Eplerenone is preferred over spironolactone in post-MI patients with left ventricular dysfunction (EPHESUS trial) for long-term treatment because:

• A Eplerenone has greater aldosterone receptor affinity and provides superior cardiac remodeling prevention
• B Eplerenone is more selective for the mineralocorticoid receptor with minimal sex hormone receptor activity, avoiding gynecomastia and impotence ✓
• C Eplerenone is metabolized to an active form that additionally inhibits cortisol synthesis
• D Eplerenone provides superior renal protection compared to spironolactone in post-MI CKD

Explanation

Spironolactone binds not only the mineralocorticoid receptor (MR) but also androgen receptors and progesterone receptors, causing dose-dependent gynecomastia, breast pain, and sexual dysfunction in men, and menstrual irregularities in women. Eplerenone is a more selective MR antagonist with negligible binding to androgen or progesterone receptors, thus lacking these sex hormone-related adverse effects. Both drugs reduce post-MI mortality in EF <40% patients, but eplerenone has better tolerability for long-term adherence.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.