依普利酮的注意事项有哪些？

Patients must understand the precautions of the drug before taking it to avoid adverse reactions caused by improper use. What are the precautions?

Hyperkalemia: Hyperkalemia may occur; the risk of hyperkalemia is increased with renal impairment, proteinuria, diabetes mellitus, and in patients concurrently taking ACE (angiotensin-converting enzyme) inhibitors, angiotensin II inhibitors, NSAIDs, or moderate CYP3A inhibitors. Monitor closely for hyperkalemia; serum potassium increased dose-related during clinical trials. As hyperkalemia develops, dose reduction or treatment interruption may be necessary. If concomitant treatment with a moderate CYP3A4 inhibitor cannot be avoided, reduce the eplerenone dose. It is contraindicated in patients with potassium greater than 5.5 meq/L at the beginning of treatment.

Interactions between eplerenone and other drugs: (1) Combined use with ACEI, AⅡR antagonists, and β-receptor blockers can enhance the antihypertensive effect and have a synergistic effect in the treatment of heart failure. Combination with ACEI may cause an increase in serum potassium, so attention should be paid to monitoring serum potassium or adding potassium-depleting diuretics. (2) Combined use with hepatic cytochrome CYP3A4 enzyme inhibitors such as ketoconazole, verapamil, erythromycin, and cyclosporine may cause an increase in eplerenone blood concentration.

The risk of hyperkalemia is higher in patients with impaired renal function, proteinuria, diabetes mellitus, and patients receiving concomitant therapy with ACEs, ARBs, NSAIDs, and moderate CYP3A inhibitors.

Patients with high serum potassium, type 2 diabetes patients with microalbuminuria, patients with high serum creatinine levels, and patients with muscle clearance <50 mL/min should not take eplerenone.