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Tekturna
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Tekturna
, Aliskiren, Direct renin inhibitor
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 Inhibitor
s,
Angiotensin Receptor Blocker
s
Additive effect in combination with
Diuretic
s
Possible additive effect in combination with
Amlodipine
Precautions
Risk of complications, especially in diabetes, when combined with
ACE Inhibitor
s and
Angiotensin Receptor Blocker
s
Increased risk in combination of
Cerebrovascular Accident
, renal complications,
Hyperkalemia
, or
Hypotension
Pharmacokinetics
Renally excreted (renal dose adjustment not necessary, but requires monitoring)
Metabolized by
CYP3A4
without inhibitory or induction effects
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%)
Monitoring
Check response 2 weeks after starting medication
Serum Creatinine
Serum
Electrolyte
s (esp.
Serum Potassium
)
Blood Pressure
response
Efficacy
Similar effect on
Blood Pressure
as
ACE Inhibitor
s and
Angiotensin Receptor Blocker
s
Unlike
ACE Inhibitor
s and
Angiotensin Receptor Blocker
s, 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
Indications
Second line antihypertensive for those unable to use
ACE Inhibitor
s or
Angiotensin Receptor Blocker
s
Dosing
Start: 150 mg orally daily
Maximum: 300 mg daily
Adverse effects
Headache
(up to 6%)
Gastrointestinal symptoms (up to 9%)
Dizziness
References
Gradman (2005) Circulation 111:1012-8 [PubMed]
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