II. Mechanism
- Direct renin inhibitor
- Full effect at current dose within 2 weeks of starting
- Additive effect on Hypertension when combined with other agents
- However increased risk in combination - see precautions below
- Addiditive effect in combination with ACE Inhibitors, Angiotensin Receptor Blockers
- Additive effect in combination with Diuretics
- Possible additive effect in combination with Amlodipine
III. Precautions
- Risk of complications, especially in diabetes, when combined with ACE Inhibitors and Angiotensin Receptor Blockers
- Increased risk in combination of Cerebrovascular Accident, renal complications, Hyperkalemia, or Hypotension
IV. Pharmacokinetics
- Renally excreted (renal dose adjustment not necessary, but requires monitoring)
- Metabolized by CYP3A4 without inhibitory or induction effects
V. Interactions
- Irbesartan (decreases Aliskiren by 50%)
- Atorvastatin (increases Aliskiren by 50%)
- Furosemide (Aliskaren decreases Furosemide efficacy by up to 50%)
- Ketoconazole (increases Aliskiren by 80%)
VI. Monitoring: Check response 2 weeks after starting medication
- Serum Creatinine
- Serum Electrolytes (esp. Serum Potassium)
- Blood Pressure response
VII. Efficacy
- Similar effect on Blood Pressure as ACE Inhibitors and Angiotensin Receptor Blockers
- Unlike ACE Inhibitors and Angiotensin Receptor Blockers, no evidence that Direct renin inhibitors improve outcomes
- No significant benefit in Hypertension, Chronic Kidney Disease, Heart Failure
- Risk of hyptension, Hyperkalemia and increased Serum Creatinine
- (2016) Presc Lett 3(6):34
VIII. Indications
- Second line antihypertensive for those unable to use ACE Inhibitors or Angiotensin Receptor Blockers
IX. Dosing
- Start: 150 mg orally daily
- Maximum: 300 mg daily
XI. References
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Related Studies
| tekturna (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| TEKTURNA 150 MG TABLET | Generic | $5.56 each |
| TEKTURNA 300 MG TABLET | Generic | $6.96 each |
| TEKTURNA HCT 300-12.5 MG TAB | $10.75 each | |
| TEKTURNA HCT 300-25 MG TABLET | $10.74 each | |
| aliskiren (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ALISKIREN 150 MG TABLET | Generic | $5.56 each |
| ALISKIREN 300 MG TABLET | Generic | $6.96 each |