Spironolactone causes painful gynecomastia in a 62-year-old man with resistant hypertension. Which alternative retains mineralocorticoid receptor blockade without significant antiandrogenic activity?

• A Chlorthalidone
• B Amiloride
• C Triamterene
• D Eplerenone ✓

Explanation

Spironolactone binds progesterone and androgen receptors in addition to the mineralocorticoid receptor, producing gynecomastia, menstrual irregularities and decreased libido. Eplerenone is a selective mineralocorticoid receptor antagonist with markedly lower affinity for androgen and progesterone receptors, giving comparable antihypertensive efficacy without these endocrine effects. Amiloride and triamterene block ENaC downstream of aldosterone but do not antagonize the receptor itself, and chlorthalidone is a thiazide-like diuretic with no mineralocorticoid blockade.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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