Drug Action
Renin inhibitors inhibit renin directly; renin converts angiotensinogen to angiotensin I.
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Drug reference
Renin inhibitors inhibit renin directly; renin converts angiotensinogen to angiotensin I.
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Essential hypertension either alone or in combination with other antihypertensives ▶BY MOUTH ▶Adult: 150 mg once daily, increased if necessary to 300 mg once daily
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Concomitant treatment with an ACE inhibitor or an angiotensin-II receptor antagonist in patients with an eGFR less than 60 mL/minute/1.73 m2. concomitant treatment with an ACE inhibitor or an angiotensin-II receptor antagonist in patients with diabetes mellitus. hereditary angioedema. idiopathic angioedema
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Combination treatment with an ACE inhibitor. combination treatment with an angiotensin-II receptor Cardiovascular system antagonist. concomitant use of diuretics (first doses may cause hypotension—initiate with care). history of angioedema. moderate to severe congestive heart failure. patients at risk of renal impairment. salt depletion (first doses may cause hypotension—initiate with care). volume depletion (first doses may cause hypotension—initiate with care) CAUTIONS, FURTHER INFORMATION ▶Concomitant use of drugs affecting the renin-angiotensin system Combination therapy with two drugs affecting the renin-angiotensin system (ACE inhibitors, angiotensin-II receptor antagonists, and aliskiren) is not recommended due to an increased risk of hyperkalaemia, hypotension, and renal impairment, compared to use of a single drug. Patients with diabetic nephropathy are particularly susceptible to developing hyperkalaemia and should not be given an ACE inhibitor with an angiotensin-II receptor antagonist. There is some evidence that the benefits of combination use of an ACE inhibitor with candesartan or valsartan may outweigh the risks in selected patients with heart failure for whom other treatments are unsuitable, however, the concomitant use of this combination, together with an aldosterone antagonist or a potassium- sparing diuretic is not recommended. For patients currently taking combination therapy, the need for continued combined therapy should be reviewed. If combination therapy is considered essential, it should be carried out under specialist supervision, with close monitoring of blood pressure, renal function, and electrolytes (particularly potassium); monitoring should be considered at the start of treatment, then monthly, and also after any change in dose or during intercurrent illness.
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Scottish Medicines Consortium (SMC) decisions SMC No. 462/08 The Scottish Medicines Consortium has advised (February 2010) that aliskiren (Rasilez ®) is not recommended for use within NHS Scotland for the treatment of essential hypertension as the economic case was not demonstrated.
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→Appendix 1: aliskiren
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▶Common or very common Arthralgia. diarrhoea. dizziness. electrolyte imbalance ▶Uncommon Cough. oral disorder. palpitations. peripheral oedema. renal impairment. severe cutaneous adverse reactions (SCARs). skin reactions ▶Rare or very rare Angioedema. hypersensitivity ▶Frequency not known Dyspnoea. hepatic disorders. nausea . vertigo. vomiting SIDE-EFFECTS, FURTHER INFORMATION If diarrhoea is severe or persistent discontinue treatment.
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Manufacturer advises avoid—no information available; other drugs acting on the renin-angiotensin system have been associated with fetal malformations and neonatal death.
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Present in milk in animal studies— manufacturer advises avoid.
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Avoid if eGFR is less than 30 mL/minute/1.73 m2— no information available. Use with caution in renal artery stenosis—no information available. Monitoring Monitor plasma-potassium concentration in renal impairment.
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Monitor patients with a history of angioedema closely during treatment.
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There can be variation in the licensing of different medicines containing the same drug. Tablet CAUTIONARY AND ADVISORY LABELS 21 Cardiovascular system ▶Rasilez (Noden Pharma DAC) Aliskiren (as Aliskiren hemifumarate) 150 mg Rasilez 150mg tablets | 28 tablet P £28.51 DT = £28.51 Aliskiren (as Aliskiren hemifumarate) 300 mg Rasilez 300mg tablets | 28 tablet P £34.27 DT = £34.27 VASODILATORS › VASODILATOR ANTIHYPERTENSIVES
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150 mg once daily, increased if necessary to
First-line fragment. Read the complete Indications and Dose section above.
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