Inspra

Basic Inspra information

• INN (international nonproprietary name): Eplerenone
• Brand names available in the United Kingdom: Inspra
• ATC code: C03DA04
• Forms and dosages: Film-coated tablets 25 mg, 50 mg
• Manufacturers in the United Kingdom: Viatris and generic manufacturers
• Registration status in the United Kingdom: Prescription-only medicine (POM)
• OTC / Rx classification: Prescription-only medicine (POM)

Everyday use and best practices

Inspra is taken once daily and can be taken in the morning or evening. Choose a consistent time each day to maintain stable blood levels of the medicine.

Taking with or without meals

Inspra tablets can be taken with or without food. Avoid grapefruit juice, which can raise eplerenone levels.

Safety priorities

Certain patient groups should avoid Inspra. Individuals with severe renal impairment (eGFR <30 mL/min/1.73m²), severe hepatic impairment, or known hypersensitivity to eplerenone or its components should not take it. Patients with a serum potassium level above 5.0 mmol/L at the time of initiation should also not start it.

Activities to limit

Dizziness and low blood pressure are possible side effects that might impair coordination or alertness. Assess how you react to the medicine before driving or operating machinery, and avoid such tasks if you feel dizzy.

Dosage and adjustments

Inspra treatment typically begins at 25 mg once daily. If tolerated, this is increased to a maximum of 50 mg once daily, usually within four weeks, guided by serum potassium levels. Do not exceed the prescribed dose without consulting your healthcare provider.

Special cases

Elderly patients may respond differently because of age-related changes in kidney function. People with renal impairment need their potassium levels and kidney function closely monitored, and severe renal impairment is a reason to avoid the medicine. A healthcare provider will assess safety individually.

What’s inside and how it works

Ingredients overview

Inspra contains the active substance eplerenone, a selective aldosterone antagonist that counteracts the effects of aldosterone, a hormone that can lead to fluid retention and raised blood pressure.

In addition to eplerenone, each Inspra tablet (available in 25 mg and 50 mg) includes film-coating agents and other excipients.

Mechanism basics explained simply

Eplerenone blocks aldosterone receptors, leading to less sodium and water retention and reduced strain on the heart.

Main indications

Approved uses (MHRA listing)

Inspra is licensed in the UK, in addition to standard optimal therapy, to reduce the risk of cardiovascular death and hospitalisation in patients with heart failure after a recent myocardial infarction who have left ventricular dysfunction, and in adults with chronic heart failure (NYHA class II) and left ventricular systolic dysfunction.

The usual starting dose is 25 mg once daily, which can be increased to 50 mg once daily within about four weeks, depending on serum potassium.

Off-label uses in UK clinics

Beyond its licensed uses, eplerenone is sometimes used by specialists for resistant hypertension, but this is outside the licence in the UK.

Interaction warnings

Food interactions (alcohol, tea/coffee)

Alcohol can add to the blood pressure-lowering effect of eplerenone and may increase the risk of dizziness. Grapefruit juice can raise eplerenone levels and should be avoided.

Drug conflicts

Strong CYP3A4 inhibitors, such as ketoconazole and clarithromycin, can significantly raise eplerenone levels and must not be used with Inspra. Concurrent use with potassium-sparing diuretics or potassium supplements is not permitted because of the risk of hyperkalaemia, and other medicines that raise potassium (such as ACE inhibitors and angiotensin receptor blockers) need careful potassium monitoring. Suspected side effects can be reported through the Yellow Card scheme.

Alternative choices

When considering alternatives to Inspra on the NHS, several options arise.

• Spironolactone: another aldosterone antagonist, which has a higher risk of side effects such as breast enlargement (gynaecomastia) because it is less selective.
• Loop diuretics (e.g., furosemide): not direct competitors, but commonly used in heart failure alongside other treatments.

The choice should be made by a healthcare professional based on the individual patient.

Regulation snapshot

Inspra (eplerenone) is a prescription-only medicine (POM) licensed by the MHRA for heart failure after myocardial infarction with left ventricular dysfunction and for chronic heart failure with systolic dysfunction. Because it is prescription-only, patients need a prescription from a doctor to start treatment, and potassium levels and kidney function are monitored during treatment.

Frequently asked questions

Common questions about Inspra:

What are the potential side effects of Inspra? Patients may experience mild to moderate side effects, such as dizziness, fatigue, or hyperkalaemia—an elevated potassium level, which is the most significant concern associated with this medication. Monitoring potassium levels is essential.

How long should I be on Inspra? Treatment duration varies depending on individual health conditions. Typically, patients will remain on Inspra long-term for conditions like heart failure, often for months or even years, with regular evaluations by their healthcare provider to assess effectiveness.

Can I stop taking Inspra suddenly? It’s crucial never to stop medication without consulting a healthcare professional. Abrupt discontinuation can lead to serious health consequences, particularly concerning hypertension management.

Will I need regular check-ups? Yes, regular follow-ups are necessary to ensure that Inspra is working effectively and to monitor for any side effects. Blood tests may be required to check potassium levels and overall kidney function.

Guidelines for proper use

UK pharmacist counselling style

When dispensing Inspra, the pharmacist will typically discuss:

• Proper dosage and administration techniques.
• Potential interactions with other medications, particularly those affecting potassium levels.
• Understanding side effects and when to seek medical attention.

Pharmacists also explain what to do in case of a missed dose.

NHS patient support advice

The NHS provides information for patients prescribed Inspra, including the patient information leaflet and NHS 111 for advice on medication-related concerns.