Drug interactions between aliskiren and Avalide
| Results for the following 2 drugs: |
|---|
| aliskiren |
| Avalide (hydrochlorothiazide/irbesartan) |
Interactions between your selected drugs
irbesartan ↔ aliskiren
Applies to:Avalide (hydrochlorothiazide/irbesartan) and aliskiren
MONITOR: Coadministration of aliskiren with ACE inhibitors or angiotensin receptor blockers (ARBs) may increase the risk of hyperkalemia. All drugs inhibiting the renin-angiotensin system (RAS) can increase serum potassium, and additive effects may occur when they are used together. Increases in serum potassium to greater than 5.5 mEq/L were infrequent with aliskiren alone (0.9% compared to 0.6% with placebo). However, when used in combination with an ACE inhibitor in a diabetic population, increases in serum potassium were more frequent (5.5%).
Pharmacokinetically, irbesartan has been reported to reduce aliskiren peak plasma concentration (Cmax) by up to 50% after multiple dosing. The mechanism of interaction and clinical significance are unknown.
GENERALLY AVOID: In patients with type 2 diabetes and renal impairment, coadministration of aliskiren with ACE inhibitors or angiotensin receptor blockers (ARBs) has been associated with an increased risk of adverse events including nonfatal stroke, renal complications, hyperkalemia, and hypotension. Interim review of data from the ALTITUDE study after 18 to 24 months revealed no additional benefit and a higher incidence of adverse events when aliskiren was added to optimal cardiovascular treatment including an ACE inhibitor or ARB. ALTITUDE was a multinational study in 8,606 patients from 36 countries evaluating the potential benefits of aliskiren to reduce the risk of cardiovascular and renal events in patients with type 2 diabetes and renal impairment, who are known to be at high risk of cardiovascular and renal events. The trial was halted in December 2011 per recommendation of the independent data monitoring committee overseeing the study.
MANAGEMENT: Caution is advised if aliskiren is used in combination with ACE inhibitors or ARBs. Routine monitoring of electrolytes and renal function may be indicated in patients with renal impairment, old age, worsening heart failure, or a risk for dehydration. Potassium supplementation should generally be avoided unless it is closely monitored, and patients should be advised to seek medical attention if they experience signs and symptoms of hyperkalemia such as weakness, listlessness, confusion, tingling of the extremities, and irregular heartbeat. Aliskiren should not be used with ACE inhibitors or ARBs in patients with diabetes. Prescribers should not initiate aliskiren in diabetic patients who are taking an ACE inhibitor or an ARB, and should stop any aliskiren-containing treatment if these patients are already receiving the combination. Alternative antihypertensive treatment should be considered as necessary.
See also...
Drug Interaction Classification
The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.
| Major | Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. |
| Moderate | Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. |
| Minor | Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. |
Do not stop taking any medications without consulting your healthcare provider.
Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date, and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. Multum's drug information does not endorse drugs, diagnose patients, or recommend therapy. Multum's drug information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug of drug combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2012 Multum Information Services, Inc. The information in contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.
