Two medicines, side by side
Eplerenone vs telmisartan
Eplerenone and telmisartan are both labeled for high blood pressure. Drugs@FDA records approvals of eplerenone since 2002 and of telmisartan since 1998. Pharmacies paid $0.308 per eplerenone 25 mg tablet and $0.106 per telmisartan 20 mg tablet (NADAC, October 7, 2026); the strengths differ, so the two prices are not like for like. In FDA's classes, eplerenone is an aldosterone antagonist and telmisartan an angiotensin 2 receptor blocker.
Check it at the source: the eplerenone FDA label on DailyMed (effective June 23, 2025); the telmisartan FDA label on DailyMed (effective May 29, 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 telmisartan record
Telmisartan (Micardis) · label of May 29, 2026
FETAL TOXICITY When pregnancy is detected, discontinue telmisartan as soon as possible [see Warnings and Precautions (5.1) and Use in Specific Populations (8.1)]. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus [see Warnings and Precautions (5.1) and Use in Specific Populations (8.1)]. WARNING: FETAL TOXICITY See full prescribing information for complete boxed warnings.
Used for
From the label: indicationsTelmisartanis an angiotensin II receptor blocker (ARB) indicated for: Treatment of hypertension to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions(1.1) 1.1 Hypertension Telmisartan is indicated for the treatment of hypertension, to lower blood pressure. […]
On the market
- Earliest approval on file
- November 10, 1998
- Generic labelers
- 28 labelers
- Pharmacy cost
- $0.106 per tablet
Supply and safety
- Shortage
- No current entry
- Recalls
- 3
Source: FDA drug labels via openFDA (Eplerenone label of June 23, 2025, Telmisartan label of May 29, 2026); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do eplerenone and telmisartan differ on the record?
In FDA's classes, eplerenone is an aldosterone antagonist and telmisartan an angiotensin 2 receptor blocker.
How each works, in its label's words: Eplerenone, “Eplerenone binds to the mineralocorticoid receptor and blocks the binding of aldosterone, a component of the renin-angiotensin-aldosterone-system (RAAS).”; Telmisartan, “Angiotensin II is formed from angiotensin I in a reaction catalyzed by angiotensin-converting enzyme (ACE, kininase II).”
Half-life, in each label's words: Eplerenone, “12.3 Pharmacokinetics Eplerenone is cleared predominantly by cytochrome P450 (CYP) 3A4 metabolism, with an elimination …”; Telmisartan, “Telmisartan shows bi-exponential decay kinetics with a terminal elimination half-life of approximately 24 hours.”
Only the telmisartan label carries a boxed warning.
Generics: eplerenone since 2008; telmisartan since 2014 (Drugs@FDA).
| Eplerenone | Telmisartan | |
|---|---|---|
| Labeled for | Heart failure, High blood pressure | High blood pressure, Heart attack and coronary artery disease |
| Pharmacologic class | Aldosterone Antagonist | Angiotensin 2 Receptor Blocker |
| 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). | Angiotensin II is formed from angiotensin I in a reaction catalyzed by angiotensin-converting enzyme (ACE, kininase II). |
| 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. | Telmisartan shows bi-exponential decay kinetics with a terminal elimination half-life of approximately 24 hours. |
| Earliest approval on file (Drugs@FDA) | September 27, 2002 | November 10, 1998 |
| First generic approved | July 30, 2008 | January 8, 2014 |
| Generic labelers (NDC) | 9 labelers | 28 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $0.308 per tablet (Eplerenone 25 mg tablet) | $0.106 per tablet (Telmisartan 20 mg tablet) |
| 12-month price change | -31% | -4% |
| Boxed warning | No | Yes |
| Shortage now | No current entry | No current entry |
| Recalls recorded | 0 | 3 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 12,729 | 17,745 |
| 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