Eplerenone and nelfinavir
Desk tier: Avoid together
Mechanism: strong CYP3A4 inhibition of clearance (↑ exposure)
“INSPRA is contraindicated in all patients with: … concomitant administration of strong CYP3A inhibitors (e.g., ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, and nelfinavir)”
Why this grade
Inspra (eplerenone) label, Contraindications
The Inspra (eplerenone) label lists this combination under Contraindications. 4 CONTRAINDICATIONS: "INSPRA is contraindicated in all patients with: … concomitant administration of strong CYP3A inhibitors (e.g., ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, and nelfinavir)" Named in the label: "nelfinavir" Retrieved from DailyMed 2026-10-12.
Inspra (eplerenone) label on DailyMedFDA interaction table
FDA's example-interaction table lists nelfinavir as a strong CYP3A inhibitor, and Eplerenone as a sensitive CYP3A substrate. FDA grades the roles; the severity tier on this row is the desk's rule. Table content current as of 2026-05-29.
FDA interaction tableAll pairs for Eplerenone · nelfinavir
Enzyme behind this pair: CYP3A4
Educational reference only. Not FDA-cleared. The Prescribing Information governs.
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