Benazepril with Aliskiren Interaction Details

Brand Names Associated with Benazepril

Brand Names Associated with Aliskiren

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Mar 04, 2024

Interaction Effect

An increased risk of hyperkalemia, renal impairment, and hypotension

Interaction Summary

According to interim results of the randomized, double-blind, placebo-controlled Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE; n=8606), the addition of aliskiren to treatment with an ACE inhibitor or an angiotensin II receptor blocker in patients with type 2 diabetes at high risk of fatal and nonfatal cardiovascular and renal events was associated with an increased risk of hyperkalemia, hypotension, and renal impairment[1]. Concomitant use of aliskiren and ACE inhibitors, such as benazepril, is contraindicated in patients with diabetes due to increased risk of hyperkalemia, hypotension, and renal impairment. The combination of aliskiren with benazepril should also be avoided in patients with renal impairment (GFR less than 60 mL/min) [2][1]. Concomitant use should generally be avoided regardless of comorbidities; however, if coadministration is necessary, closely monitor blood pressure, renal function, and electrolytes [2].

Severity

Contraindicated

Onset

Unspecified

Evidence

Probable

How To Manage Interaction

Concomitant use of aliskiren and ACE inhibitors, such as benazepril, is contraindicated in patients with diabetes due to increased risk of hyperkalemia, hypotension, and renal impairment. The combination of aliskiren with benazepril should also be avoided in patients with renal impairment (GFR less than 60 mL/min)[2][1]. Concomitant use should generally be avoided regardless of comorbidities; however, if coadministration is necessary, closely monitor blood pressure, renal function, and electrolytes [2].

Mechanism Of Interaction

Additive effects

Literature Reports

A) In patients with diabetes and renal disease who received either an ACE inhibitor or an angiotensin II receptor blocker, treatment with aliskiren 300 mg daily resulted in higher risk of hyperkalemia, hypotension, and renal impairment compared with placebo, according to interim results of the randomized, double-blind, placebo-controlled Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE; n=8606). The primary composite endpoint was the first occurrence of cardiovascular death, resuscitated sudden death, nonfatal myocardial infarction, nonfatal stroke, unplanned hospitalization for heart failure, doubling of baseline serum creatinine concentration to above ULN (for a period of 1 month), or onset of ESRD or renal death. Hyperkalemia was reported in 36.9% of aliskiren-treated patients (1.1% were rated as serious adverse events), compared with 27.1% of those treated with placebo (0.3% were rated as serious). Renal impairment (12.4% vs 10.4%) and hypotension (18.6% vs 14.8%) were also increased in the aliskiren group compared with the placebo group, respectively. The study was terminated after a median followup of approximately 27 months due to lack of efficacy [1].

References

1 ) Product Information: TEKTURNA(R) oral tablets, aliskiren oral tablets. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2012.

2 ) Product Information: Lotensin(R) oral tablets, benazepril HCl oral tablets. Validus Pharmaceuticals LLC (per FDA), Parsippany, NJ, 2014.

Benazepril Overview

• Benazepril is used alone or in combination with other medications to treat high blood pressure. Benazepril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly.

• High blood pressure is a common condition, and when not treated it can cause damage to the brain, heart, blood vessels, kidneys, and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

Aliskiren Overview

• Aliskiren is used alone or in combination with some medications to treat high blood pressure. Aliskiren is in a class of medications called direct renin inhibitors. It works by decreasing certain natural chemicals that tighten the blood vessels, so blood vessels relax and the heart can pump blood more efficiently.

• High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.