What Inspra is used for and how to use it
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Inspra - Consumer Medicine Information

Manufacture: Pfizer Inc.
Country: Canada
Condition: Heart Failure (Congestive Heart Failure), High Blood Pressure (Hypertension)
Class: Aldosterone receptor antagonists
Form: Tablets
Ingredients: eplerenone, lactose, microcrystalline cellulose, croscarmellose sodium, hypromellose, sodium lauryl sulphate, talc, magnesium stearate, titanium dioxide, polyethylene glycol, polysorbate 80, iron oxide yellow, iron oxide red

(eplerenone)

About this Medication

What the Medication is Used For

In adults, INSPRA is used alone or combined with other drugs for patients with hypertension (high blood pressure) to lower blood pressure.

In adults, INSPRA is used in combination with other drugs for patients with heart failure:

  • to prevent worsening heart failure
  • to prevent death from heart failure
  • to reduce the risk of hospitalizations for heart failure

If you are an adult under 75 years old with heart failure, INSPRA may reduce the risk of death. This is not necessarily true for patients 75 years old and older.

What it Does

Your body makes a substance called aldosterone. It is important for controlling blood pressure and heart function. Sometimes, high levels of aldosterone can cause changes in your body that may worsen heart failure. INSPRA works by blocking the actions of aldosterone, and can help prevent heart failure from getting worse.

When it Should not be Used

Do not use INSPRA if you:

  • are hypersensitive (allergic) to INSPRA or to any of the other ingredients of INSPRA (see below for the non-medicinal ingredients);
  • have high levels of potassium in your blood;
  • are taking potassium sparing diuretics (certain types of water tablets);
  • have severe liver impairment;
  • have heart failure and severe kidney impairment;
  • have hypertension and moderate kidney impairment
  • are taking other medications that may affect the elimination of INSPRA, such as:
    • ritonavir or nelfinavir (antiviral medication for treating HIV);
    • clarithromycin, or telithromycin (antibiotics used to treat bacterial infections);
    • ketoconazole or itraconazole (medicines that are used to treat fungal infections);
    • nefazadone (used to treat depression);
    • potassium supplements.

What the Medicinal Ingredient Is

Eplerenone

What the Nonmedicinal Ingredients Are

  • lactose
  • microcrystalline cellulose
  • croscarmellose sodium
  • hypromellose
  • sodium lauryl sulphate
  • talc
  • magnesium stearate
  • titanium dioxide
  • polyethylene glycol
  • polysorbate 80
  • iron oxide yellow
  • iron oxide red.

What Dosage Forms it Comes In

INSPRA tablets are available in 25 mg and 50 mg strengths.

Warnings and Precautions

BEFORE you use INSPRA tell your doctor or pharmacist if:

  • you are pregnant or if you are planning to become pregnant. The effects of INSPRA have not been evaluated during pregnancy. Ask your doctor or pharmacist for advice before taking any medicine.
  • you are breast-feeding or intend to breast-feed;
  • you have kidney or liver disease;
  • you are diabetic;
  • you are taking lithium (usually given as a mood stabilizing medication);
  • you are using potassium supplements or salt substitutes containing potassium.

Please contact your doctor if you are taking any of the above medicines, or have taken them in the past.

You may feel dizzy after taking this medicine. If this happens, tell your doctor about it and do not drive or operate machinery.

Interactions With This Medication 

Certain medications can affect the way that INSPRA is broken down by the body. Interaction with other drugs is possible. Please inform your doctor if you are taking any of the following medicines (see also "When it should not be used"):

  • ketoconazole, itraconazole or fluconazole (used to treat fungal infections);
  • verapamil or diltiazem (used for heart problems and/or high blood pressure);
  • digoxin or amiodarone (used to treat particular heart conditions including irregular heart rhythms);
  • angiotensin converting enzyme inhibitors which are any medication with generic names ending with “pril” (used for high blood pressure or heart conditions);
  • angiotensin II receptor antagonists, which are any medication with generic names ending with “sartan” (used for high blood pressure, or particular kidney conditions);
  • potassium sparing diuretics (certain water tablets used to treat fluid retention) (see also "When it should not be used");
  • potassium supplements (salt tablets);
  • herbal preparations containing large amounts of potassium (such as Noni fruit or juice, dandelion);
  • saquinavir, ritonavir or nelfinavir (antiviral medication for treating HIV);
  • erythromycin, clarithromycin, telithromycin, or rifampicin (antibiotics used to treat bacterial infections);
  • lithium (usually given as a mood stabilizing medication);
  • nefazadone and St John's Wort (used to treat depression);
  • carbamazepine, phenytoin and phenobarbital (used to treat epilepsy);
  • Non-steroidal anti-inflammatory drugs (certain pain killers, such as ibuprofen and other pain relievers).

Tell your doctor or pharmacist if you are taking any other medications, including prescription, non-prescription and natural health products.

Proper Use of This Medication

Your doctor and pharmacist will tell you how to take your medicine. Carefully follow the instructions given to you by your doctor and pharmacist.

INSPRA tablets may be taken with or after a meal or on an empty stomach. Swallow the tablets with a glass of water without chewing.

INSPRA is not recommended for children.

Usual dose

The usual starting dose will depend on the potassium level in your body and your kidney condition which will be assessed by your doctor.

In people with normal or near normal kidney function, for heart failure the usual starting dose is one 25 mg tablet once daily, increasing to one 50 mg tablet once daily in about 4 weeks, as instructed by your doctor. For hypertension, the usual dose is 50 mg tablet once daily.

The maximum daily dose for heart failure is 50 mg and for hypertension, it is 100mg.

Lower doses will be used in people with elevated potassium in the blood or weaker kidney function.

Blood potassium levels should be measured before starting INSPRA therapy, within the first week and at one month after the start of treatment or after a change in dose. The dose may be adjusted by your doctor, depending on the potassium levels in your blood. It is very important that you comply with your doctor's recommendations particularly regarding the laboratory test which may be prescribed.

It is important to keep taking INSPRA as prescribed unless your doctor tells you to stop your treatment.

Overdose

If you take more INSPRA than you should, tell your doctor or pharmacist immediately.

If you think you have taken too much INSPRA contact your doctor, nurse, pharmacist, hospital emergency department or regional Poison Control Centre immediately, even if there are no symptoms.

Missed Dose

If you forget to take a tablet take it as soon as you remember. If it is almost time to take the next tablet, do not take the tablet you have missed. Instead, take the next tablet when it is due and afterwards, continue to take your tablets as your doctor has prescribed for you. Do not take a double dose to make up for the forgotten tablet.

Side Effects and What to do About Them

Side effects may include headache. The most common side effects seen with INSPRA are related to increased blood potassium levels.

INSPRA can cause abnormal blood test results. Your doctor will decide when to perform blood tests and will interpret the results.

Serious Side Effects, how Often They Happen and What to do About Them

Symptom/effectTalk with your doctor or pharmacistStop taking
drug and
call your
doctor or
pharmacist
Only if
severe
In all
cases
CommonIncreased levels of potassium in the blood:Irregular heartbeats, muscle weakness and generally feeling unwell
Uncommon Dehydration: headaches, dizziness or fainting
Blood clot in the leg (arterial leg thrombosis): swelling, pain and redness in a leg that can be warm to touch.
Low Blood Pressure: feeling of lightheadedness or fainting especially when getting up from a lying or sitting position
Hypothyroidism: constipation, weight gain, fatigue, intolerance to cold
Gastroesophageal reflux disease (GERD): heartburn, regurgitation and trouble swallowing
Pancreatitis (inflammation of the pancreas): abdominal pain that lasts and gets worse when you lie down, nausea, vomiting
chest pain
angina
breathing difficulty
changes in rhythm or pace of heart beat
less urine than is normal for you
swelling of the hands, feet, ankles, face, lips, mouth, or throat (may cause difficulty in swallowing or breathing)
hives
fainting
yellowing of the skin and eyes, also called jaundice
weight gain

This is not a complete list of side effects. For any unexpected effects while taking INSPRA, contact your doctor or pharmacist.

How to Store It

Always keep medicine well out of sight and reach of children. Store at controlled room temperature (15–30ºC).

Reporting Suspected Side Effects

You can report any suspected adverse reactions associated with the use of health products to the Canada Vigilance Program by one of the following 3 ways:

  • Report online at www.healthcanada.gc.ca/medeffect
  • Call toll-free at 1-866-234-2345
  • Complete a Canada Vigilance Reporting Form and:
    • Fax toll-free to 1-866-678-6789, or
    • Mail to: Canada Vigilance Program
                     Health Canada
                     Postal Locator 0701E
                     Ottawa, ON K1A 0K9

Postage paid labels, Canada Vigilance Reporting Form and the adverse reaction reporting guidelines are available on the MedEffect

Canada Web site at www.healthcanada.gc.ca/medeffect.

NOTE: Should you require information related to the management of side effects, contact your

health professional. The Canada Vigilance Program does not provide medical advice.

More Information

This document plus the full product monograph, prepared for health professionals can be found at:

http://www.pfizer.ca

or by contacting the sponsor, Pfizer Canada Inc., at: 1-800-463-6001.