Drug interactions
Eplerenone + Mitotane
Severity: Major
Eplerenone and Mitotane: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Mitotane is a strong CYP3A4 inducer that markedly lowers eplerenone concentrations, and the induction persists for weeks after mitotane is stopped. This can lead to loss of antihypertensive or heart failure benefit.
What this interaction means in plain words
Eplerenone and Mitotane can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Eplerenone belongs to Cardiovascular; Mitotane belongs to Oncology.
Why it happens
Induction of CYP3A4 by mitotane increases eplerenone metabolism and lowers plasma levels.
What to do
Avoid the combination where possible and consider an alternative antihypertensive. If used, monitor blood pressure and potassium and titrate eplerenone, continuing monitoring after mitotane discontinuation.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Eplerenone
- Amiloride + Eplerenone Contraindicated
- Atazanavir + Eplerenone Contraindicated
- Clarithromycin + Eplerenone Contraindicated
- Cobicistat + Eplerenone Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Eplerenone Contraindicated
- Ensitrelvir + Eplerenone Contraindicated
Other interactions of Mitotane
- Doravirine + Mitotane Contraindicated
- Fostemsavir + Mitotane Contraindicated
- Lorlatinib + Mitotane Contraindicated
- Abiraterone + Mitotane Major
- Apixaban + Mitotane Major
- Aprepitant + Mitotane Major
Frequently asked questions
Can I take Eplerenone with Mitotane?
MediHelp rates the interaction as major. Eplerenone and Mitotane can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Mitotane is a strong CYP3A4 inducer that markedly lowers eplerenone concentrations, and the induction persists for weeks after mitotane is stopped. This can lead to loss of antihypertensive or heart failure benefit.
How serious is the interaction between Eplerenone and Mitotane?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible and consider an alternative antihypertensive. If used, monitor blood pressure and potassium and titrate eplerenone, continuing monitoring after mitotane discontinuation.
What other medicines interact with Eplerenone?
MediHelp also lists interactions of Eplerenone with, for example, Amiloride, Atazanavir, Clarithromycin. The full list is on the Eplerenone page.
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