Perindopril and Aliskiren: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 9, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Perindopril
Aliskiren
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
An increased risk of hyperkalemia, renal impairment, and hypotension
Interaction Deep Dive
According to interim results of the randomized, double-blind, placebo-controlled ALTITUDE trial (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. Concomitant use of aliskiren and ACE inhibitors, such as perindopril, is contraindicated in patients with diabetes due to increased risk of hyperkalemia, hypotension, and renal impairment. The combination of aliskiren with perindopril should also be avoided in patients with renal impairment (GFR less than 60 mL/min)1.
Why it happens (mechanism)
Additive effects
Literature reports
1 report — tap to read
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.
Common questions
Can I take Perindopril and Aliskiren together?
An increased risk of hyperkalemia, renal impairment, and hypotension Always confirm with your pharmacist or prescriber before making any change.
How serious is the Perindopril and Aliskiren interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Perindopril or Aliskiren need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: TEKTURNA(R) oral tablets, aliskiren oral tablets. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2012. DailyMed
Keep reading about Perindopril
Keep reading about Aliskiren
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist