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2D Structure
Also known as: Epoxymexrenone, Inspra, 107724-20-9, Sc-66110, Selara, Epleremone
Molecular Formula
C24H30O6
Molecular Weight
414.5  g/mol
InChI Key
JUKPWJGBANNWMW-VWBFHTRKSA-N
FDA UNII
6995V82D0B

A spironolactone derivative and selective ALDOSTERONE RECEPTOR antagonist that is used in the management of HYPERTENSION and CONGESTIVE HEART FAILURE, post-MYOCARDIAL INFARCTION.
Eplerenone is an Aldosterone Antagonist. The mechanism of action of eplerenone is as an Aldosterone Antagonist.
1 2D Structure

2D Structure

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
methyl (1R,2S,9R,10R,11S,14R,15S,17R)-2,15-dimethyl-5,5'-dioxospiro[18-oxapentacyclo[8.8.0.01,17.02,7.011,15]octadec-6-ene-14,2'-oxolane]-9-carboxylate
2.1.2 InChI
InChI=1S/C24H30O6/c1-21-7-4-14(25)10-13(21)11-15(20(27)28-3)19-16-5-8-23(9-6-18(26)30-23)22(16,2)12-17-24(19,21)29-17/h10,15-17,19H,4-9,11-12H2,1-3H3/t15-,16+,17-,19+,21+,22+,23-,24-/m1/s1
2.1.3 InChI Key
JUKPWJGBANNWMW-VWBFHTRKSA-N
2.1.4 Canonical SMILES
CC12CCC(=O)C=C1CC(C3C24C(O4)CC5(C3CCC56CCC(=O)O6)C)C(=O)OC
2.1.5 Isomeric SMILES
C[C@]12CCC(=O)C=C1C[C@H]([C@@H]3[C@]24[C@H](O4)C[C@]5([C@H]3CC[C@@]56CCC(=O)O6)C)C(=O)OC
2.2 Other Identifiers
2.2.1 UNII
6995V82D0B
2.3 Synonyms
2.3.1 MeSH Synonyms

1. 9,11-epoxy-7-(methoxycarbonyl)-3-oxo-17-pregn-4-ene-21,17-carbolactone

2. Eplerenon

3. Inspra

2.3.2 Depositor-Supplied Synonyms

1. Epoxymexrenone

2. Inspra

3. 107724-20-9

4. Sc-66110

5. Selara

6. Epleremone

7. Cgp 30083

8. Cgp-30083

9. Chembl1095097

10. Chebi:31547

11. Sc-6611o

12. 6995v82d0b

13. Ncgc00159559-02

14. Dsstox_cid_26094

15. Dsstox_rid_81333

16. Dsstox_gsid_46094

17. (+)-eplerenone

18. Eplerenone [usan]

19. Methyl (1'r,2r,2's,9'r,10'r,11's,15's,17'r)-2',15'-dimethyl-5,5'-dioxo-18'-oxaspiro[oxolane-2,14'-pentacyclo[8.8.0.0^{1,17}.0^{2,7}.0^{11,15}]octadecan]-6'-ene-9'-carboxylate

20. Methyl (1'r,2s,2's,9'r,10'r,11's,15's,17'r)-2',15'-dimethyl-5,5'-dioxo-18'-oxaspiro[oxolane-2,14'-pentacyclo[8.8.0.0^{1,17}.0^{2,7}.0^{11,15}]octadecan]-6'-ene-9'-carboxylate

21. Inspra (tn)

22. Cas-107724-20-9

23. Hsdb 7522

24. Eplerenone [usan:inn:ban]

25. Unii-6995v82d0b

26. Eplerenone- Bio-x

27. Sc 6110

28. Eplerenone [mi]

29. Eplerenone [inn]

30. Eplerenone [jan]

31. Eplerenone [hsdb]

32. Eplerenone [vandf]

33. Eplerenone [mart.]

34. Eplerenone [usp-rs]

35. Eplerenone [who-dd]

36. Schembl21515

37. 9,11alpha-epoxy-17-hydroxy-3-oxo-17alpha-pregn-4-ene-7alpha,21-dicarboxylic Acid, Gamma-lactone, Methyl Ester

38. Gtpl2876

39. Dtxsid2046094

40. Eplerenone (jp17/usan/inn)

41. Eplerenone [orange Book]

42. Eplerenone, >=98% (hplc)

43. Eplerenone [ep Monograph]

44. Hms3413k08

45. Hms3677k08

46. Hy-b0251

47. Zinc3985982

48. Tox21_111746

49. Bdbm50318300

50. Mfcd05662207

51. S1707

52. Akos015962307

53. Tox21_111746_1

54. Ac-4213

55. Ccg-268820

56. Db00700

57. Ks-1406

58. 7alpha-methoxycarbonyl-3-oxo-9,11alpha-epoxy-17alpha-pregn-4-ene-21,17-carbolactone

59. Ncgc00159559-03

60. Be164415

61. Pregn-4-ene-7,21-dicarboxylic Acid, 9,11-epoxy-17-hydroxy-3-oxo-, Gamma-lactone, Methyl Ester, (7alpha,11alpha,17alpha)-

62. Spiro(cyclopenta(7,8)phenanthro(4b,5-b)oxirene-7(3h),2'(3'h)-furan)-10-carboxylic Acid, 2,4,4',4a,5',5a,6,6a,8,9,9a,9b,10,11-tetradecahydro-4a,6a-dimethyl-2,5'-dioxo-, Methyl Ester, (4as,4br,5ar,6as,7 R,9as,9br,10r)-

63. E0905

64. D01115

65. Ab01274707-01

66. Ab01274707_02

67. A895400

68. Q423804

69. Sr-01000942233

70. Sr-01000942233-1

71. Methyl Dimethyl-5'-dioxo-spiro[[?]-[?],2'-tetrahydrofuran]carboxylate

72. (7?,11?,17?)-9,11-epoxy-17-hydroxy-3-oxo-pregn-4-ene-7,21-dicarboxylic Acid ?-lactone Methyl Ester

73. 9,11.alpha.-epoxy-17-hydroxy-3-oxo-17.alpha.-pregn-4-ene-7.alpha.,21-dicarboxylic Acid, .gamma.-lactone, Methyl Ester

74. 9,11alpha-epoxy-17-hydroxy-3-oxo-17alpha-pregn-4-ene-7alpha,21-dicarboxylic Acid Gamma-lactone Methyl Ester

75. Pregn-4-ene-7,21-dicarboxylic Acid, 9,11-epoxy-17-hydroxy-3-oxo-, G-lactone, Methyl Ester, (7.alpha.,11.alpha.,17.alpha)-

76. Ynu

2.4 Create Date
2005-06-24
3 Chemical and Physical Properties
Molecular Weight 414.5 g/mol
Molecular Formula C24H30O6
XLogP31.4
Hydrogen Bond Donor Count0
Hydrogen Bond Acceptor Count6
Rotatable Bond Count2
Exact Mass414.20423867 g/mol
Monoisotopic Mass414.20423867 g/mol
Topological Polar Surface Area82.2 Ų
Heavy Atom Count30
Formal Charge0
Complexity907
Isotope Atom Count0
Defined Atom Stereocenter Count8
Undefined Atom Stereocenter Count0
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Drug Information
1 of 4  
Drug NameEplerenone
PubMed HealthEplerenone (By mouth)
Drug ClassesCardiovascular Agent
Drug LabelEplerenone tablets contain eplerenone, a blocker of aldosterone binding at the mineralocorticoid receptor. Eplerenone is chemically described as Pregn-4-ene-7,21-dicarboxylic acid, 9,11-epoxy-17-hydroxy-3-oxo-, -lactone, methyl ester, (7,11,17...
Active IngredientEplerenone
Dosage FormTablet
RouteOral
Strength25mg; 50mg
Market StatusPrescription
CompanyApotex; Sandoz

2 of 4  
Drug NameInspra
PubMed HealthEplerenone (By mouth)
Drug ClassesCardiovascular Agent
Drug LabelINSPRA contains eplerenone, a blocker of aldosterone binding at the mineralocorticoid receptor. Eplerenone is chemically described as Pregn-4-ene-7,21-dicarboxylic acid, 9,11-epoxy-17-hydroxy-3-oxo-, -lactone, methyl ester, (7,11,17)-. Its em...
Active IngredientEplerenone
Dosage FormTablet
RouteOral
Strength25mg; 50mg
Market StatusPrescription
CompanyGd Searle

3 of 4  
Drug NameEplerenone
PubMed HealthEplerenone (By mouth)
Drug ClassesCardiovascular Agent
Drug LabelEplerenone tablets contain eplerenone, a blocker of aldosterone binding at the mineralocorticoid receptor. Eplerenone is chemically described as Pregn-4-ene-7,21-dicarboxylic acid, 9,11-epoxy-17-hydroxy-3-oxo-, -lactone, methyl ester, (7,11,17...
Active IngredientEplerenone
Dosage FormTablet
RouteOral
Strength25mg; 50mg
Market StatusPrescription
CompanyApotex; Sandoz

4 of 4  
Drug NameInspra
PubMed HealthEplerenone (By mouth)
Drug ClassesCardiovascular Agent
Drug LabelINSPRA contains eplerenone, a blocker of aldosterone binding at the mineralocorticoid receptor. Eplerenone is chemically described as Pregn-4-ene-7,21-dicarboxylic acid, 9,11-epoxy-17-hydroxy-3-oxo-, -lactone, methyl ester, (7,11,17)-. Its em...
Active IngredientEplerenone
Dosage FormTablet
RouteOral
Strength25mg; 50mg
Market StatusPrescription
CompanyGd Searle

4.2 Therapeutic Uses

Eplerenone is indicated for the treatment of hypertension. It may be used alone or in combination with other antihypertensive drugs. /Included in US product labeling/

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007., p. 1245


Inspra is indicated to improve survival of stable patients with left ventricular systolic dysfunction (ejection fraction less than or equal to 40%) and clinical evidence of congestive heart failure after an acute myocardial infarction.

Physicians Desk Reference 61st ed, Thomson PDR, Montvale, NJ 2007., p. 2537


... Eplerenone should replace spironolactone as a natriuretic and antikaliuretic in heart failure and as add-on treatment in severe systolic cardiac insufficiency, and it is indicated after an acute myocardial infarction complicated by left ventricular dysfunction and heart failure. The finding that hypertension control with diuretic-based pharmacotherapy results in better prevention of heart failure than pressure reduction with other drugs makes it pertinent to investigate whether diuretics in general, and eplerenone in particular, should constitute part of the initial pharmacotherapy for heart failure when there is no overt fluid retention and independent of the etiology. ...

PMID:15733814 Reyes AJ et al; Eur J Intern Med 16 (1): 3-11 (2005)


4.3 Drug Warning

FDA Pregnancy Risk Category: B /NO EVIDENCE OF RISK IN HUMANS. Adequate, well controlled studies in pregnant women have not shown increased risk of fetal abnormalities despite adverse findings in animals, or, in the absence of adequate human studies, animal studies show no fetal risk. The chance of fetal harm is remote but remains a possibility./

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007., p. 1246


... When used for hypertension, the drug is contraindicated in patients with type 2 diabetes mellitus with microalbuminuria, serum creatinine concentrations exceeding 2 or 1.8 mg/dL in males or females, respectively, creatinine clearance less than 50 mL/minute, ... .

McEvoy, G.K. (ed.). American Hospital Formulary Service. AHFS Drug Information. American Society of Health-System Pharmacists, Bethesda, MD. 2007., p. 1979


The most serious risk associated with eplerenone therapy is hyperkalemia (serum potassium greater than 5.5 mEq/L), which may cause serious, sometimes fatal, cardiac arrhythmias. Patients with impaired renal function or diabetes mellitus and patients receiving concurrent agents affecting the renin-angiotensin-aldosterone system (e.g., angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists) are at an increased risk for developing hyperkalemia. Eplerenone should be used with caution in patients with congestive heart failure following an acute myocardial infarction, who have renal impairment (i.e., serum creatinine concentrations exceeding 2 or 1.8 mg/dL in males or females, respectively, or creatinine clearance of 50 mL/minute or less) or those with diabetes mellitus (including those with proteinuria). Serum potassium concentrations should be monitored periodically in patients receiving eplerenone. Dosage reduction has been shown to decrease serum potassium concentrations.

McEvoy, G.K. (ed.). American Hospital Formulary Service. AHFS Drug Information. American Society of Health-System Pharmacists, Bethesda, MD. 2007., p. 1979


Adverse effects reported in 1% or more of patients receiving eplerenone for the management of hypertension are dizziness, fatigue, flu-like symptoms, cough, diarrhea, abdominal pain, hyperkalemia, decreased serum sodium concentrations, abnormal vaginal bleeding, gynecomastia, hypercholesterolemia, hypertriglyceridemia, mastodynia, or albuminuria.

McEvoy, G.K. (ed.). American Hospital Formulary Service. AHFS Drug Information. American Society of Health-System Pharmacists, Bethesda, MD. 2007., p. 1979


For more Drug Warnings (Complete) data for EPLERENONE (12 total), please visit the HSDB record page.


4.4 Drug Indication

For improvement of survival of stable patients with left ventricular systolic dysfunction (ejection fraction <40%) and clinical evidence of congestive heart failure after an acute myocardial infarction.


FDA Label


5 Pharmacology and Biochemistry
5.1 Pharmacology

Eplerenone, an aldosterone receptor antagonist similar to spironolactone, has been shown to produce sustained increases in plasma renin and serum aldosterone, consistent with inhibition of the negative regulatory feedback of aldosterone on renin secretion. The resulting increased plasma renin activity and aldosterone circulating levels do not overcome the effects of eplerenone. Eplerenone selectively binds to recombinant human mineralocorticoid receptors relative to its binding to recombinant human glucocorticoid, progesterone and androgen receptors.


5.2 MeSH Pharmacological Classification

Mineralocorticoid Receptor Antagonists

Drugs that bind to and block the activation of MINERALOCORTICOID RECEPTORS by MINERALOCORTICOIDS such as ALDOSTERONE. (See all compounds classified as Mineralocorticoid Receptor Antagonists.)


Antihypertensive Agents

Drugs used in the treatment of acute or chronic vascular HYPERTENSION regardless of pharmacological mechanism. Among the antihypertensive agents are DIURETICS; (especially DIURETICS, THIAZIDE); ADRENERGIC BETA-ANTAGONISTS; ADRENERGIC ALPHA-ANTAGONISTS; ANGIOTENSIN-CONVERTING ENZYME INHIBITORS; CALCIUM CHANNEL BLOCKERS; GANGLIONIC BLOCKERS; and VASODILATOR AGENTS. (See all compounds classified as Antihypertensive Agents.)


5.3 FDA Pharmacological Classification
5.3.1 Active Moiety
EPLERENONE
5.3.2 FDA UNII
6995V82D0B
5.3.3 Pharmacological Classes
Aldosterone Antagonists [MoA]; Aldosterone Antagonist [EPC]
5.4 ATC Code

C03DA04

S76 | LUXPHARMA | Pharmaceuticals Marketed in Luxembourg | Pharmaceuticals marketed in Luxembourg, as published by d'Gesondheetskeess (CNS, la caisse nationale de sante, www.cns.lu), mapped by name to structures using CompTox by R. Singh et al. (in prep.). List downloaded from https://cns.public.lu/en/legislations/textes-coordonnes/liste-med-comm.html. Dataset DOI:10.5281/zenodo.4587355


C - Cardiovascular system

C03 - Diuretics

C03D - Aldosterone antagonists and other potassium-sparing agents

C03DA - Aldosterone antagonists

C03DA04 - Eplerenone


5.5 Absorption, Distribution and Excretion

Absorption

The absolute bioavailability of eplerenone is unknown.


Volume of Distribution

43 to 90 L


Clearance

Apparent plasma cl=10 L/hr


Apparent plasma clearance: approximately 10 L/hr. Less than 5% is recovered as unchanged drug in the urine and feces. Renal: 67%. Fecal: 32%.

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007., p. 1245


Mean peak plasma concentrations of eplerenone are reached approximately 1.5 hours following oral administration. The absolute bioavailability of eplerenone is unknown. Both peak plasma levels (Cmax) and area under the curve (AUC) are dose proportional for doses of 25 to 100 mg and less than proportional at doses above 100 mg. The plasma protein binding of eplerenone is about 50% and it is primarily bound to alpha 1-acid glycoproteins. The apparent volume of distribution at steady state ranged from 43 to 90 L. Eplerenone does not preferentially bind to red blood cells.

Physicians Desk Reference 61st ed, Thomson PDR, Montvale, NJ 2007., p. 2536


Eplerenone is distributed into milk in rats; ... .

McEvoy, G.K. (ed.). American Hospital Formulary Service. AHFS Drug Information. American Society of Health-System Pharmacists, Bethesda, MD. 2007., p. 1979


... Preclinical data show that eplerenone and/or metabolites are present in rat breast milk (0.85:1 [milk:plasma] AUC ratio) obtained after a single oral dose. Peak concentrations in plasma and milk were obtained from 0.5 to 1 hour after dosing.

Physicians Desk Reference 61st ed, Thomson PDR, Montvale, NJ 2007., p. 2538


5.6 Metabolism/Metabolites

Eplerenone is metabolized primarily by CYP3A4, however, no active metabolites have been identified in human plasma.


Eplerenone metabolism is primarily mediated via CYP3A4. No active metabolites have been identified in human plasma.

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007., p. 1245


Eplerenone has known human metabolites that include 21-hydroxyeplerenone and 6beta-hydroxyeplerenone.

S73 | METXBIODB | Metabolite Reaction Database from BioTransformer | DOI:10.5281/zenodo.4056560


5.7 Biological Half-Life

4-6 hours


Elimination: 4 to 6 hours.

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007., p. 1245


5.8 Mechanism of Action

Eplerenone binds to the mineralocorticoid receptor and thereby blocks the binding of aldosterone (component of the renin-angiotensin-aldosterone-system, or RAAS). Aldosterone synthesis, which occurs primarily in the adrenal gland, is modulated by multiple factors, including angiotensin II and non-RAAS mediators such as adrenocorticotropic hormone (ACTH) and potassium. Aldosterone binds to mineralocorticoid receptors in both epithelial (e.g., kidney) and nonepithelial (e.g., heart, blood vessels, and brain) tissues and increases blood pressure through induction of sodium reabsorption and possibly other mechanisms.


Eplerenone has relative selectivity in binding to recombinant human mineralocorticoid receptors compared to its binding to recombinant human glucocorticoid, progesterone, and androgen receptors.

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007., p. 1245


Eplerenone has been shown to produce sustained increases in plasma renin and serum aldosterone, consistent with the inhibition of the negative regulatory feedback of aldosterone on renin secretion. The resulting increased plasma renin activity and aldosterone circulation levels do not overcome the effect of eplerenone on blood pressure.

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007., p. 1245


Eplerenone binds to the mineralocorticoid receptor and blocks the binding of aldosterone, a component of the renin-angiotensin-aldosterone-system (RAAS). Aldosterone synthesis, which occurs primarily in the adrenal gland, is modulated by multiple factors, including angiotensin II and non-RAAS mediators such as adrenocorticotropic hormone (ACTH) and potassium. Aldosterone binds to mineralocorticoid receptors in both epithelial (e.g., kidney) and nonepithelial (e.g., heart, blood vessels, brain) tissues and increases blood pressure through induction of sodium resorption and possibly other mechanisms.

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007., p. 1245