Introduction to Aliskiren
Hypertension or the common name for high blood pressure is one of the most common health issues among the population of the world. Unattended, it can result in quite severe complications such as heart attack, stroke or kidney damage. Aliskiren has become a novel option in the ever-seeking effective treatment process. It differs from many old-established blood pressure medications and provides a new alternative in the treatment of hypertension. Having knowledge of how Aliskiren works and its implication on blood pressure control may guide patients and their caregivers on decision-making in treatment.
What is Aliskiren?
Aliskiren is mostly a prescription drug, intended to treat high blood pressure. It is of a class of drugs known as direct renin inhibitors making it unique over other blood pressure drugs such as ACE inhibitors or ARBs. Aliskiren works to obstruct creations of an enzyme known as renin, which are produced by the kidney and associated with regulating body pressure. When Aliskiren inhibits renin directly, blood vessels’ tightening substances are not formed which allows them to relax and blood to flow more easily. This then reduces blood pressure.
FDA approved in 2007, Aliskiren goes under the brand name Tekturna in some of the countries. As a rule, it is used as a single drug or in combination with other antihypertensive agents. Although it has another mechanism of action it is not normally the first choice and is used when other drugs are ineffective or unsuitable.
Mechanism of Action
Aliskiren acts directly to block the activity of an enzyme known as renin – which is critical to a process known as renin-angiotensin-aldosterone system (RAAS) – a hormone system responsible for regulation of blood pressure, blood fluid and electrolyte balance. Normally, renin is secreted from the kidneys when the levels of blood pressure and/or sodium fall low. It then converts angiotensinogen (a protein produced in the liver) into angiotensin I, from this another enzyme (ACE) – angiotensin converting enzyme converts this into angiotensin II.
Angiotensin II is a strong substance that narrows blood vessels and prompts the release of aldosterone; a hormone which makes the body retain sodium and water. This chain process leads to an increase in blood volume and pressure.
Aliskiren interferes with this process right at its starting point by causing renin to stop the conversion of angiotensinogen into angiotensin I. This results in decreased levels of angiotensin II, dilated blood vessels, less water retention as well as lower blood pressure.
Since it is also a point of blocking the RAAS route, Aliskiren brings a specialized and early mode of intervention in the regulation of blood pressure.
Uses of Aliskiren
Aliskiren is mostly prescribed for treatment of hypertension (high blood pressure). It might be used alone or combined with other drugs including diuretics, calcium channel blockers or angiotensin receptor blockers (ARBs) for blood pressure control augmentation. Aliskiren helps to preserve the low blood pressure and in so doing decreases the risk of having cardiovascular complications, such as heart attacks, strokes and kidney diseases.
Some healthcare providers will also consider Alikiren in patients that are not responding well to normal blood pressure control treatments or cannot be able to tolerate medications such as ACE inhibitors. It however does not become a first choice drug and it is commonly administered when other alternatives are unsuitable or ineffective.
In certain cases, Aliskiren may be part of the treatment plan for patients with conditions that involve overactivation of the RAAS system, but this use is more specialized and determined by a physician.
Dosage and Administration
In its tablet form, aliskiren is usually prescribed once per day to be taken either with or without food. For adults, 150 mg monthly is the customary starting dose. Regarding the patient’s reaction and tolerance the doctor might be upping the dose to 300 mg per day as better blood pressure control is concerned.
It is essential to take Aliskiren at the same time every day as a way to keep constant levels in the body. Patient’s are generally not recommended to take it with a high fatty meal which may reduce the absorption and effect of the drug.
Aliskiren is for use only with a healthcare provider’s help. Do not reduce or stop dosage himself after seemingly normal blood pressure. Omission of doses or an abrupt cessation can result in an elevation of blood pressure and a proliferation of complications.
Renal patients, or patients who take diuretics, or people who are severely dehydrated should be treated with special caution since they may require a dose adjustment or tighter monitoring.
Common Side Effects
Although Aliskiren is well tolerated in general, as any drug, it may provoke side effects in some patients. (..) the most frequently reported side effects are:
Diarrhea (especially at higher doses)
Dizziness or lightheadedness (in particular when standing up quickly)
Headache
Fatigue
Cough
More serious effects when occurring are:）
High potassium levels (hyperkalemia)
Kidney problems or/and further decrease of renal function
Allergic conditions such as rash, itching or swelling of the face or throat.
Patients with the symptoms of a life-threatening allergic response or trouble breathing should consult a doctor as soon as possible. Speaking to the doctor about any new or unusual ailments, particularly while using Aliskiren with other medications for blood pressures or kidney problems should also be communicated.
Precautions and Warnings
Before commencing Aliskiren certain health conditions and risk factors must be taken into account for safe use. Listed below are major precautions and warning:
Pregnancy: Within the second and third trimesters, Aliskiren should not be used as medication in pregnant women. It can lead to serious damage or death of an unborn baby. A woman that conceives while on Aliskiren should stop the drug immediately and seek a doctor’s advice.
Kidney Problems: Aliskiren should be used with caution by patients suffering from a damaged kidney or poor renal function. Constant kidney monitoring may be necessary in order to prevent complications.
High Potassium Levels (Hyperkalemia): The blood level of potassium can be raised by the use of aliskiren. Patients should not consume potassium supplements or high potassium foods without a doctor’s advice.
Dehydration: Application of Aliskiren in dehydrated or diuretic individuals can cause critically low blood pressure. It’s important to keep well hydrated and report mild symptoms of lightheadedness or fainting.
Diabetes: Addition of Aliskiren with ACE inhibitors and ARBs is not advisable in patients with diabetes since it increases the risk of kidney damage, low blood pressure and high potassium level.
Surgery and Anesthesia: Tell your doctor if you are on Aliskiren before any surgery, as it may affect blood pressure after the operation.
Drug Interactions
Although aliskiren may interact with a number of other drugs, this may decrease its efficacy and heighten the instance of side effects. Some key drug interactions include:
ACE Inhibitors (for example, lisinopril) and ARBs (for example, losartan). Concurrent use of Aliskiren with these drugs may present additional risk of kidney damage, particularly, in persons with diabetes or a renal dysfunction.
Potassium Sparing diuretics (e.g., spironolactone); or supplements (e.g., potassium chloride). In combination with Aliskiren, they may increase one’s potassium levels to an unsafe high, causing severe heart problems.
NSAIDs (e.g., ibuprofen, naproxen): Regular use of non steroidal anti-inflammatory drugs with Aliskiren can lead to malfunctioning of kidneys, especially in the elderly or people who have kidney problems.
CYP3A4 inhibitors (e.g., ketoconazole): These can increase levels of Aliskiren in the body thereby, increasing the risk of side effects.
Always tell your health care provider about all prescription and over-the-counter medicines, vitamins and herbal products you take before taking Aliskiren.
Who Should Avoid Aliskiren?
Aliskiren works well for most people but not for all. Some people must not consume this medication owing to the possibility of severe side effects or complications. You should not take Aliskiren if you;:
Are pregnant or pregnant women. Aliskiren may injure or even kill a developing fetus, especially during late pregnancy.
Have diabetes, and am using an ACE inhibitor or an ARB. The combination boasts high risk factors for kidney problems, perilously low levels of blood pressure, and excessive concentrations of potassium.
Have a history of angioedema (swelling face, lips or throat) caused by the use of blood pressure medications: Aliskiren can cause the same reaction.
Have severe kidney impairment: Some people’s kidney function may be made worse by this drug.
Are allergic to Aliskiren’s components: Allergic reactions are possible, and can be severe.
Consult your doctor before taking Aliskiren, particularly if you have an underlying health problem or take some other drugs.
Aliskiren for Hypertension management benefit.
Aliskiren provides various possible advantages in high blood pressure treatment.
Direct implication on the RAAS system. Unlike ACE inhibitors or ARBs, Aliskiren works at the system root, by directly inhibiting renin. This early intervention is able to contain the whole chain of events that causes high blood pressure.
Effective blood pressure reduction: Clinical trials have established that Aliskiren reduces systolic and diastolic blood pressure thereby remaining a safe bet in most patients.
Can be used combined with the therapy: The drug works well with other antihypertensives including diuretics or calcium channel blockers, providing an aspect of treatment flexibility.
Long-lasting effect: Once a day administration gives around the clock control, better patient compliance and convenience.
Reduced RAAS activation rebound: By interfering with the start of the pathway, Aliskiren can prevent, or at least diminish, rebound activation of the renin-angiotensin system, sometimes a side effect of other blood pressure medications.
Aliskiren vs Other Antihypertensives
Aliskiren is unique from many conventional blood pressure drugs in mechanism of action. Here’s how it compares:
Versus ACE Inhibitors and ARBs: The mechanism in which these drugs act is lower down on the RAAS pathway by inhibiting the effects of angiotensin II. Aliskiren is earlier acting as it blocks the renin itself. But ACE inhibitors and ARBs are better funded with wider clinical evidence and are frequently the first-line treatment methods.
Versus Diuretics: Diuretics reduce blood pressure by assisting the body to reduce excess fluid and salt. Aliskiren is not a diuretic but may be taken with a diuretic for greater result.
Versus Calcium Channel Blockers (CCBs): CCBs open blood vessels through blocking the entry of calcium to the cells of the heart and arteries. Aliskiren acts on hormonal pathways instead and is therefore adopted in other physiologies.
In conclusion Alisikiren is a good option for particular patients specifically in case when another approach is required or a patient needs an add-on therapy. Nonetheless, with insufficient long term data on outcome relative to the older agents, it is usually considered a second-line agent in preference to primary treatment.
Frequently Asked Questions (FAQs)
1. Can I eat with Aliskiren?
Yes, though it can be taken either with or without food, it’s best to take it consistently the same way each time. Do not eat high fat beverages near the time one is to take the medication that can lower absorption.
2. How fast does Aliskiren reduce blood pressure?
Aliskiren normally takes effect in 2 weeks though full effect may be felt after a period of 4 weeks. Your blood pressure will be monitored by your doctor and the dose changed when necessary.
3. Can Aliskiren be used for long periods of time or not?
Aliskiren is well tolerated in long term use under doctor’s care. Periodic evaluation of kidney function and potassium levels is however required.
4. Can Aliskiren be taken with other blood pressure drugs?
Aliskiren is commonly combined with other antihypertensives. However, in diabetic or renal patients it shouldn’t be associated with ACE inhibitors or ARBs because of safety reasons.
5. What should I do if I miss a dose?
If you miss a dose, take it as soon as you remember. If it’s almost time for your next dose, skip the missed one—do not double the dose to catch up.
6. Are there any lifestyle changes needed while taking Aliskiren?
Yes, adopting a low-salt diet, staying physically active, avoiding tobacco, and managing stress will help enhance the effects of Aliskiren and improve your overall heart health.
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Conclusion: Is Aliskiren Right for You?
Aliskiren is a promising new avenue in the treatment of high blood pressure targeting the renin-angiotensin-aldosterone system in its origin. Though not the first line treatment for all – it is highly effective in particular conditions – most especially in cases where other therapies cannot be used or combination therapy is required.
It provides options for once a day administration, unique mechanism of action, and possible usefulness in long-term blood pressure control. But at the same time it is imperative to recognize precautions, as well as limitations, and especially if you suffer from diabetes or have kidney problems or if you are pregnant.
If you have out of control hypertension or you are experiencing side effects from other medications, contact your healthcare provider and find out if Aliskiren might be an appropriate medication in your treatment planning.
