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Aliskiren/amlodipine Disease Interactions

There are 7 disease interactions with aliskiren / amlodipine.

Major

Aliskiren (applies to aliskiren/amlodipine) diabetes

Major Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus

The use of aliskiren is contraindicated in patients with diabetes who are receiving angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), as there is an increased risk of renal impairment, hyperkalemia, and hypotension.

References

  1. (2007) "Product Information. Tekturna (aliskiren)." Novartis Pharmaceuticals
Major

CCBs (applies to aliskiren/amlodipine) cardiogenic shock/hypotension

Major Potential Hazard, High plausibility. Applicable conditions: Aortic Stenosis

In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.

References

  1. Stehle G, Buss J, Eibach J, et al. (1990) "Cardiogenic shock associated with verapamil in a patient with liver cirrhosis." Lancet, 336, p. 1079
  2. (2002) "Product Information. Vascor (bepridil)." McNeil Pharmaceutical
  3. (2002) "Product Information. Cardizem (diltiazem)." Hoechst Marion Roussel
  4. (2001) "Product Information. Calan (verapamil)." Searle
  5. Kubota K, Pearce GL, Inman WHW (1995) "Vasodilation-related adverse events in diltiazem and dihydropyridine calcium antagonists studied by prescription-event monitoring." Eur J Clin Pharmacol, 48, p. 1-7
  6. Pahor M, Manto A, Pedone C, Carosella L, Guralnik JM, Carbonin P (1996) "Age and severe adverse drug reactions caused by nifedipine and verapamil." J Clin Epidemiol, 49, p. 921-8
View all 6 references
Major

CCBs (applies to aliskiren/amlodipine) coronary artery disease

Major Potential Hazard, Low plausibility. Applicable conditions: Ischemic Heart Disease

Increased frequency, duration, and/or severity of angina, as well as acute myocardial infarction, have rarely developed during initiation or dosage increase of calcium channel blockers (CCBs), particularly in patients with severe obstructive coronary artery disease and those treated with immediate-release formulations. The mechanism of this effect is not established. Therapy with CCBs should be administered cautiously in patients with significant coronary artery disease.

References

  1. Schanzenbacher P, Deeg P, Liebau G, Kochsiek K (1984) "Paradoxical angina after nifedipine: angiographic documentation." Am J Cardiol, 53, p. 345-6
  2. Manga P, Vythilingum (1984) "Unstable angina precipitated by nifedipine." S Afr Med J, 66, p. 144
  3. Sia STB, MacDonald PS, Triester B, et al. (1985) "Aggravation of myocardial ischaemia by nifedipine." Med J Aust, 142, p. 48-50
  4. Myrhed M, Wiholm B-E (1986) "Nifedipine: a survey of adverse effects." Acta Pharmacol Toxicol (Copenh), 58, p. 133-6
  5. Lambert CR, Hill JA, Feldman RL, Pepine CJ (1985) "Myocardial ischemia during intravenous nicardipine administration." Am J Cardiol, 55, p. 844-5
  6. Thomassen AR, Bagger JP, Nielsen TT (1988) "Hemodynamic and cardiac metabolic changes during nicardipine-induced myocardial ischemia." Cathet Cardiovasc Diagn, 14, p. 41-3
  7. (2002) "Product Information. Norvasc (amlodipine)." Pfizer U.S. Pharmaceuticals
  8. (2002) "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc
  9. (2002) "Product Information. Procardia (nifedipine)." Pfizer U.S. Pharmaceuticals
  10. Furberg CD, Psaty BM, Meyer JV (1995) "Nifedipine: dose-related increase in mortality in patients with coronary heart disease." Circulation, 92, p. 1326-31
  11. Kloner RA (1995) "Nifedipine in ischemic heart disease." Circulation, 92, p. 1074-8
  12. Yusuf S (1995) "Calcium antagonists in coronary artery disease and hypertension: time for reevaluation?" Circulation, 92, p. 1079-82
  13. (2001) "Product Information. Sular (nisoldipine)." Astra-Zeneca Pharmaceuticals
  14. Oei SG, Oei SK, Brolmann HAM (1999) "Myocardial infarction during nifedipine therapy for preterm labor." N Engl J Med, 340, p. 154
  15. Abernathy DR, Schwrtz JB (1999) "Calcium-antagonist drugs." N Engl J Med, 341, p. 1447-57
View all 15 references
Major

CCBs (applies to aliskiren/amlodipine) liver disease

Major Potential Hazard, High plausibility.

Calcium channel blockers (CCBs) are extensively metabolized by the liver. The half-lives of CCBs may be prolonged substantially in patients with severe hepatic impairment, with the potential for significant drug accumulation. In addition, the use of some CCBs has been associated with elevations in serum transaminases, both with and without concomitant elevations in alkaline phosphatase and bilirubin. While these effects may be transient and reversible, some patients have developed cholestasis or hepatocellular injury. Therapy with CCBs should be administered cautiously and often at reduced dosages in patients with significantly impaired hepatic function. Periodic monitoring of liver function is advised.

References

  1. Echizen H, Eichelbaum M (1986) "Clinical pharmacokinetics of verapamil, nifedipine and diltiazem." Clin Pharmacokinet, 11, p. 425-49
  2. Saracheck NS, London RL, Matulewicz TJ, et al. (1985) "Diltiazem and granulomatous hepatitis." Gastroenterology, 88, p. 1260-2
  3. Shallcross H, Padley SP, Glynn MJ, Gibbs DD (1987) "Fatal renal and hepatic toxicity after treatment with diltiazem." Br Med J, 295, p. 1256-7
  4. Colombo G, Zucchella G, Planca E, Grieco A (1987) "Intravenous diltiazem in the treatment of unstable angina: a study of efficacy and tolerance." Clin Ther, 9, p. 536-47
  5. Toft E, Vyberg M, Therkelsen K (1991) "Diltiazem-induced granulomatous hepatitis." Histopathology, 18, p. 474-5
  6. Abramson M, Littlejohn GO (1985) "Hepatic reactions to nifedipine." Med J Aust, 142, p. 47-8
  7. Toner M, White A, Moriarty J, Clancy L (1988) "Allergic urticarial eruption, leukocytosis and abnormal liver function tests following nifedipine administration." Chest, 93, p. 1320-1
  8. Babany G, Uzzan F, Larrey D, et al. (1989) "Alcoholic-like liver lesions induced by nifedipine." J Hepatol, 9, p. 252-5
  9. Brodsky SJ, Cutler SS, Weiner DA, Klein MD (1981) "Hepatotoxicity due to treatment with verapamil." Ann Intern Med, 94, p. 490-1
  10. Somogyi A, Albrecht M, Kliems G, et al. (1981) "Pharmacokinetics, bioavailability and ECG response of verapamil in patients with liver cirrhosis." Br J Clin Pharmacol, 12, p. 51-60
  11. Woodcock BG, Rietbrock I, Vohringer HF, Rietbrock N (1981) "Verapamil disposition in liver disease and intensive-care patients: kinetics, clearance, and apparent blood flow relationships." Clin Pharmacol Ther, 29, p. 27-34
  12. Woodcock BG, Rietbrock N (1982) "Verapamil bioavailability and dosage in liver disease." Br J Clin Pharmacol, 13, p. 240-1
  13. Stern EH, Pitchon R, King BD, Wiener I (1982) "Possible hepatitis from verapamil." N Engl J Med, 306, p. 612-3
  14. Stehle G, Buss J, Eibach J, et al. (1990) "Cardiogenic shock associated with verapamil in a patient with liver cirrhosis." Lancet, 336, p. 1079
  15. Hare DL, Horowitz JD (1986) "Verapamil hepatotoxicity: a hypersensitivity reaction." Am Heart J, 111, p. 610-11
  16. Guarascio P, D'Amato C, Sette P, et al. (1984) "Liver damage from verapamil." Br Med J, 288, p. 362-3
  17. Dow RJ, Graham DJM (1986) "A reveiw of the human metabolism and pharmacokinetics of nicardipine hydrochloride." Br J Clin Pharmacol, 22, s195-202
  18. McAllister RG Jr, Hamann SR, Blouin RA (1985) "Pharmacokinetics of calcium-entry blockers." Am J Cardiol, 55, b30-40
  19. Kates RE (1983) "Calcium antagonists: pharmacokinetic properties." Drugs, 25, p. 113-24
  20. Finucci GF, Padrini R, Piovan D, et al. (1988) "Verapamil pharmacokinetics and liver function in patients with cirrhosis." Int J Clin Pharmacol Res, 8, p. 123-6
  21. Giacomini KM, Massoud N, Wong FM, Giacomini JC (1984) "Decreased binding of verapamil to plasma proteins in patients with liver disease." J Cardiovasc Pharmacol, 6, p. 924-8
  22. Razak TA, McNeil JJ, Sewell RB, Drummer OH, Smallwood RA, Conway EL, Louis WJ (1990) "The effect of hepatic cirrhosis on the pharmacokinetics and blood pressure response to nicardipine." Clin Pharmacol Ther, 47, p. 463-9
  23. Rush WR, Alexander O, Hall DJ, Cairncross L, Dow RJ, Graham DJ (1986) "The metabolism of nicardipine hydrochloride in healthy male volunteers." Xenobiotica, 16, p. 341-9
  24. Benet LZ (1985) "Pharmacokinetics and metabolism of bepridil." Am J Cardiol, 55, c8-13
  25. Kurosawa S, Kurosawa N, Owada E, et al. (1990) "Pharmacokinetics of diltiazem in patients with liver cirrhosis." Int J Clin Pharmacol Res, 10, p. 311-8
  26. Elliott HL, Meredith PA (1991) "The clinical consequences of the absorption, distribution, metabolism and excretion of amlodipine." Postgrad Med J, 67, s20-3
  27. Stopher DA, Beresford AP, Macrae PV, Humphrey MJ (1988) "The metabolism and pharmacokinetics of amlodipine in humans and animals." J Cardiovasc Pharmacol, 12, s55-9
  28. Kleinbloesem CH, van Harten J, Wilson JP, et al. (1986) "Nifedipine: kinetics and hemodynamic effects in patients with liver cirrhosis after intravenous and oral administration." Clin Pharmacol Ther, 40, p. 21-8
  29. Raemsch KD, Sommer J (1983) "Pharmacokinetics and metabolism of nifedipine." Hypertension, 5, p. 18-24
  30. Ramsch KD, Graefe KH, Scherling D, et al. (1986) "Pharmacokinetics and metabolism of calcium-blocking agents nifedipine, nitrendipine, and nimodipine." Am J Nephrol, 6, p. 73-80
  31. Challenor VF, Waller DG, Renwick AG, et al. (1987) "The trans-hepatic extraction of nifedipine." Br J Clin Pharmacol, 24, p. 473-7
  32. Dunselman PH, Edgar B (1991) "Felodipine clinical pharmacokinetics." Clin Pharmacokinet, 21, p. 418-30
  33. Regardh CG, Edgar B, Olsson R, Kendall M, Collste P, Shansky C (1989) "Pharmacokinetics of felodipine in patients with liver disease." Eur J Clin Pharmacol, 36, p. 473-9
  34. Cotting J, Reichen J, Kutz K, Laplanche R, Nuesch E (1990) "Pharmacokinetics of isradipine in patients with chronic liver disease." Eur J Clin Pharmacol, 38, p. 599-603
  35. Tse FL, Jaffe JM (1987) "Pharmacokinetics of PN 200-110 (isradipine), a new calcium antagonist, after oral administration in man." Eur J Clin Pharmacol, 32, p. 361-5
  36. Graham D, Dow R, Hall D, Alexander O, Mroszczak E, Freedman A (1985) "The metabolism and pharmacokinetics of nicardipine hydrochloride in man." Br J Clin Pharmacol, 20, s23-8
  37. Gengo FM, Fagan SC, Krol G, Bernhard H (1987) "Nimodipine disposition and haemodynamic effects in patients with cirrhosis and age-matched controls." Br J Clin Pharmacol, 23, p. 47-53
  38. Meredith P, Elliott H (1992) "Clinical pharmacokinetics of amlodipine." Clin Pharmacokinet, 22, p. 22-31
  39. (2002) "Product Information. Norvasc (amlodipine)." Pfizer U.S. Pharmaceuticals
  40. (2002) "Product Information. Vascor (bepridil)." McNeil Pharmaceutical
  41. (2002) "Product Information. Cardizem (diltiazem)." Hoechst Marion Roussel
  42. (2002) "Product Information. Plendil (felodipine)." Merck & Co., Inc
  43. (2002) "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc
  44. (2002) "Product Information. Procardia (nifedipine)." Pfizer U.S. Pharmaceuticals
  45. (2002) "Product Information. Nimotop (nimodipine)." Bayer
  46. (2001) "Product Information. Calan (verapamil)." Searle
  47. Johnson KE, Balderston SM, Pieper JA, Mann DE, Reiter MJ (1991) "Electrophysiologic effects of verapamil metabolites in the isolated heart." J Cardiovasc Pharmacol, 17, p. 830-7
  48. "Product Information. Dynacirc (isradipine)." Sandoz Pharmaceuticals Corporation
  49. Kumar KL, Colley CA (1994) "Verapamil-induced hepatotoxicity." West J Med, 160, p. 485-6
  50. Traverse JH, Swenson LJ, Mcbride JW (1994) "Acute hepatic injury after treatment with diltiazem." Am Heart J, 127, p. 1636-9
  51. Scherling D, Karl W, Ahr G, Ahr HJ, Wehinger E (1988) "Pharmacokinetics of nisoldipine. III. Biotransformation of nisoldipine in rat, dog, monkey, and man." Arzneimittelforschung, 38, p. 1105-10
  52. (2001) "Product Information. Sular (nisoldipine)." Astra-Zeneca Pharmaceuticals
  53. Abernathy DR, Schwrtz JB (1999) "Calcium-antagonist drugs." N Engl J Med, 341, p. 1447-57
  54. (2020) "Product Information. Conjupri (levamlodipine)." CSPC Ouyi Pharmaceutical Co, Ltd
View all 54 references
Moderate

Aliskiren (applies to aliskiren/amlodipine) hypotension

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Dehydration, Hyponatremia

Symptomatic hypotension may occur after treatment initiation with aliskiren in patients with marked volume depletion, salt depletion, or with combined use of aliskiren and other agents acting on the renin-angiotensin-aldosterone system. It is recommended to correct the volume or salt depletion before administering aliskiren. Close monitoring is recommended.

References

  1. (2007) "Product Information. Tekturna (aliskiren)." Novartis Pharmaceuticals
Moderate

Aliskiren (applies to aliskiren/amlodipine) renal impairment

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction, Congestive Heart Failure, History - Myocardial Infarction

Renal function should be monitored periodically in patients treated with aliskiren, as changes can occur including acute renal failure. Patients on aliskiren whose renal function may depend in part of the RAAS (renin-angiotensin-aldosterone system), such as patients with renal artery stenosis, severe heart failure, or postmyocardial infarction may be at higher risk for developing acute renal failure. Treatment should be discontinued in any patients who develop clinically significant decrease in renal function. Patients with renal impairment should be observed closely. The safety and effectiveness of aliskiren have not been established in patients with severe renal impairment (CrCl < 30 mL/min), as these patients were excluded from clinical trials.

References

  1. (2007) "Product Information. Tekturna (aliskiren)." Novartis Pharmaceuticals
Moderate

CCBs (applies to aliskiren/amlodipine) CHF/AMI

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Congestive Heart Failure, Myocardial Infarction

Calcium channel blockers (CCBs) may have varying degrees of negative inotropic effect. Congestive heart failure (CHF), worsening of CHF, and pulmonary edema have occurred in some patients treated with a CCB, primarily verapamil. Some CCBs have also caused mild to moderate peripheral edema due to localized vasodilation of dependent arterioles and small blood vessels, which can be confused with the effects of increasing left ventricular dysfunction. Although some CCBs have been used in the treatment of CHF, therapy with CCBs should be administered cautiously in patients with severe left ventricular dysfunction (e.g., ejection fraction < 30%) or moderate to severe symptoms of cardiac failure and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker. Likewise, caution is advised in patients with acute myocardial infarction and pulmonary congestion documented by X-ray on admission, since associated heart failure may be acutely worsened by administration of a CCB.

References

  1. Gillmer DJ, Kark P (1980) "Pulmonary oedema precipitated by nifedipine." Br Med J, 280, p. 1420-1
  2. Batra AK, Segall PH, Ahmed T (1985) "Pulmonary edema with nifedipine in primary pulmonary hypertension." Respiration, 47, p. 161-3
  3. Myrhed M, Wiholm B-E (1986) "Nifedipine: a survey of adverse effects." Acta Pharmacol Toxicol (Copenh), 58, p. 133-6
  4. Prigogine T, Waterlot Y, Gottignies P, et al. (1991) "Acute nonhemodynamic pulmonary edema with nifedipine in primary pulmonary hypertension." Chest, 100, p. 563-4
  5. Batlouni M, Armaganijan D, Ghorayeb N, Magliano MF (1992) "Clinical efficacy and tolerability of isradipine in the treatment of mild-to-moderate hypertension in young and elderly patients." J Cardiovasc Pharmacol, 19, s53-7
  6. Walton T, Symes LR (1993) "Felodipine and isradipine: new calcium-channel-blocking agents for the treatment of hypertension." Clin Pharm, 12, p. 261-75
  7. Scheidt S, LeWinter MM, Hermanovich J, Venkataraman K, Freedman D (1986) "Efficacy and safety of nicardipine for chronic, stable angina pectoris: a multicenter randomized trial." Am J Cardiol, 58, p. 715-21
  8. Taylor SH, Frais MA, Lee P, Verma SP, Jackson N, Reynolds G, Silke B (1985) "A study of the long-term efficacy and tolerability of oral nicardipine in hypertensive patients." Br J Clin Pharmacol, 20, s139-42
  9. Dubois C, Blanchard D (1989) "Efficacy and safety of nicardipine in 29,104 patients with hypertension." Clin Ther, 11, p. 452-60
  10. Yedinak KC, Lopez LM (1991) "Felodipine: a new dihydropyridine calcium-channel antagonist." DICP, 25, p. 1193-206
  11. Lorimer AR, Pringle SD (1990) "The safety of felodipine." J Cardiovasc Pharmacol, 15, s85-9
  12. Sundstedt CD, Ruegg PC, Keller A, Waite R (1989) "A multicenter evaluation of the safety, tolerability, and efficacy of isradipine in the treatment of essential hypertension." Am J Med, 86, p. 98-102
  13. Ruegg PC, Nelson DJ (1989) "Safety and efficacy of isradipine, alone and in combination, in the treatment of angina pectoris." Am J Med, 86, p. 70-4
  14. (2002) "Product Information. Norvasc (amlodipine)." Pfizer U.S. Pharmaceuticals
  15. (2002) "Product Information. Plendil (felodipine)." Merck & Co., Inc
  16. (2002) "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc
  17. (2002) "Product Information. Procardia (nifedipine)." Pfizer U.S. Pharmaceuticals
  18. (2002) "Product Information. Nimotop (nimodipine)." Bayer
  19. "Product Information. Dynacirc (isradipine)." Sandoz Pharmaceuticals Corporation
  20. Fagan TC, Haggert BE, Liss C (1994) "Efficacy and tolerability of extended-release felodipine and extended-release nifedipine in patients with mild-to-moderate essential hypertension." Clin Ther, 16, p. 634-46
  21. Blecker D (1994) "Antihypertensive therapy with isradipine in patients with special safety concerns." Angiology, 45, p. 997-1008
  22. Brogden RN, Sorkin EM (1995) "Isradipine: an update of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy in the treatment of mild to moderate hypertension." Drugs, 49, p. 618-49
  23. Kubota K, Pearce GL, Inman WHW (1995) "Vasodilation-related adverse events in diltiazem and dihydropyridine calcium antagonists studied by prescription-event monitoring." Eur J Clin Pharmacol, 48, p. 1-7
  24. Johnson BF, Eisner GM, Mcmahon FG, Jain AK, Rudd P, Sowers JR (1995) "A multicenter comparison of adverse reaction profiles of isradipine and enalapril at equipotent doses in patients with essential hypertension." J Clin Pharmacol, 35, p. 484-92
  25. (2001) "Product Information. Sular (nisoldipine)." Astra-Zeneca Pharmaceuticals
  26. Sleight P (1996) "Calcium antagonists during and after myocardial infarction." Drugs, 51, p. 216-25
  27. Elkayam U (1998) "Calcium channel blockers in heart failure." Cardiology, 89, p. 38-46
  28. Schaefer RM, Aldons PM, Burgess ED, Tilvis R, Singh GP, Rehn L, Morgan TO (1998) "Improved tolerability of felodipine compared with amlodipine in elderly hypertensives: A randomised, double-blind study in 535 patients, focusing on vasodilatory adverse events." Int J Clin Pract, 52, p. 381
  29. Abernathy DR, Schwrtz JB (1999) "Calcium-antagonist drugs." N Engl J Med, 341, p. 1447-57
View all 29 references

Aliskiren/amlodipine drug interactions

There are 600 drug interactions with aliskiren / amlodipine.

Aliskiren/amlodipine alcohol/food interactions

There are 4 alcohol/food interactions with aliskiren / amlodipine.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

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