aliskiren

aliskiren,

an antihypertensive.

indications This drug is used to treat hypertension, alone or in combination with other antihypertensives.

contraindications Second and third trimester pregnancy and known hypersensitivity to this drug prohibit its use.

adverse effects Adverse effects of this drug include orthostatic hypotension, hypotension, headache, dizziness, renal stones, increased uric acid, rash, and hyperkalemia. Life-threatening side effects include angioedema.

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aliskiren

Tekturna

Pharmacologic class: Direct renin inhibitor

Therapeutic class: Antihypertensive

Pregnancy risk category C (first trimester), D (second and third trimesters)

FDA Boxed Warning

• When used during second or third trimester of pregnancy, drug may cause fetal injury and death. Discontinue as soon as possible when pregnancy is detected.

Action

Decreases plasma renin activity and inhibits conversion of angiotensinogen to angiotensin

Availability

Tablets: 150 mg, 300 mg

⊘Indications and dosages

➣ Hypertension (alone or in combination with other antihypertensives)

Adults: Initially, 150 mg P.O. once daily; may increase to 300 mg if blood pressure isn't adequately controlled

Contraindications

None

Precautions

Use cautiously in:
• patients with severe renal dysfunction, nephrotic syndrome, renovascular hypertension, or history of dialysis
• diabetic patients (when combined with ACE inhibitors) because of hyperkalemia risk
• angioedema (laryngeal edema)
• females of childbearing age
• pregnant or breastfeeding patients
• children (safety and efficacy not established).

Administration

• Give consistently with or without food, but not with high-fat foods.

Route	Onset	Peak	Duration
P.O.	Unknown	1-3 hr	Unknown

Adverse reactions

CNS: headache, fatigue

CV: dizziness, hypotension

EENT: nasopharyngitis

GI: diarrhea, gastroesophageal reflux

Musculoskeletal: back pain

Respiratory: upper respiratory tract infection, cough

Skin: rash

Other: edema, angioedema

Interactions

Drug-drug. Atorvastatin: increased aliskiren Cand area under the curve (AUC) after multiple doses

Furosemide: diminished furosemide efficacy

Ketoconazole: increased aliskiren blood level

Irbesartan: reduced aliskiren C and AUC up to 50% after multiple doses

Drug-diagnostic tests. BUN, creatine kinase, potassium, serum creatinine, serum uric acid: increased values

Hematocrit, hemoglobin: decreased values

Drug-food. High-fat meals: decreased drug absorption

Patient monitoring

• Monitor routinely for hyperkalemia in patients with diabetes mellitus receiving concurrent ACE inhibitors.
• Stay alert for signs and symptoms of renal dysfunction.
• Monitor patient for angioedema; discontinue drug if signs and symptoms occur.

Patient teaching

• Instruct patient to take drug consistently with or without food, but not with high-fat foods.
• Advise female to tell prescriber if she's pregnant or breastfeeding before taking drug.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.