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07-SEPTEMBER-2008 03:17:44 - Aliskiren Aliskiren Systematic IUPAC name 2S,4S,5S,7S-5-amino-N-2-carbamoyl-2-methyl- propyl-4-hydroxy-7-4-methoxy-3-3-methoxypropoxy phenylmethyl-8-methyl-2-propan-2-yl-nonanamide Identifiers CAS number 173334-57-1 ATC code C09XA02 C09XA52 PubChem 5493444 Chemical data Formula C30H53N3O6 Mol. mass 551.758 g/mol Pharmacokinetic data Bioavailability Low approximately 2.5% Metabolism Hepatic, CYP3A4-mediated Half life 24 hours Excretion Renal Therapeutic considerations Licence data EU, US Pregnancy cat. C in first trimester D in second and third trimesters Legal status POMUK ℞-onlyUS Routes Oral Aliskiren INN Tekturna, U.S.; Rasilez, U.K. and elsewhere is the first in a class of drugs called a direct renin inhibitor, for lowering blood pressure. The renin-angiotensin-aldosterone system is a key system in blood pressure control. Renin creates angiotensin. Angiotensin causes blood vessels to constrict, which drives blood pressure up. Angiotensin also creates aldosterone. Aldosterone causes the tubules of the kidneys to retain sodium and water, which also drives blood pressure up. Many drugs control blood pressure by interfering with angiotensin or aldosterone. However, when these drugs are used for a long time, the body increases renin production, which drives blood pressure up again. Therefore, doctors have been looking for a drug to inhibit renin directly. Aliskiren is the first drug to do so.1 Aliskiren was co-developed by the Swiss pharmaceutical companies Novartis and Speedel.23 It was approved by the U.S. Food and Drug Administration in 2007 for the treatment of hypertension.4 Contents 1 Adverse effects 2 Contraindications 3 Drug Interactions 4 References 5 External links Adverse effects Angioedema A rare adverse event was allergic swelling of the face, lips or tongue and difficulty breathing. Hyperkalemia particularly when used with ACE inhibitors in diabetic patients Hypotension particularly in volume-depleted patients Diarrhea and other GI symptoms Rash, elevated uric acid, gout, and renal stones. Contraindications As with ACE inhibitors, renin inhibitors should not be used in pregnancy, specifically the second and third trimesters, during which they will interfere with fetal kidney development and lead to oligohydramnios. Aliskiren has not yet been evaluated in patients with significantly impaired renal function. Drug Interactions Minor substrate of CYP3A4: Reduces furosemide blood concentration. Atorvastatin or ketoconazole may increase blood concentration. References ^ Ingelfinger JR June 2008. Aliskiren and dual therapy in type 2 diabetes mellitus. N. Engl. J. Med. 358 23: 2503-5. doi:10.1056/NEJMe0803375. PMID 18525047. ^ Gradman A, Schmieder R, Lins R, Nussberger J, Chiang Y, Bedigian M 2005. Aliskiren, a novel orally effective renin inhibitor, provides dose-dependent antihypertensive efficacy and placebo-like tolerability in hypertensive patients. Circulation 111 8: 1012-8. doi:10.1161/01.CIR.0000156466.02908.ED. PMID 15723979. ^ Straessen JA, Li Y, and Richart T 2006. Oral Renin Inhibitors. Lancet 368 9545: 1449-56. doi:10.1016/S0140-67360669442-7. PMID 17055947. ^ First Hypertension Drug to Inhibit Kidney Enzyme Approved, CBC 2007-03-06. Retrieved on 2007-03-14. External links Tekturna U.S. prescribing informationPDF 143 KiB at the U.S. Food and Drug Administration website Aliskiren at KEGG Ligand Database MeSH aliskiren Speedel v d e Agents acting on the renin-angiotensin system C09 ACE inhibitors Alacepril Benazepril Captopril Cilazapril Delapril Enalapril Fosinopril Imidapril Lisinopril Moexipril Perindopril Quinapril Ramipril Rentiapril Spirapril Temocapril Trandolapril Zofenopril Angiotensin II receptor antagonists AIIRA Azilsartan Candesartan Eprosartan Irbesartan Losartan Olmesartan Tasosartan Telmisartan Valsartan Renin inhibitors Aliskiren Remikiren Retrieved from http://en..org/wiki/Aliskiren Categories: Antihypertensive agents | Renin inhibitors Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Italiano Magyar Nederlands Polski Português Svenska This page was last modified on 19 August 2008, at 19:14
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