Dosage adjustment for potassium concentrations with Eplerenone and Spironolactone

Eplerenone: Drug information

Dosage adjustment per serum potassium concentrations:

<5 mEq/L:

Increase dose from 25 mg every other day to 25 mg daily or

Increase dose from 25 mg daily to 50 mg daily

5-5.4 mEq/L: No adjustment needed

5.5-5.9 mEq/L:

Decrease dose from 50 mg daily to 25 mg daily or

Decrease dose from 25 mg daily to 25 mg every other day or

Modify dose from 25 mg every other day to withhold medication

≥6 mEq/L: Withhold medication until potassium <5.5 mEq/L, then restart at 25 mg every other day

 

Spironolactone: Drug information

Dosage adjustment per serum potassium concentrations:

Note: Per the manufacturer, if potassium >5 mEq/L or serum creatinine >4 mg/dL, discontinue or interrupt therapy.

Alternatively, the ACCF/AHA 2013 HF guidelines recommend withholding treatment if potassium >5.5 mEq/L or renal function worsens; hold doses until potassium is <5 mEq/L and consider restarting with a reduced dose after confirming resolution of hyperkalemia/renal insufficiency for at least 72 hours (ACCF/AHA [Yancy 2013]).