sodium in the blood
  • dehydration
  • elevated quantity of triglycerides (fats) in your blood
  • fast heartbeat
  • inflammation of the gall bladder
  • decreased blood pressure that can cause dizziness upon standing
  • thrombosis (blood clot) in the leg
  • sore throat
  • flatulence
  • underactive thyroid
  • increase in blood glucose
  • reduced sense of touch
  • increased sweating
  • musculoskeletal pain
  • feeling generally unwell
  • kidney inflammation
  • enlargement of breasts in men
  • changes in some blood test results

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme (website www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store). By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Eplerenone

Keep this medicine out of the sight and reach of children.

This medicine does not require any special storage conditions.

Do not use this medicine after the expiry date which is stated on the pack and blister after ‘EXP’. The expiry date refers to the last day of that month.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information

What Eplerenone contains

  • The active substance of this medicine is eplerenone. Each tablet contains 25mg or 50mg of eplerenone.
  • The other ingredients are: lactose monohydrate, microcrystalline cellulose (E460), croscarmellose sodium (Type A), hypromellose (Benecel E3), talc and magnesium stearate.

The opadry yellow coating of Eplerenone 25mg and 50mg film-coated tablets contain macrogol/PEG 6000, HPMC 2910/Hypromellose 5cP, talc (E553b), titanium dioxide (E171), iron oxide yellow (E172), iron oxide red (E172).

What Eplerenone looks like and contents of the pack

Eplerenone 25mg film-coated tablets are presented as yellow, round biconvex tablets, engraved with ‘E25’ on one side.

Eplerenone 50mg film-coated tablets are presented as yellow, round biconvex tablets, engraved with ‘E50’ on one side.

Eplerenone 25mg and 50mg film-coated tablets are available in a cardboard box containing white opaque PVC-Aluminium foil blisters with 10, 20, 28, 30, 50, 90, 100, and 200 film-coated tablets.

Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder

Aspire Pharma Limited
Unit 4
Rotherbrook Court
Bedford Road
Petersfield
Hampshire
GU32 3QG
United Kingdom

Manufacturer

Pharmathen S.A.
6, Dervenakion str.
15351
Pallini
Attiki
Greece

or

Pharmathen International S.A.
Sapes Industrial Park Block 5
69300 Rodopi
Greece

This leaflet was last revised in 04/2018

1010262-P4.10