Mineralocorticoid receptor antagonists
Also known as: aldosterone antagonists, aldosterone receptor antagonists, MRAs
Mineralocorticoid receptor antagonists, also called aldosterone antagonists, are medicines that act against the hormone aldosterone. Spironolactone and eplerenone are the two members covered here, and a Northern Care Alliance heart failure leaflet covers both.
- Biological target
- Mineralocorticoid (aldosterone) receptor
- Also called
- aldosterone antagonists, aldosterone receptor antagonists, MRAs
Mechanism of action
A review of spironolactone and eplerenone says they increase the amount of sodium lost in the urine and cause the kidneys to hold on to potassium when aldosterone levels are high, which is why they are described as facultative diuretics. Eplerenone is more selective for the mineralocorticoid receptor, whereas StatPearls says spironolactone also binds progesterone and androgen receptors, which underlies its anti-androgen effects such as breast enlargement in men. A 2024 meta-analysis in people with heart failure found lower rates of gynaecomastia with eplerenone than with spironolactone.
Members of the class
Members with a page on this site are linked.
Conditions treated
Class effects
- Hyperkalaemia (high blood potassium) and acute kidney injury are described as the predominant safety concerns across the mineralocorticoid receptor antagonists in pharmacovigilance data
- Gynaecomastia (breast enlargement in men) is reported more often with spironolactone than with eplerenone in a 2024 heart failure meta-analysis
Cautions
- US prescribing information for spironolactone says that potassium supplements, potassium-containing salt substitutes, and medicines that can raise potassium, such as ACE inhibitors, NSAIDs and heparin, may lead to severe hyperkalaemia
- Potassium and kidney function are checked before treatment and monitored during treatment, according to NHS Specialist Pharmacy Service guidance for spironolactone and a review of eplerenone
Class interactions
Open the Drug Interaction Checker
Connected pages in detail
What each linked page on Anatomy Nexus covers, in a line, for Mineralocorticoid receptor antagonists.
Conditions
- Heart failure A syndrome in which the heart cannot pump enough blood to meet the body's needs, or can do so only at raised filling pressures.
Medications
- Spironolactone Spironolactone is a diuretic, a medicine that helps reduce fluid build-up in the body.