NSTK · 01.2026Independent supplement reference
NutriStack
Edition 1.0Updated July 13, 2026

Eplerenone

Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026

Eplerenone is a selective mineralocorticoid receptor antagonist with significantly less anti-androgenic activity than spironolactone. The EPHESUS trial showed mortality reduction in post-MI patients with heart failure, and EMPHASIS-HF demonstrated benefit in mild heart failure (NYHA II). It is preferred over spironolactone when gynecomastia or sexual side effects are a concern.

Evidence tier
Strong
Indexed sources
10 2022–2026
Interactions
0
Category
Prescription
Read the sources → Compare profiles
Publication status

Exploratory record, not a reviewed medical publication.

See the editorial and medical-review policies for the publication gate.

This generated database record has not completed a claim-level review by a qualified human medical reviewer. Bibliography links and evidence labels are not approval. The page remains available for reference and is excluded from search indexing.

In short

What the research says.

A quick, data-only summary. The full evidence, dosing, and sources are below.

Eplerenone is a selective mineralocorticoid receptor antagonist with significantly less anti-androgenic activity than spironolactone. NutriStack rates the supporting evidence as strong. Common adult dosing is 25–50 mg once daily (as prescribed by your physician), though a prescriber sets the actual dose. This profile indexes 10 sources.

What it's good for
  • Reduces mortality post-MI with HF (EPHESUS trial)6,8
  • Reduces CV death and HF hospitalization in mild HF (EMPHASIS-HF)7
  • Selective MR antagonism, much lower gynecomastia risk than spironolactone6
  • Potassium-sparing diuresis
What to watch for
  • Hyperkalemia (most important adverse effect)
  • Dizziness
  • Diarrhea
  • Serum potassium >5.0 mEq/L at initiation
  • CrCl <30 mL/min (or <50 mL/min when used for hypertension)4

The bottom line

Evidence rating strong. Most-documented uses: reduces mortality post-mi with hf (ephesus trial), reduces cv death and hf hospitalization in mild hf (emphasis-hf), selective mr antagonism, much lower gynecomastia risk than spironolactone. 10 sources indexed (2022–2026), with 0 interaction records on file.

The science

How it works, mechanistically.

Core mechanism

Selectively blocks the mineralocorticoid (aldosterone) receptor with ~500-fold lower affinity for androgen and progesterone receptors compared to spironolactone. Blocks aldosterone-mediated sodium reabsorption and potassium excretion in the collecting duct. In heart failure, prevents aldosterone-driven cardiac fibrosis, inflammation, and vascular remodeling. The selectivity accounts for the markedly lower rate of gynecomastia and sexual side effects.8,6

Class
Selective Mineralocorticoid Receptor Antagonist
Dosing

Dosing & protocol.

Common range
25–50 mg once daily (as prescribed by your physician)
Recommended form
Oral tablet

Can be taken with or without food; food does not significantly affect absorption

Safety

Full safety detail.

Side effects

  • Hyperkalemia (most important adverse effect)
  • Dizziness
  • Diarrhea
  • Cough
  • Fatigue
  • Hyponatremia

Contraindications

  • Serum potassium >5.0 mEq/L at initiation
  • CrCl <30 mL/min (or <50 mL/min when used for hypertension)4
  • Type 2 diabetes with microalbuminuria and serum creatinine >2.0 mg/dL (males) or >1.8 mg/dL (females)10
  • Concurrent strong CYP3A4 inhibitors (ketoconazole, itraconazole, nefazodone, clarithromycin, ritonavir)
  • Concurrent potassium supplements or potassium-sparing diuretics
Sources

Sources, by evidence tier.

Numbered references. Citations throughout the page link here.

Meta-analyses & systematic reviews

5

Reference material

5
FAQ

Common questions.

Quick answers about Eplerenone, drawn from the data on this page.

What is Eplerenone?

Eplerenone is a selective mineralocorticoid receptor antagonist with significantly less anti-androgenic activity than spironolactone. The EPHESUS trial showed mortality reduction in post-MI patients with heart failure, and EMPHASIS-HF demonstrated benefit in mild heart failure (NYHA II). It is preferred over spironolactone when gynecomastia or sexual side effects are a concern.

What is Eplerenone used for?

Commonly cited benefits of Eplerenone include: Reduces mortality post-MI with HF (EPHESUS trial); Reduces CV death and HF hospitalization in mild HF (EMPHASIS-HF); Selective MR antagonism, much lower gynecomastia risk than spironolactone; Potassium-sparing diuresis. NutriStack rates the overall evidence as strong.

What is a typical dose of Eplerenone?

A typical adult dose of Eplerenone is 25–50 mg once daily (as prescribed by your physician). The commonly recommended form is Oral tablet. These are general ranges, not personalized advice; confirm the right dose with a clinician.

What are the side effects of Eplerenone?

Reported side effects include hyperkalemia (most important adverse effect), dizziness, diarrhea, cough, fatigue, hyponatremia. This is educational information; check with a healthcare professional before use.

How strong is the evidence for Eplerenone?

NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.

Use this with your stack

Eplerenone in NutriStack.

Add it to your stack, see how it interacts with everything else you take, and get a Stack Score that updates the moment it does.

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NutriStack is an informational and organizational tool, not a medical service, and not a substitute for professional advice. Always consult a qualified healthcare professional before starting, stopping, or changing any supplement or medication.