-
Aldosterone antagonist therapy is indicated in patients with LVEF < 35% and NYHA II-IV HF
-
Dosing: the usual dose is 25mg daily, however, those with poor renal function and/or a history of hyperkalemia should be initiated on 12.5mg daily and titrated
-
Triple therapy with ACEI + ARB + aldosterone antagonist should be avoided secondary to increased hyperkalemia, renal dysfunction and hypotension
-
Recent evidence has documented significant issues with hyperkalemia and renal dysfunction and warrants close clinical monitoring
-
Stop K+ supplementation and other K+ sparing diuretic at initiation of aldosterone antagonist
-
Patients should be on maximal ACEI/ARB and BB therapy prior to initiation
-
Other considerations: Gynecomastia (4-5%), impotence, and other hormonal effects with aldosterone antagonist