Two medicines, side by side
Eplerenone vs hydrochlorothiazide
Eplerenone and hydrochlorothiazide are both labeled for high blood pressure and heart failure. Drugs@FDA records approvals of eplerenone since 2002 and of hydrochlorothiazide since 1959. Pharmacies paid $0.308 per eplerenone 25 mg tablet and $0.0115 per hydrochlorothiazide 25 mg tablet (NADAC, October 7, 2026). Hydrochlorothiazide's other strengths are brand-only: $4.46 per mL (Inzirqo 10 mg/mL oral suspension). In FDA's classes, eplerenone is an aldosterone antagonist and hydrochlorothiazide a thiazide diuretic.
Check it at the source: the eplerenone FDA label on DailyMed (effective June 23, 2025); the hydrochlorothiazide FDA label on DailyMed (effective June 12, 2026).
Highlights of the eplerenone record
Eplerenone (Inspra) · label of June 23, 2025
Used for
From the label: indicationsINSPRA is an aldosterone antagonist indicated for: • Improving survival of stable adult patients with symptomatic heart failure with reduced ejection fraction (HFrEF) after an acute myocardial infarction. ( 1.1 ) • The treatment of hypertension in adults, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. […]
On the market
- Earliest approval on file
- September 27, 2002
- Generic labelers
- 9 labelers
- Pharmacy cost
- $0.308 per tablet
Supply and safety
- Shortage
- No current entry
- Recalls
- 0
Highlights of the hydrochlorothiazide record
Hydrochlorothiazide (Inzirqo) · label of June 12, 2026
Used for
From the label: indicationsHydrochlorothiazide tablets USP are indicated as adjunctive therapy in edema associated with congestive heart failure, hepatic cirrhosis, and corticosteroid and estrogen therapy. Hydrochlorothiazide tablets USP have also been found useful in edema due to various forms of renal dysfunction such as nephrotic syndrome, acute glomerulonephritis, and chronic renal failure. […]
On the market
- Earliest approval on file
- February 12, 1959
- Generic labelers
- 43 labelers
- Pharmacy cost
- $0.0115 per tablet
Supply and safety
- Shortage
- A presentation being discontinued
- Recalls
- 7
Source: FDA drug labels via openFDA (Eplerenone label of June 23, 2025, Hydrochlorothiazide label of June 12, 2026); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do eplerenone and hydrochlorothiazide differ on the record?
In FDA's classes, eplerenone is an aldosterone antagonist and hydrochlorothiazide a thiazide diuretic.
Half-life, in each label's words: Eplerenone, “12.3 Pharmacokinetics Eplerenone is cleared predominantly by cytochrome P450 (CYP) 3A4 metabolism, with an elimination …”; Hydrochlorothiazide, “When plasma levels have been followed for at least 24 hours, the plasma half-life has been observed to vary between 5.6 …”
Generics: eplerenone since 2008; hydrochlorothiazide since 1973 (Drugs@FDA).
| Eplerenone | Hydrochlorothiazide | |
|---|---|---|
| Labeled for | Heart failure, High blood pressure | Heart failure, High blood pressure, Edema (fluid retention) |
| Pharmacologic class | Aldosterone Antagonist | Thiazide Diuretic |
| How it works (label) | Eplerenone binds to the mineralocorticoid receptor and blocks the binding of aldosterone, a component of the renin-angiotensin-aldosterone-system (RAAS). | n/a |
| Half-life (label) | 12.3 Pharmacokinetics Eplerenone is cleared predominantly by cytochrome P450 (CYP) 3A4 metabolism, with an elimination half-life of 3 to 6 hours. | When plasma levels have been followed for at least 24 hours, the plasma half-life has been observed to vary between 5.6 and 14.8 hours. |
| Earliest approval on file (Drugs@FDA) | September 27, 2002 | February 12, 1959 |
| First generic approved | July 30, 2008 | January 12, 1973 |
| Generic labelers (NDC) | 9 labelers | 43 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $0.308 per tablet (Eplerenone 25 mg tablet) | $0.0115 per tablet (Hydrochlorothiazide 25 mg tablet) |
| 12-month price change | -31% | -7% |
| Boxed warning | No | No |
| Shortage now | No current entry | A presentation being discontinued |
| Recalls recorded | 0 | 7 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 12,729 | 144,413 |
| DEA schedule | none | none |
Source: Drugs@FDA, FDA NDC Directory, CMS NADAC of October 7, 2026, FDA shortages and recalls, FAERS via openFDA (FDA files October 8, 2026)
What next?
- Alternatives to eplerenone
- every medicine labeled for the same conditions