Names and pronunciation
(a-lis′kir-en) Rasilez , Tekturna
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Drug reference
(a-lis′kir-en) Rasilez , Tekturna
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Func. class.: Antihypertensive
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Chem. class.: Direct renin inhibitor
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ACTION: Renin inhibitor that acts on the renin-angiotensin system (RAS)
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USES: Hypertension, alone or in com- bination with other antihypertensives
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Black Box Warning: Pregnancy Precautions: Breastfeeding, children, geriatric patients, angioedema, aortic/ renal artery stenosis, cirrhosis, CAD, dialysis, hyper/hypokalemia, hyponatre- mia, hypotension, hypovolemia, renal/ hepatic disease, surgery, diabetes Black Box Warning: Pregnancy: To no- tify if pregnancy is planned or suspected; if pregnant, product will need to be dis- continued
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SIDE EFFECTS CV: Orthostatic hypotension, hypotension CNS: Headache, dizziness, seizures GI: Diarrhea GU: Renal stones, increased uric acid INTEG: Rash META: Hyperkalemia MISC: Angioedema, cough
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INTERACTIONS • Do not use with ACE inhibitors, angio- tensin II receptor antagonists in diabetes mellitus Increase: potassium levels—ACE inhibi- tors, angiotensin II receptor antagonists, potassium supplements, potassium-sparing diuretics Increase: hypotension—other antihyper- tensives, diuretics Increase: aliskiren levels—atorvastatin, itraconazole, ketoconazole, cycloSPO- RINE; concurrent use is not recom- mended Decrease: levels of warfarin Drug/Food Decrease: aliskiren effect—high-fat meal, grapefruit Drug/Lab Test A Increase: uric acid, BUN, serum creati- nine, potassium
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DOSAGE AND ROUTES • Adult/child ≥6 yr and >50 kg: PO 150 mg/day, may increase to 300 mg/day if needed, max 300 mg/day Child ≥6 yr and 20-50 kg: PO 75 mg daily, max 150 mg/day
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Available forms: Tablets 150, 300 mg
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Administer: • May use with other antihypertensives • Do not use with a high-fat meal • Daily with a full glass of water; titrate up to achieve correct dose • Do not discontinue abruptly; correct electrolyte/volume depletion before treatment • Store in tight container at room tem- perature
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Assess: • Renal studies: uric acid, serum creati- nine, BUN may be increased; hyperkale- mia may occur; correct salt depletion, hyperkalemia, volume before starting therapy • Allergic reactions: angioedema may occur (swelling of face; trouble breathing, swallowing) • Daily dependent edema in feet, legs; weight, B/P, orthostatic hypotension • Diabetes: identify the use of ACE in- hibitors, angiotensin II receptor antago- nists; if in use, do not use aliskiren
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Evaluate: • Therapeutic response: decrease in B/P
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About the importance of complying with dosage schedule even if feeling bet- ter; that if dose is missed, take as soon as possible; that if it is almost time for the next dose, take only that dose; do not double dose; do not take with high-fat meal or grapefruit • How to take B/P and normal reading for age group • Not to use OTC products including herbs, supplements unless approved by prescriber • To report to prescriber immedi- ately: dizziness, faintness, chest pain, palpitations, uneven or rapid heartbeat, headache, severe diarrhea, swelling of tongue or lips, trouble breathing, difficulty swallowing, tightening of the throat • Not to operate machinery or perform hazardous tasks if dizziness occurs • To rise slowly to avoid faintness
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PHARMACOKINETICS Poorly absorbed, bioavailability 2.5%, peak 1-3 hr, steady state 7-8 days, 91% excreted unchanged in the feces, half-life 24 hr
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• Adult/child ≥6 yr and >50 kg: PO 150 mg/day, may increase to 300 mg/day if needed, max 300 mg/day Child ≥6 yr and 20-50 kg: PO 75 mg daily, max 150 mg/day
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