tag:blogger.com,1999:blog-9181810725696409953.post6755088601570224146..comments2024-03-17T04:20:11.083-04:00Comments on The Population Health Blog: The Aldosterone Antagonist Eplerenone in Populations with Heart Failure: Another Task for Disease Management ProgramsJaan Sidorovhttp://www.blogger.com/profile/05072456803925863874noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-9181810725696409953.post-29884572192647251022010-11-18T16:03:36.948-05:002010-11-18T16:03:36.948-05:00The results of the EMPHASIS-HF trial caused quite ...The results of the EMPHASIS-HF trial caused quite the discussion at AHA. Numerous doctors at the meeting recognized a wider use of spironolactone as a less costly alternative to eplerenone -- the generic spironolactone costs less than 20 cents a day compared to $133 a month for eplerenone. Given the results, past president of the American College of Cardiology, Dr. Alfred Bove, was led to say, “It’s hard to tell now which patients should get the pricey medicine.” Given all the emphasis on controlling costs in health care and appreciating that previous studies demonstrated a similar benefit with the generic spironolactone I agree with Dr Bove's assessment as to not knowing clinically when eplerenone would be preferred over spironolactone particularly appreciating the marked cost differences between the two medications.Dr. Brindisnoreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-50342199948260658522010-11-16T05:09:13.738-05:002010-11-16T05:09:13.738-05:00Yes, the dose was adjusted. The dose was started ...Yes, the dose was adjusted. The dose was started at 25 mg qd, unless the estimated GFR was less than 50 (but greater than 30), in which case it was 25 qod. If the K remained less than 5 over the next month, the dose was then doubled (50 or 25 qd) which the K was watched at least every 4 months. If it was high, the drug was stopped, the K monitored and when it dropped, restarted at a lower dose. Sounds like a need for what nurses call "standing orders."Jaan Sidorovhttps://www.blogger.com/profile/05072456803925863874noreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-81083521826073667592010-11-15T15:47:31.255-05:002010-11-15T15:47:31.255-05:00Two comments:
1)It will be interesting to see how ...Two comments:<br />1)It will be interesting to see how docs implement this given their fear of hyperkalemia. It will be similar to the glucophage and renal insuff issue in Type 2 diabetics. We're reluctant to use it when the Creatinine rises even though the studies suggest <br /><br /><i>Damn the torpedoes; full sspeed ahead</i><br /><br />2) Was it a set dose of epleronone? spironolactone is supposed to be a set dose but it seemed so hard for docs not to want to treat it as a titratable interventionPhil 314https://www.blogger.com/profile/04133300763922742206noreply@blogger.com