From the Guidelines
Aliskiren (brand name Tekturna) is no longer commonly used for hypertension treatment due to safety concerns and limited effectiveness compared to other antihypertensive medications. The 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults recommends against the use of aliskiren in combination with ACE inhibitors or ARBs, especially in patients with diabetes or kidney disease, due to increased risks of stroke, kidney complications, and hypotension 1.
Some key points to consider when evaluating the use of aliskiren include:
- Increased risk of hyperkalemia in patients with chronic kidney disease (CKD) or those on potassium supplements or potassium-sparing drugs 1
- Potential for acute renal failure in patients with severe bilateral renal artery stenosis 1
- Avoidance of use in pregnancy due to potential risks 1
- Limited effectiveness in preventing cardiovascular events compared to more established medications 1
Current hypertension guidelines favor first-line agents like thiazide diuretics, calcium channel blockers, ACE inhibitors, and ARBs, which have stronger evidence for cardiovascular protection and better safety profiles 1. Most physicians now reserve aliskiren for specialized cases where standard treatments have failed or are contraindicated.
In terms of alternative treatment options, the guidelines recommend considering the following:
- Beta blockers, such as atenolol, betaxolol, bisoprolol, and metoprolol, which are preferred in patients with ischemic heart disease or heart failure 1
- Alpha-1 blockers, such as doxazosin, prazosin, and terazosin, which may be considered as second-line agents in patients with concomitant benign prostatic hyperplasia (BPH) 1
- Central alpha-2 agonists, such as clonidine, methyldopa, and guanfacine, which are generally reserved as last-line due to significant CNS adverse effects, especially in older adults 1
From the FDA Drug Label
Aliskiren tablets are a renin inhibitor (RI) indicated for the treatment of hypertension in adults and in pediatric patients weighing 50 kg or greater who are at least 6 years of age, to lower blood pressure. The FDA drug label does not mention tekTurna, but AlisKiren (aliskiren) is indicated for the treatment of hypertension in adults and pediatric patients weighing 50 kg or greater who are at least 6 years of age 2.
- Aliskiren is still used for hypertension treatment.
- There is no information about tekTurna.
From the Research
Current Usage of Aliskiren and Tekturna
- Aliskiren, also known as Tekturna, is an orally active, nonpeptidic inhibitor of renin, used in the management of hypertension 3.
- It was approved by the US Food and Drug Administration in 2007 for the treatment of hypertension and may be used alone or in combination with other antihypertensive agents 3, 4.
- However, there is no recent evidence to suggest that Aliskiren or Tekturna is still widely used for hypertension, as the most recent study provided is from 2012 5.
Efficacy and Safety
- Aliskiren has been shown to be effective in reducing blood pressure and is generally well tolerated 3, 6, 7.
- It has been compared to other antihypertensive agents, such as hydrochlorothiazide, ramipril, and valsartan, and has been found to be similar in efficacy 3, 6.
- The most common adverse effects reported in clinical trials were headache, fatigue, dizziness, diarrhea, and nasopharyngitis 6, 7.
Combination Therapy
- Aliskiren has been shown to provide significant additional blood pressure-lowering effects when combined with other antihypertensive agents, such as hydrochlorothiazide, ramipril, and valsartan 3, 6.
- However, the use of Aliskiren in combination with ACE inhibitors or ARBs has been associated with an increased risk of adverse effects, particularly in patients with diabetes and renal impairment 5.