Aliskiren

About Aliskiren

Aliskiren blocks renin, the enzyme that starts the chain of steps producing angiotensin II, a hormone that narrows blood vessels and makes the body hold on to salt; ACE inhibitors and ARBs act further along the same chain. The label approves it for high blood pressure in adults and in children 6 years and older who weigh at least 50 kg, and notes that no controlled trial has shown that it reduces cardiovascular risk. The usual starting dose is 150 mg once a day, raised to 300 mg once a day if blood pressure is not controlled; higher doses did not lower blood pressure further but caused more diarrhea. High-fat meals cut its absorption substantially, so the label asks patients to keep a routine pattern for taking it with regard to meals.

The boxed warning is fetal toxicity: drugs that act directly on this hormone system can injure and kill a developing baby, so aliskiren is stopped as soon as pregnancy is detected. It must not be taken with an ARB or an ACE inhibitor by people with diabetes, and the label says to avoid that combination in general, because it adds to the risk of low blood pressure, high potassium and kidney problems. Anaphylaxis and swelling of the face, lips, tongue or throat (angioedema) can occur at any time during treatment, including in people who never had angioedema on an ACE inhibitor or ARB; aliskiren is then stopped and not given again. Blood pressure can fall too far at the start in people markedly low on body fluid or salt, which is corrected first, and kidney function and potassium are checked periodically. Diarrhea is the most common side effect, and cough was slightly more frequent than with placebo.

Aliskiren is contraindicated in children under 2 and avoided from 2 to under 6 years and in children under 20 kg; children 6 and older weighing 20 to under 50 kg are outside the approval because of the lack of a suitable dosage form. An oral pellet form approved in 2017 is listed as discontinued, as is Tekturna HCT, the combination with hydrochlorothiazide, in all four strengths. Cyclosporine and itraconazole are avoided with aliskiren; it lowers furosemide levels, so the diuretic effect is watched; and the label advises against breastfeeding during treatment.

Taking Aliskiren

How to take it

Once a day at about the same time, following the same routine each day: always with food or always without it. If you take it with a meal, avoid high-fat meals such as fried or fast food. It controls high blood pressure but does not cure it.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in the original container, tightly closed, away from heat and moisture, out of reach of children; leave the moisture-absorbing packet in the bottle. Use a take-back program rather than flushing.

Interactions to know about

Talk to the prescriber before using potassium supplements or potassium salt substitutes, which can raise potassium, as can potassium-sparing diuretics. Aspirin, ibuprofen, naproxen and other NSAIDs can strain the kidneys. ACE inhibitors and ARBs are generally avoided with it, and never combined with it in diabetes; cyclosporine and itraconazole are avoided; and it lowers furosemide levels, so the prescriber watches the diuretic effect.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Aliskiren differs from pharmacy to pharmacy

Only one generic aliskiren is approved, so there is little competition among suppliers, and it may not be on a pharmacy’s flat-price generic list. Tekturna is still listed as a brand, and a prescription that names it and blocks substitution is filled with the brand and priced as one.

A pharmacy that rarely fills aliskiren may need to order it in, and a 300 mg dose written as two 150 mg tablets raises the count where a pharmacy prices per tablet.

Ways to pay less for Aliskiren without insurance

• Ask for the generic, and check that the prescription does not block substitution.
• Once your dose is settled, ask for a ninety-day supply, and compare more than one pharmacy.
• If your dose is 300 mg, check that it is written as one 300 mg tablet rather than two 150 mg tablets.
• If your prescription is for Tekturna HCT, which is discontinued, ask the prescriber whether aliskiren and hydrochlorothiazide as separate tablets would suit you.
• If it is quoted high, ask the prescriber whether a generic ARB, such as losartan, or an ACE inhibitor would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Aliskiren

1. 1.Should I take my dose with or without meals, and which meals should I avoid with it?
2. 2.When will my kidney function and potassium be checked?
3. 3.Is it safe with my ACE inhibitor, ARB, water pill or anti-inflammatory painkiller?
4. 4.What should I do if I become pregnant or plan to?

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