Malidum (Eplerenone)

Malidum (eplerenone) acts on the mineralocorticoid pathway to control fluid balance and vascular tone.

• Hypertension: lowers blood pressure by reducing sodium and water retention.
• Heart failure: improves cardiac function and reduces hospitalizations by decreasing fluid overload.
• Post‑myocardial infarction with reduced ejection fraction: helps prevent adverse remodeling and further cardiovascular events.

• Eplerenone selectively blocks aldosterone binding at mineralocorticoid receptors in the distal nephron, kidneys, and cardiovascular tissues. This inhibition reduces sodium reabsorption and potassium excretion, leading to decreased extracellular fluid volume and lower arterial pressure, while also attenuating aldosterone‑mediated cardiac remodeling.

Eplerenone may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Hyperkalaemia: elevated serum potassium levels.
• Dizziness or light‑headedness.
• Headache.
• Fatigue.
• Gastrointestinal discomfort such as nausea or abdominal pain.
• Cough.

Serious or Rare Side Effects

• Severe hyperkalaemia leading to cardiac arrhythmia.
• Acute renal impairment or worsening kidney function.
• Angioedema or severe allergic reactions.
• Hepatic injury with elevated liver enzymes.
• Life‑threatening hypotension.
• Myocardial infarction in susceptible patients.

Before initiating therapy, clinicians should evaluate patient‑specific factors and monitor key parameters.

• Monitor serum potassium: check levels regularly, especially after dose changes.
• Assess renal function: evaluate creatinine and eGFR before and during treatment.
• Avoid in patients with existing hyperkalaemia: contraindicated when potassium >5.0 mmol/L.
• Caution in elderly: increased sensitivity to blood‑pressure lowering effects.
• Review concomitant potassium‑sparing agents: adjust therapy to prevent excess potassium.
• Store at ambient temperature: keep in the original container, protect from moisture and direct sunlight.

Eplerenone can interact with several medicines, altering electrolyte balance or renal function.

Major Interactions (Avoid)

• ACE inhibitors or ARBs combined with eplerenone: markedly increase risk of hyperkalaemia and renal dysfunction.
• Potassium supplements or potassium‑rich salt substitutes: may cause dangerous potassium accumulation.
• NSAIDs (e.g., ibuprofen, naproxen): can impair renal function and exacerbate hyperkalaemia.

Moderate Interactions (Monitor Closely)

• Loop or thiazide diuretics: may require potassium monitoring and dose adjustments.
• Digoxin: altered serum levels may occur; monitor for toxicity.
• Lithium: reduced clearance may increase lithium toxicity risk.
• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): can raise eplerenone concentrations, necessitating closer monitoring.