Comprehensive medication guide to Eplerenone including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$45 copay for generic Eplerenone on most commercial plans (typically Tier 1–2); prior authorization or step therapy may be required by some plans.
Estimated Cash Pricing
$90–$145 retail for generic Eplerenone without a discount; as low as $17–$22 with GoodRx or SingleCare coupons for a 30-day supply.
Medfinder Findability Score
85/100
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Eplerenone (brand name Inspra) is a prescription medication belonging to the mineralocorticoid receptor antagonist (MRA) class. It works by blocking aldosterone, a hormone that causes the kidneys to retain sodium and water — which raises blood pressure and stresses the heart. By blocking aldosterone's action, Eplerenone lowers blood pressure, reduces fluid retention, and protects the heart from aldosterone-driven damage.
Eplerenone has two FDA-approved indications: improving survival in stable patients with heart failure with reduced ejection fraction (HFrEF, LVEF ≤40%) following a myocardial infarction (heart attack), and treating hypertension (high blood pressure) alone or in combination with other antihypertensive agents. It was FDA-approved in 2002 and has been available as a generic for many years.
Eplerenone is available as 25 mg and 50 mg oral tablets and is manufactured by multiple generic companies. The brand-name Inspra is made by Viatris.
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Eplerenone is a selective mineralocorticoid receptor (MR) antagonist. Aldosterone, a hormone produced by the adrenal glands, normally binds to MRs in the kidneys, heart, and blood vessels. In the kidneys, this binding causes sodium and water reabsorption — raising blood volume and blood pressure. In the heart and blood vessels, aldosterone promotes inflammation and fibrosis (scarring).
Eplerenone competitively blocks the mineralocorticoid receptor — like a key that fits the lock but doesn't open it — preventing aldosterone from exerting these effects. The result is increased sodium and water excretion, lower blood pressure, reduced cardiac remodeling, and improved survival in post-MI heart failure patients.
Compared to spironolactone (an older MRA), Eplerenone is far more selective — it binds up to 500 times less strongly to androgen and progesterone receptors. This selectivity is responsible for Eplerenone's significantly lower rate of hormonal side effects (gynecomastia, menstrual irregularities, sexual dysfunction). Eplerenone is primarily metabolized by CYP3A4 in the liver and has a half-life of 4–6 hours with no active metabolites.
25 mg — tablet
Starting dose for post-MI HFrEF; also used in hypertension when moderate CYP3A4 inhibitors are present
50 mg — tablet
Target maintenance dose for both post-MI HFrEF and hypertension; can be given once or twice daily depending on indication and response
Eplerenone is generally well-stocked and easy to find. As of 2026, it is not listed on the FDA Drug Shortage Database and is manufactured by multiple generic companies. It receives a findability score of 85/100 — reflecting that while it is widely available, individual pharmacies may occasionally run low on a specific strength (25 mg or 50 mg), and insurance-related access barriers can create friction for some patients.
The most common reasons patients have trouble filling Eplerenone are not manufacturing shortages but rather: insurance prior authorization or step therapy requirements, pharmacies stocking only one of the two available strengths, or patients being quoted a high cash price without knowing about discount options (GoodRx brings generic Eplerenone to as low as $17/month).
If you can't find Eplerenone at your regular pharmacy, use medfinder to identify which pharmacies near you have it in stock right now. medfinder contacts pharmacies on your behalf and texts you the results — no hold times required.
Eplerenone is not a controlled substance, so there are no DEA restrictions on who can prescribe it. Any licensed prescriber with authority to write prescriptions in their state can prescribe Eplerenone. Baseline potassium and renal function labs are required before initiating therapy.
Cardiologists — most common prescribers for the post-MI HFrEF indication; manage ongoing GDMT
Primary Care Physicians (PCPs) and Internists — frequently prescribe Eplerenone for hypertension and manage ongoing therapy
Nephrologists — manage patients with cardiorenal conditions involving aldosterone excess
Nurse Practitioners (NPs) and Physician Assistants (PAs) — in most states can prescribe Eplerenone independently or collaboratively for both indications
Eplerenone is available via telehealth for hypertension management and ongoing heart failure follow-up. For new post-MI HFrEF patients, most telehealth providers will require documentation of the cardiac event and recent lab results (potassium, creatinine) before initiating therapy. Platforms such as Teladoc, MDLive, and cardiology-focused telehealth services can prescribe Eplerenone where clinically appropriate.
No. Eplerenone (Inspra) is not a controlled substance. It has no DEA schedule, meaning there are no federal restrictions on how it is prescribed, dispensed, or refilled beyond the standard prescription requirements for non-controlled medications.
Any licensed prescriber — including primary care physicians, cardiologists, nurse practitioners, physician assistants, and telehealth providers — can prescribe Eplerenone without special DEA registration or restricted prescribing authority. Prescriptions can be written for 30-day or 90-day supplies depending on clinical need and insurance plan requirements.
Eplerenone is generally well-tolerated, but the following side effects are reported:
Hyperkalemia (elevated potassium) — the most clinically significant side effect; requires regular blood monitoring
Dizziness or lightheadedness, especially when standing up quickly
Hypotension (low blood pressure)
Increased creatinine (mild rise in kidney function marker)
Fatigue
Nausea
Severe hyperkalemia — can cause cardiac arrhythmia or cardiac arrest; call your doctor immediately if you experience muscle weakness, irregular heartbeat, or tingling in your extremities
Severe hypotension — especially when combined with other antihypertensive medications; seek emergency care if you faint
Significant renal impairment — monitor creatinine; Eplerenone is contraindicated with CrCl <30 mL/min in the HFrEF indication
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Spironolactone (Aldactone)
Older, non-selective MRA; same drug class as Eplerenone; effective for heart failure and hypertension; more hormonal side effects (gynecomastia, menstrual changes); very inexpensive generic ($3–$10/month)
Finerenone (Kerendia)
Newer non-steroidal MRA; FDA-approved for CKD with type 2 diabetes; more selective and fewer side effects; brand-name only; significantly more expensive
Losartan (Cozaar)
Angiotensin II receptor blocker (ARB); different mechanism; commonly used for hypertension; widely available as generic; often used alongside Eplerenone in HFrEF, not as a substitute
Sacubitril/Valsartan (Entresto)
ARNI for HFrEF; different mechanism (neprilysin inhibition + ARB); used alongside Eplerenone in guideline-directed therapy, not as a replacement; brand-name only; expensive
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Ketoconazole/Itraconazole
majorStrong CYP3A4 inhibitors — contraindicated with Eplerenone; increases Eplerenone exposure >5-fold, causing severe hyperkalemia and hypotension risk
Ritonavir/Clarithromycin
majorStrong CYP3A4 inhibitors — contraindicated with Eplerenone; dramatically increase Eplerenone blood levels
Potassium Supplements
majorCombination can cause dangerous hyperkalemia; contraindicated in hypertension indication; use with extreme caution in all patients
ACE Inhibitors (lisinopril, enalapril)
moderateIncreases hyperkalemia risk when combined with Eplerenone; combination is guideline-recommended for HFrEF but requires close potassium monitoring
ARBs (losartan, valsartan)
moderateIncreases hyperkalemia risk; monitor potassium closely; combination used in HFrEF per guidelines
NSAIDs (ibuprofen, naproxen)
moderateMay reduce antihypertensive effect and increase hyperkalemia risk, especially in renal impairment
Erythromycin/Fluconazole (moderate CYP3A4 inhibitors)
moderateIncrease Eplerenone exposure 100-190%; dose reduction of Eplerenone required
Rifampin/St. John's Wort (CYP3A4 inducers)
minorDecrease Eplerenone levels by ~30%, potentially reducing efficacy
Lithium
moderatePotential for increased lithium toxicity; monitor lithium levels closely
Eplerenone is a proven, guideline-recommended medication that has been helping patients with heart failure and high blood pressure since 2002. Its key advantage over the older drug spironolactone is its receptor selectivity — providing effective aldosterone blockade with far fewer hormonal side effects. It's a foundational part of guideline-directed medical therapy for HFrEF patients, backed by landmark clinical trial evidence from the EPHESUS trial.
Eplerenone is widely available as a generic and is not in a national shortage as of 2026. Most patients can find it at their local pharmacy, and those paying cash can bring the price down to $17–$22/month with a GoodRx or SingleCare coupon. The main challenges are insurance hurdles (step therapy, prior authorization) and occasional local pharmacy stock gaps — both of which are solvable with the right tools.
If you're having trouble filling your Eplerenone prescription, medfinder can quickly identify which pharmacies near you have it in stock — saving you the time and frustration of calling pharmacy after pharmacy on your own.
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