Mineralocorticoid receptor antagonists
Blocking aldosterone receptors, so sodium is lost and potassium kept.
Also called aldosterone antagonists, MRAs and antimineralocorticoids.
Class card
- Drugs
- Spironolactone and Eplerenone
- Used for
- Heart failure with reduced ejection fraction
- Resistant high blood pressure
- Primary hyperaldosteronism
- Edema and ascites in liver cirrhosis
- Known for
- High potassium (hyperkalemia)
- Breast enlargement in men (gynecomastia)
- Name stems
- -renone
3 cards: the class, and each drug in it.
Mechanism of action
How do mineralocorticoid receptor antagonists work?
They bind to mineralocorticoid receptors in the late distal tubule and collecting duct and stop aldosterone from switching them on. Less sodium and water are reabsorbed while potassium is kept, so they are potassium-sparing diuretics. They also block aldosterone in the heart and blood vessels, and in heart failure with reduced ejection fraction they improve survival.
The drugs
Mineralocorticoid receptor antagonists with a card
Uses
What are mineralocorticoid receptor antagonists used for?
- Heart failure with reduced ejection fraction
- Resistant high blood pressure
- Primary hyperaldosteronism
- Edema and ascites in liver cirrhosis
Side effects
Side effects of mineralocorticoid receptor antagonists
- High potassium (hyperkalemia)Known forSerious
- Breast enlargement in men (gynecomastia)Known for
- Worsening kidney functionSerious
- Low blood pressure and dehydration
- Low sodium
- Dizziness
- Headache
- Nausea and diarrhea
- Menstrual changes or low libido (mainly spironolactone)
- Muscle and leg cramps
What the class has in common. Each drug's card has its own, and Known for marks what an exam expects you to know.
Watch for
Cautions
- ACE inhibitors, ARBs, NSAIDs, potassium supplements and salt substitutes raise the risk of hyperkalemia.
- Potassium and kidney function are checked within a week of starting and regularly after.
- Contraindicated in hyperkalemia; spironolactone and eplerenone are never combined.
- Kidney impairment raises the risk of hyperkalemia; eplerenone is contraindicated at a creatinine clearance of 30 mL/min or less.
Remember them
A way to remember them
Block aldosterone, keep potassium.
Aldosterone makes the kidney hold on to sodium and let potassium go. Blocking its receptor reverses this, so these diuretics spare potassium, and hyperkalemia is their main danger, above all alongside ACE inhibitors or ARBs.
Written for biofideX
Name stems
-renone means mineralocorticoid receptor antagonist
Eplerenone and finerenone block the aldosterone (mineralocorticoid) receptor. Spironolactone, the oldest drug of the class, doesn't carry the stem.
- Every drug name stem
Don't mix them up
Classes easily confused with these
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Spironolactone tablets: label (DailyMed)
- Eplerenone tablets: label (DailyMed)
- Aldosterone receptor antagonist (NCI Thesaurus)
- Spironolactone (NHS)
- About eplerenone (NHS)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Heart failure, rhythm and angina
Practice mineralocorticoid receptor antagonists with the other classes in this group: what each drug is, how it works, what it treats and what it's known for.
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