CHF and arrhythmias:
Indications for: INSPRA
To improve survival of stable patients with left ventricular systolic dysfunction (ejection fraction ≤40%) and clinical evidence of CHF after acute MI.
Adult Dosage:
Initially 25mg once daily; titrate within 4 weeks to 50mg once daily. Adjust based on serum K+ (see full labeling). Concomitant moderate CYP3A inhibitors (eg, erythromycin, verapamil, saquinavir, fluconazole): max 25mg daily.
Children Dosage:
Not established.
INSPRA Contraindications:
Hyperkalemia (serum K+ >5.5mEq/L) at initiation, severe renal impairment (CrCl ≤30mL/min), or concomitant strong CYP3A inhibitors (eg, ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir).
INSPRA Warnings/Precautions:
Renal impairment, proteinuria, diabetes: increased risk of hyperkalemia. Monitor serum K+ at baseline, within 1st week, at 1 month after starting and after dose adjustment, then periodically. Check serum K+ and serum creatinine within 3–7 days after initiating a moderate CYP3A inhhibitors, ACEIs, ARBs, or NSAIDs. Elderly. Pregnancy. Nursing mothers.
INSPRA Classification:
Aldosterone receptor blocker (mineralocorticoid-selective).
INSPRA Interactions:
CYP3A inhibitors (see Contraindications and Dose). NSAIDs may antagonize antihypertensive effects. Angiotensin II receptor blockers, ACEIs, and NSAIDs increase hyperkalemia risk. Monitor lithium.
Adverse Reactions:
Hyperkalemia, increased creatinine.
Generic Drug Availability:
NO
How Supplied:
Tabs—30, 90
Hypertension:
Indications for: INSPRA
Hypertension.
Adult Dosage:
Initially 50mg once daily; may increase after 4 weeks to max 50mg twice daily. Concomitant moderate CYP3A inhibitors (eg, erythromycin, verapamil, saquinavir, fluconazole): initially 25mg once daily; max 25mg twice daily.
Children Dosage:
Not established.
INSPRA Contraindications:
Hyperkalemia (serum K+ >5.5mEq/L) at initiation, severe renal impairment (CrCl ≤30mL/min), or concomitant strong CYP3A inhibitors (eg, ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir). Type 2 diabetes with microalbuminuria, CrCl<50mL/min, serum creatinine >2mg/dL (males), >1.8mg/dL (females), or concomitant K+ supplements or K+ sparing diuretics.
INSPRA Warnings/Precautions:
Renal impairment, proteinuria, diabetes: increased risk of hyperkalemia. Monitor serum K+ at baseline, within 1st week, at 1 month after starting and after dose adjustment, then periodically. Check serum K+ and serum creatinine within 3–7 days after initiating a moderate CYP3A inhhibitors, ACEIs, ARBs, or NSAIDs. Elderly. Pregnancy. Nursing mothers.
INSPRA Classification:
Aldosterone receptor blocker (mineralocorticoid-selective).
INSPRA Interactions:
CYP3A inhibitors (see Contraindications and Dose). NSAIDs may antagonize antihypertensive effects. Angiotensin II receptor blockers, ACEIs, and NSAIDs increase hyperkalemia risk. Monitor lithium.
Adverse Reactions:
Hyperkalemia, increased creatinine.
Generic Drug Availability:
NO
How Supplied:
Tabs—30, 90
