The evolution of aldosterone antagonists.
Since the isolation and purification of aldosterone from adrenal extracts 50 years ago (Experientia 9 (1953) 33), scientists have learned a great deal about how and where aldosterone acts, the factors that control its release, what is its role in the pathophysiology of cardiovascular disease, how to make and study aldosterone antagonists, and for what medical purposes these agents are useful. In this paper, we will discuss the evolution of aldosterone antagonists from the relatively nonselective spironolactone (Aldactone), to the highly selective eplerenone (Inspra). Eplerenone represents a molecule with improved steroid receptor selectivity and pharmacokinetic properties in man compared to spironolactone. Recent clinical results have demonstrated that these improvements translate into tolerability and efficacy in patients with cardiovascular disease.
Garthwaite
Susan M
SM
Pfizer Incorporated, Global Project Management, Skokie, IL, USA.
McMahon
Ellen G
EG
D000450:Aldosterone / Q000266:history / Q000378:metabolism; D000818:Animals; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000378:metabolism; D002986:Clinical Trials as Topic; D000077545:Eplerenone; D006177:Gynecomastia / Q000188:drug therapy / Q000378:metabolism; D049673:History, 20th Century; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000138:chemical synthesis / Q000266:history / Q000493:pharmacokinetics / Q000627:therapeutic use; D013148:Spironolactone / Q000031:analogs & derivatives* / Q000138:chemical synthesis / Q000266:history / Q000493:pharmacokinetics / Q000627:therapeutic use
D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000450:Aldosterone; D000077545:Eplerenone