Aliskiren

How it works

It directly inhibits renin, reducing the conversion of angiotensinogen to angiotensin I and thereby lowering angiotensin II and aldosterone activity within the renin-angiotensin-aldosterone system.

Prescribing in practice

• Combining aliskiren with an ACE inhibitor or angiotensin receptor blocker increases the risk of hyperkalaemia, hypotension and renal impairment and is contraindicated in patients with diabetes or moderate-to-severe renal impairment.
• Contraindicated in pregnancy because of the risk of fetal harm from drugs acting on the renin-angiotensin system.
• Use with caution in patients at risk of volume depletion, in whom first-dose hypotension may occur.

Monitoring

Monitor blood pressure, serum potassium and renal function, particularly in those with renal impairment or taking other renin-angiotensin system blockers.

Counselling the patient

• Avoid this medicine if you are or may become pregnant, and tell your prescriber straight away if pregnancy occurs.
• Avoid potassium-containing salt substitutes unless advised, and attend for blood tests as requested.

Evidence & guidelines

The ALTITUDE trial showed harm from adding aliskiren to other renin-angiotensin system blockers in high-risk patients, supporting current contraindications.