Nurses Compass
Drug Guide
Aliskiren Hemifumarate
Classification
Therapeutic: Antihypertensive
Pharmacological: Direct renin inhibitor
FDA Approved Indications
- Treatment of hypertension
Mechanism of Action
Aliskiren inhibits renin enzymatic activity, thereby decreasing the formation of angiotensin I and subsequently angiotensin II, resulting in vasodilation and reduced blood pressure.
Dosage and Administration
Adult: Typically 150 mg once daily, can be increased to 300 mg once daily based on response.
Pediatric: Not approved for pediatric use.
Geriatric: No specific dosage adjustments, but monitor for hypersensitivity.
Renal Impairment: Adjustment may be necessary; use with caution.
Hepatic Impairment: Use with caution; no specific dose adjustment recommended.
Pharmacokinetics
Absorption: Well absorbed with bioavailability around 30%.
Distribution: Vast distribution; protein binding approximately 50%.
Metabolism: Primarily excreted unchanged; minimal metabolism.
Excretion: Excreted via feces and urine, mostly unchanged.
Half Life: Approximately 24 hours.
Contraindications
- Pregnancy (second and third trimesters), bilateral renal artery stenosis, hypersensitivity to aliskiren.
Precautions
- Use with caution in renal impairment, hypotension, and hyperkalemia.
Adverse Reactions - Common
- Diarrhea (Unknown)
- Dizziness (Common)
- Cough (Uncommon)
Adverse Reactions - Serious
- Angioedema (Rare)
- Hyperkalemia (Uncommon)
- Hypotension (Uncommon)
Drug-Drug Interactions
- ACE inhibitors, ARBs, potassium-sparing diuretics (risk of hyperkalemia)
Drug-Food Interactions
- Potassium-rich foods (risk of hyperkalemia)
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood pressure, renal function, and serum potassium periodically.
Diagnoses:
- Ineffective tissue perfusion related to decreased blood pressure.
Implementation: Administer once daily, monitor for signs of hypotension and hyperkalemia.
Evaluation: Assess blood pressure response; adjust dose accordingly.
Patient/Family Teaching
- Take medication as directed, even if feeling well.
- Avoid potassium supplements and potassium-rich foods unless advised.
- Report signs of angioedema, hyperkalemia, or severe dizziness.
Special Considerations
Black Box Warnings:
- Pregnancy: Use during second and third trimesters can cause fetal injury and death.
Genetic Factors: None established.
Lab Test Interference: May increase serum creatinine and serum potassium levels.
Overdose Management
Signs/Symptoms: Severe hypotension, dizziness, nausea.
Treatment: Discontinue drug, provide supportive care, monitor vital signs, administer vasopressors if needed.
Storage and Handling
Storage: Store at room temperature between 20°C and 25°C.
Stability: Stable under recommended storage conditions.