Eplerenone reverses spironolactone-induced painful gynaecomastia in cirrhotics

To investigate the efficacy and safety of aldosterone antagonist, eplerenone in the treatment of spironolactone-induced painful gynaecomastia in cirrhotic patients. A number of 19 consecutive patients with cirrhosis due to alcohol abuse or chronic hepatitis B, who had been administered spironolactone and suffered from painful gynaecomastia, have been included in the study. Substitution of spironolactone with eplerenone was followed for 3 months under close inspection. Age and gender, along with Child-Pugh stage of cirrhosis, pain (in a 1-5 visual analogue scale), Na(+), K(+), FSH, LH, 17 (OH) progesterone, DHEA-S, testosterone, and prolactin were measured at the beginning and the end of the study. All 19 patients expressed alleviation of pain (P < 0.001). Two patients deteriorated and two other ameliorated as far as the Child-Pugh score is referred. All biochemical and hormonal parameters remained unchanged. In cirrhotic patients with painful gynaecomastia, the use of eplerenone instead of spironolactone might reverse pain and seems to be safe and clinically acceptable option.