An older man develops painful bilateral gynecomastia three months after starting an aldosterone antagonist for resistant hypertension. The drug that would provide equivalent mineralocorticoid receptor antagonism without this endocrine adverse effect is:
- A Drospirenone
- B Finerenone
- C Amiloride
- D Eplerenone ✓
Explanation
Spironolactone binds progesterone and androgen receptors in addition to the mineralocorticoid receptor, producing gynecomastia, menstrual irregularity, and reduced libido in a dose-dependent manner. Eplerenone is a selective mineralocorticoid receptor antagonist with minimal affinity for steroid sex hormone receptors, giving similar antihypertensive and antialdosterone effects without antiandrogenic effects. Finerenone is primarily studied in diabetic kidney disease and heart failure, and amiloride acts on epithelial sodium channels rather than the aldosterone receptor.
Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.